Psychosocial factors associated with mental health and quality of life during the COVID-19 pandemic among low-income urban dwellers in Peninsular Malaysia.

BACKGROUND AND AIMS: Mental well-being among low-income urban populations is arguably challenged more than any other population amid the COVID-19 pandemic. This study investigates factors associated with depression and anxiety symptoms and quality of life among Malaysia's multi-ethnic urban lower-income communities. METHODS: This is a community-based house-to-house survey conducted from September to November 2020 at the Petaling district in Selangor, Malaysia. Five hundred and four households were identified using random sampling, and heads of eligible households were recruited. Inclusion criteria were age ≥18 years with a monthly household income ≤RM6960 (estimated $1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life, respectively. Multivariable logistic regression was performed for the final analysis. RESULTS: A total of 432 (85.7%) respondents with a mean age of 43.1 years completed the survey. Mild to severe depression was detected in 29.6%, mild to severe anxiety in 14.7%, and problematic quality of life in 27.8% of respondents. Factors associated with mild to severe depression were younger age, chronic health conditions, past stressful events, lack of communication gadgets and lack of assets or commercial property. While respiratory diseases, marital status, workplace issues, financial constraints, absence of investments, substance use and lack of rental income were associated with mild to severe anxiety. Attributing poverty to structural issues, help-seeking from professionals, and self-stigma were barriers, while resiliency facilitated good psychological health. Problematic quality of life was associated with depression, older age, unemployment, cash shortage, hypertension, diabetes, stressful life events and low health literacy. CONCLUSIONS: A high proportion of the sampled urban poor population reported mild to severe anxiety and depression symptoms. The psychosocial determinants should inform policymakers and shape future work within this underserved population.

Income Disparity and Mental Wellbeing among Adults in Semi-Urban and Rural Areas in Malaysia: The Mediating Role of Social Capital.

Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.

Health-related quality of life of younger and older lower-income households in Malaysia.

BACKGROUND: Globally, a lower income is associated with poorer health status and reduced quality of life (QOL). However, more research is needed on how being older may influence QOL in lower-income households, particularly as older age is associated with an increased risk of chronic diseases and care needs. To this end, the current study attempts to determine the health-related QOL (HRQOL) among individuals from lower-income households aged 60 years and over compared to lower-income adults aged less than 60 years. METHODS: Participants were identified from the Department of Statistics Malaysia sampling frame. Surveys were carried out with individual households aged 18 years and older through self-administered questionnaires. Information was collected on demographics, household income, employment status, number of diseases, and HRQOL assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool. RESULTS: Out of a total of 1899 participants, 620 (32.6%) were female and 328 (17.3%) were aged 60 years and above. The mean (SD) age was 45.2 (14.1) and mean (SD) household income was RM2124 (1356). Compared with younger individuals, older respondents were more likely to experience difficulties in mobility (32.1% vs 9.7%, p<0.001), self-care (11.6% vs 3.8%, p<0.001), usual activities (24.5% vs 9.1%, p<0.001), pain/discomfort (38.8% vs 16.5%, p<0.001) and anxiety/depression (21.4% vs 13.5%, p<0.001). The mean (SD) EQ-5D index scores were lower among older respondents, 0.89 (0.16) vs 0.95 (0.13), p = 0.001. After adjusting for covariates, age was a significant influencing factor (p = 0.001) for mobility (OR = 2.038, 95% CI:1.439-2.885), usual activities (OR = 1.957, 95% CI:1.353-2.832) and pain or discomfort (OR = 2.241, 95% CI:1.690-2.972). CONCLUSION: Lower-income older adults had poorer HRQOL compared to their younger counterparts. This has important implications concerning intervention strategies that incorporate active ageing concepts on an individual and policy-making level to enhance the QOL and wellbeing, particularly among the older lower-income population.

Pandemic-Related Differences in Physical and Mental Health of Older Adults (preprint)

Background: As a result of the COVID-19 pandemic, changes in data collection methods have been introduced in research to ensure continuity despite physical distancing and lockdown restrictions. However, little is currently known about the potential differences in information collected using these traditional face-to-face methods compared to the incorporation of virtual methods to address the above, particularly in studies involving older adults. Aims Our objectives were, therefore, to compare data collected during the pandemic using hybrid methods from older individuals participating in falls research to that collected through traditional face-to-face methods. Methods Participants comprised of individuals recruited to two fall studies which hurdled the start of the COVID-19 pandemic. Both studies recruited individuals aged 60 years and over with at least one fall in the past 12 months, and controls with no history of falls in the past 12 months. Pre-pandemic, individuals were interviewed face-to-face exclusively, those interviews after the start of the pandemic were conducted virtually with physical assessments conducted face-to-face to minimize physical contact. Cognitive, physical, and psychological status were determined using the visual cognitive assessment tool (VCAT), timed-up-and-go (TUG), functional reach (FR), handgrip strength (HGS), and the 21-item depression, anxiety and stress scale (DASS-21). In addition quality of life, physical activity and social participation were also measured. Results Of the 145 participants (median age (interquartile range, IQR) of 73.5 (67-81) years), 69 (47.6%) were interviewed face-to-face, while 76 (53.4%) were assessed using a hybrid method. Participants in both groups had similar age, gender, ethnic breakdown, marital status, education levels, anthropometric measurements, and medication burden. More face-to-face participants had hypertension and fall compared to hybrid participants Differences were observed in presence of fall characteristics, with fewer fallers seeing a doctor and more fallers attending the emergency department after the start of the pandemic. After adjustment for baseline differences, participants interviewed using hybrid status had lower depression scores (odds ratio, OR (95% confidence interval, CI)=0.29(0.14-0.61) and stress scores (OR(95%CI)=0.33(0.15-0.72)), but greater fear of falling (OR(95%CI)=2.16(1.04-4.48)) and reduced social participation (OR(95%CI)=2.64(1.20-5.79)). Conclusion Alterations in recruitment and data collection methods to overcome pandemic restrictions should take into consideration potential differences in individuals who agree to participate as well as the influence of major life events on the psychological status of participants.

Feasibility of Virtual Research on the Psychological Status and Group Exercises among Community-Dwelling Older Adults during the COVID-19 Pandemic (preprint)

Social isolation magnified by the restriction of movement order during the COVID-19 pandemic may lead to negative psychosocial health impact among community-dwelling older adults. We evaluated the feasibility of virtual research methods and virtual group exercises among individuals aged 60 years and over in Malaysia. Participants were recruited from the Promoting Independence in Seniors with Arthritis (PISA) pilot cohort through social media messages. A four-week course of virtual group exercise was offered. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS) during the last attended follow-up of the cohort study (pre-pandemic), pre-intervention, and post-intervention. Exercise adherence was recorded using diary with daily entries and attendance to the virtual group exercise sessions were captured daily. The outcomes of interest were changes of anxiety and depression scores from baseline to pre-intervention (pandemic-related) and post-intervention (virtual exercise related). Forty-three individuals were recruited. A significant increase in anxiety scores from baseline to pre-intervention was observed. Comparisons using repeated-measures analysis of variance between those who attendance ≥14 and <14 group exercise sessions revealed no between-within subjects differences in depression scores. There was a 23% dropout rate in the post intervention survey and 60.5% of diaries were returned. This study demonstrated the feasibility of conducting research entirely virtually among older persons during the peak of global first wave of a pandemic. The pandemic has led to increased anxiety among community-dwelling older adults.