Depression and Anxiety Predict Healthcare Workers' Understanding of and Willingness to Help Suicide Attempt Patients.

We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation, self-efficacy in preventing suicide and demographic factors predicted the understanding of and willingness to help suicidal patients among hospital healthcare workers. A total of 368 healthcare workers from the major surgical and medical departments in a general hospital setting were recruited. Participants responded to the Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and Understanding Suicide Attempt Patient Scale. Those from the psychiatric department, with higher suicide prevention self-efficacy, and lower personal accomplishment indicated more understanding and helpful attitudes; doctors, depressed and anxious healthcare workers reported less understanding and helpful attitudes. Suicide prevention efforts must be conducted in tandem with equipping and supporting the healthcare workers who manage suicidal patients.

Attitude Towards Suicide and Help-Seeking Behavior Among Medical Undergraduates in a Malaysian University.

OBJECTIVE: The attitude of medical personnel towards suicide may influence the outcome of suicidal-patients management. This study aimed to determine the attitudes of medical undergraduates towards suicide and its association with their help-seeking behavior. METHODS: A cross-sectional study involving 290 medical undergraduates was conducted in a Malaysian university. The questionnaires on the attitude towards suicide and general help-seeking behavior were used as research instruments. RESULTS: The mean age of the participants was 22.4 years. Participants who did psychiatry posting indicated a greater tendency to agree on suicide as a way of communication (p = 0.008) than those who did not. Participants previously diagnosed with a psychiatric illness indicated a greater ability to understand and accept suicide (p < 0.001) as well as a greater tendency to agree on the normality of suicide (p = 0.019) than those without a previous diagnosis. Those who attended a suicide prevention program also indicated a greater tendency to agree that loneliness and avoidance could be triggers to suicide (p = 0.037) than those who did not. No correlation was found between the "attitude towards suicide" and "general help-seeking behavior" variable. CONCLUSION: Education programs in suicide prevention and management need to be incorporated early into the undergraduate medical curriculum to cultivate a more positive attitude towards suicide and help-seeking behavior.

Health-Care Workers' Perception of Patients' Suicide Intention and Factors Leading to It: A Qualitative Study.

This study explored health-care workers' perception of patients' suicide intention and their understanding of factors leading to particular interpretations. Semistructured face-to-face in-depth interviews were conducted with 32 health-care workers from a general hospital in Klang Valley, Malaysia. Interview data were transcribed verbatim and analyzed using the interpretative phenomenological analysis. The health-care workers were found to have four types of perceptions: to end life, not to end life, ambivalence about intention, and an evolving understanding of intention. Factors leading to their perceptions of patients' suicide intention were patient demographics, health status, severity of ideation/attempt, suicide method, history of treatment, moral character, communication of suicide intention, affective/cognitive status, availability of social support, and health-care workers' limited knowledge of patients' condition/situation. Insufficient knowledge and negative attitudes toward suicidal patients led to risk minimization and empathic failure, although most health-care workers used the correct parameters in determining suicide intention.

The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia.

BACKGROUND: The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents. METHODS: A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB). RESULTS: The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents. CONCLUSION: Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.

Depressive symptoms in adolescents in Kuching, Malaysia: Prevalence and associated factors.

BACKGROUND: The trend of depression is rising worldwide. There are limited studies on depression in adolescents. The aim of this study was to estimate the prevalence of and identify the factors associated with depressive symptoms in adolescents in Kuching, Malaysia, and to analyze the relationship between depressive symptoms and suicidal ideation. METHODS: A cross-sectional study was conducted in 320 students from urban and rural secondary schools. The participants were randomly selected via multi-stage sampling. They completed the Malay versions of the Children's Depression Inventory (CDI) and Beck Scale for Suicide Ideation (BSS). RESULTS: The prevalence of depressive symptoms was 26.2%. On binary logistic regression analysis, variables with significant association with depressive symptoms were race (P = 0.028), type of class (P < 0.001), mother's education level (P = 0.036), type of housing (P = 0.036), parents' marital status (P = 0.012), alcohol intake (P = 0.005), stealing (P < 0.001) and history of disciplinary record (P = 0.005). Variables that remained significant on multivariable logistic regression were type of class (P = 0.004), parents' marital status (P = 0.017) and stealing (P < 0.001). Students from the Arts stream (OR, 2.43) with parents who were separated, divorced or widowed (OR, 3.13) and who had experience of stealing (OR, 3.27) were predicted to be at risk of developing depressive symptoms. There was a significant correlation between total CDI score and total BSS score (P < 0.001). CONCLUSIONS: The prevalence of depressive symptoms in adolescents was high. Depressive symptoms are significantly correlated with suicidal ideation. Greater collaboration between the education and health agencies is essential for mental health promotion in schools and early detection of depression, especially in at-risk adolescents.

The Attitude of Psychiatric and Non-psychiatric Health-care Workers Toward Suicide in Malaysian Hospitals and Its Implications for Training.

OBJECTIVES: This research is aimed to examine the attitude of health-care workers toward suicidal patients in Malaysian hospitals, comparing responses from psychiatric and non-psychiatric workers, and to identify specific needs in suicide prevention and management training. METHOD: This is a multi-site cross-sectional study. The authors conducted a survey based on a translated self-administered questionnaire to participants from seven core hospital departments. RESULTS: While most health-care workers regardless of department and specialty took their duty to prevent suicide seriously, a large majority of them expressed negative attitudes such as finding suicidal behavior irritating, and more than half believed suicidal attempts were a way of making others sorry. However, psychiatric workers were less likely to have judgmental attitudes that included believing suicide attempters as being selfish or trying to get sympathy from others. CONCLUSIONS: As there were more similarities than differences in health-care workers' attitudes toward suicide, recommendations on basic and continuous suicide prevention and management training among hospital workers were made. The interventions focused on improving knowledge, affective, and skill-based areas that were aimed to correct the wrongful understanding of and to minimize the negative attitudes toward suicidal individuals indicated by the study results.

Development and Validation of a Coping Scale for Caregivers in Malaysia.

INTRODUCTION: Caregivers often experience stressful situations while in the midst of the caregiving process. Thus, various methods of coping have been widely applied and studied in previous researches. The aim of this study was to develop a novel questionnaire to assess the coping strategies employed by those who provide care to patients, and to further validate it among caregivers of schizophrenia patients in Malaysia. METHODS: This study, which involved the caregivers of schizophrenia patients from a hospital in Kuala Lumpur, Malaysia, was comprised of three parts, namely in-depth interviews, a pilot study, and the validation of the developed questionnaire, known as Caregiver Cope (CgCopeTM). RESULTS: Part A originally consisted of eight themes, and it was later modified to seven themes with four items each after discussions with some experts. Part B initially had 28 items derived from the seven themes in Part A, which were then reduced to six components after a factor analysis. Part C of the questionnaire consisted of 19 items, with six components (Distraction, Caring for patient, Venting, Religion, Recreation, and Social support) having a moderate to high reliability ranging from a Cronbach's alpha coefficient of 0.54 to 0.82. A factor analysis showed that the six factors of coping accounted for 62.36% of the total variance. CONCLUSION: The CgCOPETM questionnaire is suitable for use among caregivers of schizophrenia patients. There is a need to further validate the instrument among caregivers of other patient populations.

An Adaptation and Validation of Cocaine Craving Questionnaire for Malaysians Who Use Amphetamine-Type Stimulants.

Introduction: Cases of amphetamine-type stimulants (ATS) use have been increasing over the past decade. Cravings are considered a causal factor for recurrent relapses in ATS use cases. The absence of questionnaires measuring cravings for ATS in the local population necessitates the creation of one, especially considering the rising number of cases. Objective: This study aimed to adapt and validate the Cocaine Cravings Questionnaire into a questionnaire suitable for measuring cravings for ATS in the local population. Methodology: The original questionnaire was adapted by substituting "cocaine" with "ATS". The process involved a back-to-back translation, followed by a round of face and content validation. The participants included people who use drugs (PWUD) with a history of ATS use recruited from rehabilitation centers in Malaysia. A set of questionnaires consisting of demographic items and the adapted ATS Cravings Questionnaire (ATS-CQ) were given. Results: This cross-sectional study recruited a total of 205 PWUD, mostly single men, with a mean age of 33.32 (s.d.=13.14). The mean age of ATS initiation was 22.89 (s.d.=9.39), with a median duration of ATS use of 60 months (IQR=24.00, 120.00). The adapted questionnaire received a good score for content validation. Unlike the original, this adapted version was found to have only three factors showing good internal consistency, ranging from 0.707 to 0.918 for all three factors. Test-retest reliability also showed good results, with an interclass correlation coefficient of 0.875 (95% CI=0.835, 0.905). Conclusion: The translated ATS-CQ has been finalized and deemed valid and reliable for use among Malaysian substance users to measure ATS cravings.

Hypnotherapy as Treatment for Depression: A Scoping Review.

This scoping review aims to provide a comprehensive overview of studies that explore the use of hypnotherapy as a treatment for depression, adhering to the PRISMA-ScR guidelines. A total of 232 articles were identified through systematic search strategies in four databases. Following rigorous screening, 14 studies, varying from case studies to randomized controlled trials, were included in the final review. The age range of participants spanned from 18 to 70 years, and the number of female participants generally exceeded that of males in these studies. Hypnotherapy was found to be frequently used as an adjunct treatment alongside various types of psychotherapy such as cognitive behavioral therapy and often included techniques like hypnotic induction, ego strengthening, and self-hypnosis. The treatment duration varied from 3 sessions to as long as 20 weekly sessions. Most importantly, the majority of the studies found hypnotherapy to be effective in reducing symptoms of depression, with some studies suggesting it has superior effects to antidepressant treatment in areas such as overall health and vitality. This review highlights the potential of hypnotherapy as a viable treatment option for depression and highlights the need for further controlled studies to establish its efficacy.

Predictors of drug and substance abuse among school-going adolescents living in drug hotspot in Malaysia.

This study explored the pressing issue of drug and substance abuse (DSA) among adolescents in drug hotspots in Malaysia. The Malaysian Anti-drug Agency (AADK) has identified 155 hotspot areas across Malaysia, of which 78 were randomly selected as the study sites. These areas were identified as having extreme drug-related activities such as drug trafficking and drug-related crimes. According to the literature, several factors influence adolescents to be involved in DSA. Therefore, understanding the risk factors in the context of Malaysian school-going adolescents is of utmost importance. The study examined, in particular, a wide range of potential predictors, including socioeconomic factors, peer influence, family dynamics, educational experiences, drug access, and community characteristics. Adolescents in the hotspot areas were selected by means of a cross-sectional survey design with a cluster sampling method. The sample comprised 3382 school-going adolescents, and the data were collected through face-to-face interviews. The logit model method with STATA software was used to analyse the data. The findings of the study revealed that school-going adolescents with disciplinary issues face a two-fold increase in the risk of becoming current drug users compared to their peers. Further, those exhibiting externalising behaviours, such as aggression and rule-breaking, also face greater odds of becoming involved in DSA. Drug pushers were identified as the most significant risk factor, with adolescents exposed to them being 46 times more likely to become current drug users. The factors of friends and family also contribute significantly to adolescent drug involvement. However, adolescents with academic-related issues may be less involved if they have the protective factor of better coping skills. These findings will contribute to efforts to mitigate drug addiction and drug-related activities, particularly in high-risk communities, as well as help policymakers and healthcare professionals develop targeted interventions and generally promote the well-being of adolescents.

Survey data on socioeconomic demographics of drug-free families living in high-risk drug environments in East Coast States of Peninsular Malaysia.

The dataset represents the socioeconomic demographic of drug-free families living in a high-risk drug environment in East Coast states of Peninsular Malaysia. The purposive sampling technique was used to choose among drug free families living in high drug environment, have children aged between 13 and 17 and none of the family members involved in any substance abuse cases via face-to-face interview questionnaires between 3rd April 2021 and 8th April 2021, gathering a total of 200 responses. The survey assessing socioeconomic demographic information (14 items) and involvement in drug prevention programs (8 items). The survey data was analyzed using descriptive analysis through frequencies and percentages. The data will assist the government, policymakers, and researchers to improve the content and delivery of family-based drug prevention programs and improve family awareness on risk and protective factors towards preventing drug abuse among youths.

Clinical Improvement in Depression and Cognitive Deficit Following Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is a long-standing treatment choice for disorders such as depression when pharmacological treatments have failed. However, a major drawback of ECT is its cognitive side effects. While numerous studies have investigated the therapeutic effects of ECT and its mechanism, much less research has been conducted regarding the mechanism behind the cognitive side effects of ECT. As both clinical remission and cognitive deficits occur after ECT, it is possible that both may share a common mechanism. This review highlights studies related to ECT as well as those investigating the mechanism of its outcomes. The process underlying these effects may lie within BDNF and NMDA signaling. Edema in the astrocytes may also be responsible for the adverse cognitive effects and is mediated by metabotropic glutamate receptor 5 and the protein Homer1a.

Psychosocial Risk Factors Associated with Lifetime Amphetamine-Type Stimulants (ATS) Dependence in Drug Detention Centres: Perspectives from the Multiethnicity Study.

ATS dependence in Malaysia is growing tremendously across multiracial Malaysian groups, increasing concerns among public health experts and the community. This study highlighted the chronicity of ATS dependence and factors associated with ATS use. Interviewer-administered questionnaires were administered using ASSIST 3.0. A total of N = 327 multiracial people who use ATS were enrolled in this study. The study findings show that 190/327 (58.1%) respondents were ATS dependent. Malays reported the highest number of ATS-dependent (55.8%), followed by Bajau (21.6%) and Kadazan-Dusun (16.8%) ethnic. Across all races, three factors were significantly associated with the ATS dependence: respondents who had a lifetime history of needle sharing aOR = 0.023 (95% CI: 0.003, 0.183) and a lifetime history of heroin use aOR = 0.192 (95% CI: 0.093, 0.396) were at a reduced odd of ATS dependent. Meanwhile, being married reduced the likelihood of becoming dependent on ATS with aOR = 0.378 (95% CI: 0.206, 0.693) compared to being single or divorced. This study revealed that the use of ATS among multiracial Malaysians is alarmingly high, including those in detention centers. Comprehensive harm reduction strategies are urgently needed to prevent the spreading of infectious diseases and other negative health consequences associated with ATS use.

Prevalence of psilocybin use in vaping and associated factors: a study among amphetamine-type stimulants (ATS) use disorder in Malaysia.

BACKGROUND: The emergence of New Psychoactive Substances (NPS), including synthetic psilocybin, has raised concern among health experts due to the numerous health and socioeconomic consequences. The current trend is shifting to the hazardous use of synthetic psilocybin in vaping, and little is known about the prevalence of use, specifically among amphetamine-type stimulants (ATS) users. METHODS: Interviewer-administered questionnaires were conducted in drug detention centers between March and October 2022. The study was conducted using ASSIST 3.0 and obtained information on the respondents' socio-demographic characteristics and clinical profiles. N = 355 ATS users were enrolled in this study. RESULTS: The results show a high prevalence of psilocybin vaping among ATS users (182/355, 53.1%). Most of the respondents were males (85.1%) and unmarried (69.3%), with a mean age of 29.2 (SD = 7.3). Across all respondents, five factors were associated with psilocybin vaping: tobacco smoking, aOR =5.790 (95% CI: 1.723, 8.183); cannabis uses, aOR= 9.152 (95% CI: 2.693, 10.396); and alcohol use, aOR= 3.137 (95% CI: 1.461, 5.817). Respondents of the Malay race had higher odds of being involved in psilocybin vaping compared to other races, with aOR= 1.638 (0.043, 2.459). Meanwhile, a reduction in age by 1.9 will increase the likelihood of involvement in psilocybin vaping with aOR = 1.897 (95% CI: 0.857, 1.938). CONCLUSION: Psilocybin in vaping is growing among ATS users and across all populations. Unfortunately, knowledge regarding the long-term effects on health is limited. Further studies should highlight the harmful effects of psilocybin and the potential risk of psilocybin vaping among the younger population.

Association between childhood trauma, intimate partner violence, and perceived parental competence among women abusing amphetamine-type stimulant.

Introduction: This cross-sectional study examines the correlation between childhood trauma, intimate partner violence (IPV), and parenting self-efficacy among women who reported using amphetamine-type stimulants (ATS) in an institutional drug rehabilitation center. Methods: A total of 106 participants were recruited by purposive sampling, of which 88 were mothers. Questionnaires were used to collect sociodemographic data and study variables. Results: Most of these women had experienced emotional abuse, sexual abuse, and physical neglect in their childhood. IPV assessments revealed that 70.5% (n = 74) and 30.5% (n = 32) had experienced physical and sexual violence, respectively. In terms of parenting competency, they scored 79.5% for self-efficacy and 54.4% for parenting satisfaction. Childhood emotional abuse significantly increases the odds of individuals experiencing sexual violence by 20.9%. Discussion: We found that childhood trauma and IPV did not have a significant relationship with parenting efficacy. Conversely, childhood emotional abuse and physical abuse were negatively correlated to parenting satisfaction. It is imperative that any form of childhood abuse be recognized and stopped early to reduce the harm it brings to women later in life.

Suicidal Behavior Among Elderly Inpatients: its Relation to Functional Disability and Pain.

Background: Suicidal behavior (SB) among elderly inpatients has exhibited a growing global drift. This study aimed to establish the prevalence of SB among elderly inpatients and identify the relationship between SB and depression and functional disability. Methods: This cross-sectional study included 136 randomly selected elderly inpatients aged 60 years and older who were hospitalized in a tertiary referral center in Kuala Lumpur, Malaysia. The study utilized the following scales as the assessment tools: The Columbia Suicide Severity Rating Scale (CSSRS), Geriatric Depression Scale (GDS-15), Mini International Neuropsychiatric Interview (M.I.N.I.), the Modified Barthel Index (Shah version) (MBI), and visual analog scale. Results: The rates of current major depressive disorder (MDD), recurrent MDD, passive suicidal ideation (SI), and active SI were 24.3%, 8.8%, 27.9%, and 5.9%, respectively. Depressed elderly had 6 to 17 times higher risk of developing passive or active SI. "Wish to be dead," ie, passive SI was associated with admission to oncology or surgical ward and the presence of current MDD. The findings of the study revealed that active SI was associated with being over 80 years old (p = 0.027), being single (p = 0.042), admission to the oncology ward (p = 0.012) or orthopedic ward (p = 0.032), having positive GDS (p = 0.049), and the presence of current MDD (p = 0.019) or recurrent MDD (p = 0.010). According to the study findings, no association has been observed between passive and active SI and level of independence and acute pain. Conclusion: The risk of depressed elderly inpatients having passive and active SI is high. Hence, screening for depression and SI is crucial for prompt treatment and management.

Case Report: Cotard's Syndrome in Anti-N-methyl D-aspartate (NMDA) Receptor (Anti-NMDAR) Encephalitis.

Cotard's syndrome is uncommon psychopathology among patients with psychotic illnesses. Limited cases had been reported regarding the occurrence of this syndrome in anti-NMDAR encephalitis which itself is a relatively new disease that often presents with florid psychotic symptoms. This poses difficulties in differentiating it from a primary psychiatric illness. Late recognition of anti-NMDAR encephalitis can lead to death as it can progress to autonomic instability in its natural course of illness. We report a patient who first presented with psychotic symptoms with initial negative findings from baseline investigations. Further investigation revealed anti NMDAR antibodies in the cerebrospinal fluid. Prompt treatment was initiated and despite early poor response to the first-line treatment with the development of allergic reaction, our patient recovered completely after 1 month of hospitalization. This case report aims to highlight the importance of early detection of anti-NMDAR encephalitis and the possibility of uncommon psychopathology such as Cotard's syndrome occurring in this disease.

Case scenario: Management of major depressive disorder in primary care based on the updated Malaysian clinical practice guidelines.

Major depressive disorder (MDD) is a common but complex illness that is frequently presented in the primary care setting. Managing this disorder in primary care can be difficult, and many patients are underdiagnosed and/or undertreated. The Malaysian Clinical Practice Guidelines (CPG) on the Management of Major Depressive Disorder (MDD) (2nd ed.), published in 2019, covers screening, diagnosis, treatment and referral (which frequently pose a challenge in the primary care setting) while minimising variation in clinical practice.

Typologies and Psychological Profiles of Child Sexual Abusers: An Extensive Review.

Child sexual abuse is a public health issue that has been associated with a variety of negative health outcomes. Child sexual abusers constitute a heterogeneous population of individuals. This review lays out an overview of the current understanding of typologies and psychological profiles of child sexual abusers. Typologies of child sexual abusers in general and online child sexual abusers are reviewed to summarise the existing knowledge. Psychological traits including personality traits, cognitive distortion, empathy, and impulsivity are examined to provide a wider perspective of the psycho-criminogenic factors of child sexual abuse. Although past research on child sexual abusers has provided insights into the organisation and classification of different types of child sexual abusers, the classification of these typologies has drawn widespread criticisms. In this review, we discuss the challenges and limitations pertaining to the existing typologies and studies related to the psychological profile of child sexual abusers.