Psychological assessment of atopic dermatitis in Asia: a systematic review.

Atopic dermatitis (AD) is a frequently occurring skin disorder in Asia that substantially impacts the social, financial, and psychological lives of individuals. However, there is uncertainty regarding the psychological instruments for this domain. Hence, this review systematically assessed the existing measurement instruments used, developed, and/or validated for the measurement of psychological outcomes in Asian adult patients with AD as well as the scope of those assessment tools (e.g. validity and reliability). Electronic searches were performed using six databases (inception to February 2020) to identify studies. Thematic analysis of 44 included studies revealed that the commonly employed tools to assess the quality of life were the Dermatology Life Quality Index followed by the Skindex-16 questionnaire, the European Quality of Life-5 Dimensions, and the Quality of Life Hand Eczema Questionnaire. Similarly, the Patient Health Questionnaire, Self-rating depression scale (SDS), and Hospital Anxiety and Depression Scale were frequently employed to assess depressive symptoms. Additionally, symptoms of anxiety were frequently assessed through Interaction Anxiousness Scale and the Spielberger State-Trait Anxiety Inventory. Although a variety of psychological assessment measures have been used in research, data on their reliability and validity is limited. Also, information on the cultural applicability of these instruments is scantier. More research is needed to ascertain the suitability of tools for use in clinical practice.

Involvement of children in hands-on meal preparation and the associated nutrition outcomes: A scoping review.

BACKGROUND: Emerging research has explored hands-on meal preparation as a strategy to improve children's nutrition-related outcomes. This scoping review was conducted to describe the extent of studies on children's involvement in hands-on meal preparation and the related psychosocial outcomes, actual nutrition behaviour/food consumption and weight status. METHODS: Scoping review methodology was used to select relevant studies, as well as extract and collate the data. Four databases (PubMed, Google Scholar, Science Direct and Cochrane Database of Systematic Reviews) were searched from the earliest available time up to December 2020. Observational studies, experimental studies and reviews that were conducted among children aged 5-12 years old and published from 2010 to 2020 were retrieved. Studies extracted involved children in hands-on healthy meal preparation activities and explored the associated nutrition outcomes. RESULTS: In total, 28 studies (5 observational studies, 21 experimental studies, 2 reviews) were included in the final review. Studies conducted demonstrated improvement in children's psychosocial outcomes and actual nutrition behaviour/food consumption after participating in hands-on meal preparation activities, despite differences in methodology, programme content and settings (countries/cultural origins). Limited studies assessed children's nutrients intake and weight status. CONCLUSIONS: The current review suggests that hands-on meal preparation comprises approach for instilling positive perceptions towards nutrition/healthy foods, potentially improving children's diet. Future studies should include the assessment of nutrient intake and weight status. The long-term sustainability of these nutrition outcomes should be explored.

Prevalence of mental health problems in women in polygamous versus monogamous marriages: a systematic review and meta-analysis.

While some studies suggest different mental health outcomes among women in polygamous versus monogamous marriages, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of marriage types (i.e., polygamous and monogamous marriages) and differences in the prevalence of mental health issues. Eleven electronic databases, along with further identified references lists, were searched. Thirteen studies met the inclusion criteria. They included 3166 participants, and 986 women were in a polygamous marriage. All studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the five symptoms to assess for the effect of marriage type. The studies indicate a significant association of marriage type with psychological symptoms. The meta-analysis indicates that women in polygamous marriage had worsened mental health as compared with women in monogamous marriages. The weighted mean differences with 95% confidence intervals were somatization 0.53, 0.44-0.63; obsession-compulsion 0.35, 0.14-0.56; interpersonal sensitivity 0.42, 0.12-0.73; depression 0.41, 0.15-0.67; anxiety 0.41, 0.15-0.68; hostility = 0.47, 0.28-0.66; phobic anxiety 0.39, 0.17-0.61; paranoid ideation 0.35, 0.24-0.47; psychoticism 0.41, 0.23, 0.59; and Global Severity Index (GSI) 0.43, 0.25-0.60. A higher self-esteem and life satisfaction among women in polygamous marriages and statistically superior family functioning among women in monogamous marriages were also found. However, there was no statistically significant difference between the marital satisfaction of women in polygamous versus monogamous marriages. Results are consistent with the existing research on the prevalence of mental health issues among women in polygamous marriages. Nonetheless, these women were found to have elevated self-esteem and life satisfaction than women in monogamous marriages. Directions for future research are indicated.

Children's psychosocial factors of healthy meal preparation as predictors for nutritional status measures.

Involving school-age children in the preparation of healthy meals is shown to be associated with positive eating behavior. Yet, it remains unclear whether this can extend to their nutritional status. The present study aimed to determine the association of school-age children's psychosocial factors (knowledge, attitude, practice, self-efficacy) towards healthy meal preparation with their nutritional status (BMI-for-age, waist circumference, body fat percentage). Stratified random sampling was used to select primary schools (n = 8) in Kuala Lumpur, Malaysia. Two hundred school children aged between 9-11 years old were involved. Psychosocial factors towards healthy meal preparation were assessed using validated questionnaire. Anthropometry measures were determined using standard protocol. Almost half (46 %) of the school-age children were obese/overweight, 39 % were abdominally obese and 40 % were overfat. Approximately half had poor knowledge (49 %), poor practice (45 %), good attitude (56 %) and good self-efficacy (47 %) towards healthy meal preparation. Significant positive correlations were observed between knowledge with attitude (r = 0.23, p < 0.001); knowledge with self-efficacy (r = 0.30, p < 0.001); attitude with practice (r = 0.34, p < 0.001); attitude with self-efficacy (r = 0.59, p < 0.001) and practice with self-efficacy (r = 0.50, p < 0.001). Adjusted logistic regression revealed that school-age children with good attitude were less likely to be abdominally obese (OR = 0.87, 95 % Cl = 0.78 to 0.96) and overfat (OR = 0.84, 95 % Cl = 0.76 to 0.94). Children with good knowledge had lower risk of being abdominally obese (OR = 0.84, 95 % Cl = 0.72 to 0.97). Findings revealed that children's psychosocial factors were interrelated, and improvements may have the potential in affecting nutritional status. Hands-on healthy meal preparation should be explored further as an innovative approach to address the obesity epidemic.

Impact of Mindfulness-Based Cognitive Therapy on Depressive Symptoms Reduction among Depressed Patients in Nigeria: A Randomized Controlled Trial.

Depression is a common mental health disease with a high risk of relapse in people with a mental health condition. Mindfulness-based cognitive therapy (MBCT) showed higher efficacy in reducing depressive symptoms and prevent relapse for depressed patients. The study examined the effectiveness of MBCT versus the control group (CG) for the depression symptom reduction. A controlled trial was used to examine the effectiveness of MBCT or CG on depressive patients in Nigeria. Out of 357 screened subjects, 101 patients were randomized to receive either MBCT (n = 50) or CG (n = 51) and prospectively followed for 2 months. The intervention delivered according to the published manuals, and Beck Depression Inventory (BDI) was used to assess MDD severity among the patients. All assessments were conducted at three levels (baseline, 2 and 4 months). At the end of the 8 weeks of MBCT intervention, MBCT participants did not have significantly fewer depressive symptoms compared to those in the CG. However, the MBCT group had a significant depressive symptom reduction after 2 month follow up. The findings are in line with other studies, which show MBCT significantly decreased depression severity and improved treatment response rates after 2 months follow up, confirmed MBCT viability in the management of MDD.

Adapting cognitive-behavioral therapy for a Malaysian muslim.

Background: Over the years, cognitive-behavioural therapy (CBT) has gained momentum because of its robust evidence in the treatment of several disorders. However, there is an issue of religious and cultural appropriateness as CBT principles are based on Western conceptualization. This single-case study (N = 1) implements a culturally and religiously adapted CBT on a 34-year-old male with panic disorder with agoraphobia in Malaysia. The client had symptoms comprising various episodes of sudden onset of breathlessness, accelerated heart rate, and fear of dying for the last 14 years. The CBT was culturally and religiously adapted based on (1) A CBT manual in Bahasa Malaysia that was previously modified and adjusted according to the norms of the Malaysian society and (2) General guidelines in "Religious-Cultural Psychotherapy in the Management of Anxiety Patients" by Razali et al in 2002. The present modified CBT had 3 assessments formulation sessions and 12 intervention sessions. Methods: The first 6 sessions were based on the behaviour component of CBT (ie, a relaxation technique using Islamic prayer, reciting verses from the Holy Quran, slow breathing exercise, body scan, and progressive muscular relaxation). However, sessions 7 to 12 were focused on cognitive restructuring and exercises, such as identification of negative automatic thoughts, cognitive distortions, dysfunctional thought records, vertical arrow technique, and the coping statement was practised through collaborative empiricism, while implementing Islamic and cultural elements. The focus of termination sessions was on interoceptive exposure, cognitive rehearsal, and in vivo situational exposure. Results: Beck Anxiety Inventory (BAI) was administered at regular intervals. BAI scores revealed the effectiveness of adapting the intervention. Conclusion: Panic attacks, worry about panic attacks, and anxiety scores reduced remarkably and the client was able to go out of the house, travel independently, and pursue religious/social activities.

Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial.

AIMS: This study aimed to evaluate the effect of the stress management interventional program in reducing occupational stress and improving coping strategies among public health nurses. DESIGN: A double-blind, cluster-randomized approach was used as a randomization method for this study to evaluate the stress management interventional program. METHODS: A cluster-randomized controlled trial was carried out in eight comprehensive healthcare centres in Amman city, Jordan; four centres were randomly assigned to each experimental and control group. One hundred and seventy nurses were selected randomly from March 2019 - August 2019 and data were collected by using the Nursing Stress Scale & brief COPE over three data collection times. Both descriptive and inferential statistics (repeated measure ANOVA, Independent t test, and chi-squared) were used to answer the research questions of this study. RESULTS: The results showed that both the levels of occupational stress and coping strategies were significantly different between the two study groups over the three data collection points (p < 0.05). CONCLUSION: Based on the findings of this study, the stress management program is an effective non-invasive method that can be used to reduce stress levels and improve coping strategies for public health nurses. The implementation of stress management interventions in health care is likely to help nurses manage occupational stress in practice. IMPACT: Nurses suffer from a high level of occupational stress. In particular, approximately74% of nurses experience severe occupational stress, which can lead to many mental and physical disorders. However, nurses were less able to utilize the correct stress preventive strategies due to gaps in knowledge, skills, and awareness. This study contributed to the provision of empirical evidence of the effectiveness of the stress management program in reducing occupational stress and improving coping strategies among public health nurses. A stress management intervention program is a valuable non-invasive method that can be used by healthcare organizations to reduce stress levels and improve coping strategies for nurses in practice. CLINICAL TRIAL REGISTRATION NUMBER: NCT03833986.

Effectiveness of stress management interventional programme on occupational stress for nurses: A systematic review.

AIM: The purpose of this systematic review is to evaluate the effectiveness of stress management interventional programme in reducing occupational stress among nurses. BACKGROUND: Nursing professionals are placed continuously at the forefront in the area of health care which makes them highly exposed to professional stress. EVALUATION: Randomized controlled trial studies (RCTs) were systematically searched in eight different databases for works published in English from 2011 to 2019; inclusion criteria were applied by two reviewers critically and assessed the risk of bias using Consolidated Standards of Reporting Trials (CONSORT). KEY ISSUES: The systematic search contributed to the extraction of approximately 10 most relevant RCTs. Most of the RCTs considered in this systematic review revealed that the stress reduction interventions and strategies were effective in reducing the levels of occupational stress experienced by nurses. CONCLUSIONS: Current review shows that stress management interventional programme tends to be effective, but additional well-designed RCTs are needed to confirm their effectiveness. IMPLICATIONS FOR NURSING MANAGEMENT: Implementing stress management interventions within health care organisations are likely to assist nurses in reducing occupational stress and in improving coping strategies used by nurses for dealing with stress.

Influences of psychosocial factors and home food availability on healthy meal preparation.

The involvement of children in healthy meal preparation activities has emerged as a potential strategy to promote healthy eating behaviour among children. However, there is a lack of understanding of children's internal (psychosocial factors) and external factors (home food availability) that may support the practice of preparing healthy meals. This study aimed to determine children's psychosocial factors of healthy meal preparation within themselves and their external environment of home food availability as predictors for the practice of healthy meal preparation. Public schools (n = 8) from all three zones (Bangsar-Pudu, Keramat and Sentul) in Kuala Lumpur, Malaysia, were selected through stratified random sampling. Two hundred children aged 9-11 and their parents participated. Children's psychosocial factors towards healthy meal preparation and their home food availability were assessed through children and parents, respectively, using validated questionnaires. Majority of the schoolchildren (86.5%) had poor practice of healthy meal preparation. Increased attitude (r = 0.344, P < 0.001) and self-efficacy (r = 0.501, P < 0.001) of healthy meal preparation and the availability of fruits (r = 0.304, P < 0.001), vegetables (r = 0.243, P < 0.001) and healthful ready-to-eat foods (r = 0.227, P = 0.001) at home were positively correlated with the practice of preparing healthy meals. After adjusting for age, sex and monthly household income, increased self-efficacy (P < 0.001), availability of fruits (P = 0.01) and lower availability of less healthful ready-to-eat food (P = 0.01) were associated with better healthy meal preparation practices. Outcomes revealed that positive self-efficacy of healthy meal preparation, home food availability of fruits and less healthful alternatives were associated with the practice of healthy meal preparation and thus should be targeted in future health-promotion strategy.

Stress management interventions for intensive and critical care nurses: A systematic review.

BACKGROUND: The level of occupational stress of nurses working in intensive and critical care units is high. Although many studies have assessed the effectiveness of stress management interventions among intensive and critical care nurses, the methodological quality of these studies remains unclear. PURPOSE: The purpose of this review was to summarize and appraise the methodological quality of primary studies on interventions for management of occupational stress among intensive and critical care nurses. METHODS: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted to identify primary studies that assessed the effectiveness of interventions in managing occupational stress among intensive and critical care nurses using multiple databases from January 2009 to June 2019. RESULTS: Twelve studies published between 2011 and 2019 were eligible for inclusion. These included studies were classified as being of good or fair quality. The consensus across the included studies was that, compared with control condition, cognitive-behavioural skills training and mindfulness-based intervention were more effective in reducing occupational stress among intensive and critical care unit nurses. CONCLUSION: Further research should focus on methodologically strong studies by blinding the outcome assessors, using Randomized Controlled Trial (RCT) design with an active control group, using standardized assessment tools, and reporting enough details about the stress management intervention-related adverse events. RELEVANCE TO CLINICAL PRACTICE: This review demonstrates the need for high methodological quality studies to rigorously evaluate the effectiveness of stress management interventions before it can be recommended for use in clinical practice to reduce stress in intensive and critical care unit nurses. In addition, attention should be given to developing research protocols that place more emphasis on interventions aimed at the organization level to address the growing problem of occupational stress among intensive and critical care nurses.

Treatments for Anxiety Disorders in Malaysia.

This current study aims to systematically review the treatments for anxiety disorders in Malaysia. PsycINFO, MEDLINE databases, and 28 local journals were used to search published papers in this area. Eight articles were subjected to review after excluding 273 papers that did not meet the inclusion criteria. A total of 598 participants with various types of anxiety disorders were included in the review. Based on the findings, the combination of pharmacotherapy and psychotherapy provided better treatment outcomes if compared to psychotherapy or pharmacotherapy alone. The combination of selective serotonin reuptake inhibitors and cognitive behaviour therapy was considered as one of the most effective treatment to treat patients with anxiety disorders in Malaysia. This is in line with the clinical practice guidelines from the Ministry of Health Singapore and Canada. Even though there were some limitations in the methodology and reporting of the results, it can be concluded that efforts have been taken to conduct studies related to treatments for patients with anxiety disorders in Malaysia. Future studies are suggested to make conscious efforts to overcome these limitations.

Family-based intervention using face-to-face sessions and social media to improve Malay primary school children's adiposity: a randomized controlled field trial of the Malaysian REDUCE programme.

BACKGROUND: Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions - the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme - on adiposity of Malay children. METHODS: Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8-11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children. RESULTS: Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup ((F(6, 517) = 2.817, p = 0.010) and (F(6, 297) = 6.072, p < 0.001) respectively. For waist circumference percentile and body fat percentage, the intervention group experienced a significant reduction compared to the wait-list group, within the obese subgroup ((F(6, 297) = 3.998, p = 0.001) and within the overweight subgroup (F(6, 201) = 2.526, p = 0.022). CONCLUSIONS: The four-month REDUCE intervention programme was effective in reducing childhood adiposity. Further research using this approach needs to be conducted including cost-effectiveness studies before implementing it in a child obesity prevention programme. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617000844347 (7 June 2017 retrospectively registered). National Medical Research Register, Ministry of Health Malaysia: NMRR-14-685-21,874 (July 2014).

Impact of culture on autobiographical life structure in depression.

OBJECTIVES: Distortions in autobiographical memory have been implicated in major depressive disorder (MDD). Those with MDD demonstrate a 'depressogenic' autobiographical life structure. Research has not examined how culture influences this process. We investigated whether Malay individuals (members of an interdependent culture) with MDD demonstrated a 'depressogenic' autobiographical life structure similar to that of British individuals (members of an independent culture) with MDD. DESIGN: A 2 (Culture; Malay, British) × 2 (Mood; depressed, control) cross-sectional design using a card sort task and self-report measures was used. METHODS: Malay individuals with MDD or no history of MDD completed the life-structure card-sorting task, which provided a novel method for investigating organizational structure of the life narrative. These data were compared to previously collected data in which British individuals with MDD or without MDD had completed the same task within the same experimental protocol. RESULTS: Pan-culturally those with MDD had greater negativity (i.e., used more negative attributes), negative redundancy (i.e., used the same negative attributes repeatedly across life chapters) and negative emodiversity (i.e., had greater variety and relative abundance of negative attributes), and reduced positive redundancy (i.e., used the same positive attributes repeatedly across chapters) in their structuring relative to controls. While the British MDD group had greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters) than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls. CONCLUSIONS: The findings suggest culture may shape aspects of the autobiographical life structure in MDD. PRACTITIONER POINTS: The majority of the literature investigating depression pertains to individuals from European Western cultures, despite recognition that depression ranks as one of the most debilitating diseases worldwide. This raises questions as to whether current depression models and interventions can be applied universally or whether they are limited to European Western groups. The current study found that pan-culturally those with MDD had similar structuring of their life story relative to controls. However, there were some cultural differences that need to be considered (e.g., Malay individuals provided less detailed, less elaborate and less emotionally diverse life stories and while the British MDD group had greater compartmentalization than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls). Limitations of the study included group differences in gender and mood at the time of testing. Cultural differences in the number of attributes used may have influenced findings. Only the Malay group completed the individualism-collectivism measure.

The effectiveness of a value-based EMOtion-cognition-Focused educatIonal programme to reduce diabetes-related distress in Malay adults with Type 2 diabetes (VEMOFIT): study protocol for a cluster randomised controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) patients experience many psychosocial problems related to their diabetes. These often lead to emotional disorders such as distress, stress, anxiety and depression, resulting in decreased self-care, quality of life and disease control. The purpose of the current study is to evaluate the effectiveness of a brief value-based emotion-focused educational programme in adults with T2DM on diabetes-related distress (DRD), depressive symptoms, illness perceptions, quality of life, diabetes self-efficacy, self-care and clinical outcomes. METHODS: A cluster randomised controlled trial will be conducted in 10 public health clinics in Malaysia, all providing diabetes care according to national clinical practice guidelines. Patients' inclusion criteria: Malay, ≥ 18 years with T2DM for at least 2 years, on regular follow-up with one of three biomarkers HbA1c, systolic blood pressure and LDL-cholesterol sub-optimally controlled, and with a mean 17-item Diabetes Distress Scale (DDS-17) score ≥ 3. The intervention consists of four sessions and one booster over a period of 4 months that provide information and skills to assist patients in having proper perceptions of their T2DM including an understanding of the treatment targets, understanding and managing their emotions and goal-setting. The comparator is an attention-control group with three meetings over a similar period. With an estimated intra-cluster correlation coefficient ρ of 0.015, a cluster size of 20 and 20% non-completion, the trial will need to enroll 198 patients. PRIMARY OUTCOME: the between groups difference in proportion of patients achieving a mean DDS-17 score < 3 (non-significant distress) at 6 months post-intervention. Secondary outcomes will be the differences in the above mentioned variables between groups. DISCUSSION: We hypothesize that primary and secondary outcomes will improve significantly after the intervention compared to the comparator group. The results of this study can contribute to better care for T2DM patients with DRD. TRIAL REGISTRATION: ClinicalTrials.gov NCT02730078 . Registered on 29 March 2016, last updated on 4 January 2017.

Prevalence, associated factors and predictors of anxiety: a community survey in Selangor, Malaysia.

BACKGROUND: Anxiety is the most common mental health disorders in the general population. This study aimed to determine the prevalence of anxiety, its associated factors and the predictors of anxiety among adults in the community of Selangor, Malaysia. METHODS: A cross sectional study was carried out in three districts in Selangor, Malaysia. The inclusion criteria of this study were Malaysian citizens, adults aged 18 years and above, and living in the selected living quarters based on the list provided by the Department of Statistics Malaysia (DOS). Participants completed a set of questionnaires, including the validated Malay version of Generalized Anxiety Disorder 7 (GAD 7) to detect anxiety. RESULTS: Of the 2512 participants who were approached, 1556 of them participated in the study (61.90%). Based on the cut-off point of 8 and above in the GAD-7, the prevalence of anxiety was 8.2%. Based on the initial multiple logistic regression analysis, the predictors of anxiety were depression, serious problems at work, domestic violence and high perceived stress. When reanalyzed again after removing depression, low self-esteem and high perceived stress, six predictors that were identified are cancer, serious problems at work, domestic violence, unhappy relationship with family, non-organizational religious activity and intrinsic religiosity. CONCLUSION: This study reports the prevalence of anxiety among adults in the community of Selangor, Malaysia and also the magnitude of the associations between various factors and anxiety.

Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study.

Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (ß = 0.19, ΔR2 = 0.04, p = .040, f (2) = 0.05), perceived stress (ß = -0.26, ΔR2 = 0.07, p = .009, f (2) = 0.10); mental distress (ß = -0.28, ΔR2 = 0.10, p = .003, f (2) = 0.15); and self-efficacy (ß = 0.30, ΔR2 = 0.09, p < .001, f (2) = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (ß = 0.24, ΔR2 = 0.06, p = .020, f (2) = 0.08); but there was no difference in other outcome measures. More than 90% of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.

Testing comparison models of DASS-12 and its reliability among adolescents in Malaysia.

OBJECTIVE: The 21-item Depression, Anxiety and Stress Scale (DASS-21) is frequently used in non-clinical research to measure mental health factors among adults. However, previous studies have concluded that the 21 items are not stable for utilization among the adolescent population. Thus, the aims of this study are to examine the structure of the factors and to report on the reliability of the refined version of the DASS that consists of 12 items. METHOD: A total of 2850 students (aged 13 to 17 years old) from three major ethnic in Malaysia completed the DASS-21. The study was conducted at 10 randomly selected secondary schools in the northern state of Peninsular Malaysia. The study population comprised secondary school students (Forms 1, 2 and 4) from the selected schools. RESULTS: Based on the results of the EFA stage, 12 items were included in a final CFA to test the fit of the model. Using maximum likelihood procedures to estimate the model, the selected fit indices indicated a close model fit (χ(2)=132.94, df=57, p=.000; CFI=.96; RMR=.02; RMSEA=.04). Moreover, significant loadings of all the unstandardized regression weights implied an acceptable convergent validity. Besides the convergent validity of the item, a discriminant validity of the subscales was also evident from the moderate latent factor inter-correlations, which ranged from .62 to .75. The subscale reliability was further estimated using Cronbach's alpha and the adequate reliability of the subscales was obtained (Total=76; Depression=.68; Anxiety=.53; Stress=.52). CONCLUSION: The new version of the 12-item DASS for adolescents in Malaysia (DASS-12) is reliable and has a stable factor structure, and thus it is a useful instrument for distinguishing between depression, anxiety and stress.

The Effectiveness of Brain Injury Family Intervention in Improving the Psychological Well-Being of Caregivers of Patients With Traumatic Brain Injury: Protocol for a Randomized Controlled Trial.

BACKGROUND: Globally, traumatic brain injury (TBI) is recognized as one of the most significant contributors to mortality and disability. Most of the patients who have experienced TBI will be discharged home and reunited with their families or primary caregivers. The degree of severity of their reliance on caregivers varies. Therefore, the task of delivering essential care to the patients becomes demanding for the caregivers. A significant proportion of caregivers expressed considerable burden, distress, and discontentment with their lives. Therefore, it is critical to comprehend the dynamic of TBI and caregivers to optimize patient care, rehabilitation, and administration. The effectiveness of the Brain Injury Family Intervention (BIFI) program tailored for caregivers of patients with TBI has been widely proven in Western countries. However, the impact is less clear among caregivers of patients with TBI in Malaysia. OBJECTIVE: This study aims to assess the effectiveness of BIFI in reducing emotional distress and burden of care, fulfilling the needs, and increasing the life satisfaction of caregivers of patients with TBI at government hospitals in Malaysia. METHODS: This is a 2-arm, single-blinded, randomized controlled trial. It will be conducted at Hospital Rehabilitasi Cheras and Hospital Sungai Buloh. In total, 100 caregivers of patients with TBI attending the neurorehabilitation unit will be randomized equally to the intervention and control groups. The intervention group will undergo the BIFI program, whereas the control group will receive standard treatment. Caregivers aged ≥18 years, caring for patients who have completed >3 months after the injury, are eligible to participate. The BIFI program will be scheduled for 5 sessions as recommended by the developer of the module. Each session will take approximately 90 to 120 minutes. The participants are required to attend all 5 sessions. A total of 5 weeks is needed for each group to complete the program. Self-reported questionnaires (ie, Beck Depression Inventory, Positive and Negative Affect Schedule, Caregiver Strain Index, Satisfaction With Life Scale, and Family Needs Questionnaire) will be collected at baseline, immediately after the intervention program, at 3-month follow-up, and at 6-month follow-up. The primary end point is the caregivers' emotional distress. RESULTS: The participant recruitment process began in January 2019 and was completed in December 2020. In total, 100 participants were enrolled in this study, of whom 70 (70%) caregivers are women and 30 (30%) are men. We are currently at the final stage of data analysis. The results of this study are expected to be published in 2024. Ethics approval has been obtained. CONCLUSIONS: It is expected that the psychological well-being of the intervention group will be better compared with that of the control group after the intervention at 3-month follow-up and at 6-month follow-up. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20180809040746N1; https://irct.behdasht.gov.ir/trial/33286. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/53692.

A pilot randomized control trial on the feasibility, acceptability, and initial effects of a digital-assisted parenting intervention for promoting mental health in Malaysian adolescents.

Objective: Online parenting interventions for enhancing child development, specifically mental health is relatively new in Malaysia. This pilot study tests the feasibility, acceptability, and initial effects of a universal digital-assisted parenting intervention (DaPI) in promoting mental health in adolescents by improving parental behaviors and self-efficacy. Methods: A two-arm pilot randomized controlled trial was conducted. Twenty-four mothers of adolescent aged 10 to 14 years from a non-clinical sample were recruited online and randomly allocated into two groups (intervention [DaPI] and waitlist-control [WLC]). Eight weekly sessions were delivered online via technological devices. Feasibility outcomes were based on the participants' engagement in DaPI and study retention. Primary (parental behaviors and self-efficacy) and secondary (adolescent mental health) outcomes were assessed using an online survey at baseline (T0), post-intervention (T1), and 1-month follow-up (T2). Data were analyzed using descriptive and inferential statistics and an intention-to-treat approach. Results: The DaPI was well received by the mothers. Retention was high (81.8%) in both groups and intervention adherence was excellent (91.6%). Within-group analyses showed a significant decrease in physical control at T2 and an increase in parental self-efficacy at T1 and T2 among the DaPI mothers. No significant differences were observed in adolescents' mental health at any time point. As for the WLC group, there were no significant differences in all the outcome variables across the three assessment moments. Between groups analyses revealed DaPI mothers had significant differences in proactive parenting at T1, and in positive reinforcement and lax control at T2. There were no significant differences in adolescents' mental health between the groups at any time point. Discussion: The DaPI is feasible and acceptable in the Malaysian context. Findings show promise regarding the initial effects of the DaPI. However, a larger RCT is needed to determine its effectiveness in promoting mental health of adolescents. Trial registration: https://www.irct.ir/; identifier: IRCT20211129053207N1.

Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures.

The DASS-21 is a well-established instrument for measuring depression, anxiety, and stress with good reliability and validity reported from Hispanic American, British, and Australian adults. However, the lack of appropriate validation among Asian populations continues to pose concerns over the use of DASS-21 in Asian samples. Cultural variation may influence the individual's experience and emotional expression. Thus, when researchers and practitioners employ Western-based assessments with Asian populations by directly translating them without an appropriate validation, the process can be challenging. We conducted a series of rigorous statistical tests and minimized any potential confounds from the demographic information. Following factor analyses, we performed multigroup analysis across six nations to demonstrate consistency of our findings. The advantages of this revised DASS-18 stress scale are twofold. First, it possesses fewer items, which results in a cleaner factorial structure. Second, it has a smaller interfactor correlation. With these justifications, the revised DASS-18 stress scale is potentially more suitable for Asian populations. Nonetheless, given limitations, findings should be considered preliminary.