Using the Indonesian Computer-Based Game Prototype as a Computer-Based Game Inventory for Executive Function in Children and Adolescents: A Confirmatory Factor Analysis and Concurrent Validity Study.

Executive function influences children's learning abilities and organizes their cognitive processes, behaviors, and emotions. This cross-sectional study examined whether an Indonesian Computer-Based Game (ICbG) prototype could be used as a Computer-Based Game Inventory for Executive Function (CGIEF) in children and adolescents. The study was conducted with 200 children, adolescents, and their parents. The parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire, and the children and adolescents completed the CGIEF. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were performed using LISREL Version 8.80. The construct of CGIEF was valid/fit with normal theory-weighted least squares = 15.75 (p > .05). SEM analysis showed that the theoretical construct of the CGIEF was a valid predictor of executive function. The critical t value of the pathway was 2.45, and normal theory-weighted least squares was 5.74 (p > .05). The construct reliability (CR) for CGIEF was 0.91. Concurrent validity was assessed using the Bland-Altman plot, and the coefficient of repeatability (bias/mean) was nearly zero between the t scores of total executive functions of the CGIEF and BRIEF. This preliminary study showed that the CGIEF can be useful as a screening tool for executive dysfunction, metacognitive deficits, and behavioral regulation problems among children and adolescents in clinical samples.

Effectiveness of an online mental health strengthening module to build resilience and overcome stress for transitional aged medical students.

Introduction: Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience. Methods: A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group (n = 52) and control group (n = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week. Results: Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference (P < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups. Conclusion: The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability.

MIESRA mHealth: Marital satisfaction during pregnancy.

The transition of a pregnant woman's role often causes emotional changes that have an impact on marital satisfaction. We develop MIESRA mHealth and evaluate its impact on satisfaction of husband-wife relationship during pregnancy. A quasi-experimental study was conducted on 82 couples of pregnant women and divided into control, single, and paired group. We implemented MIESRA mHealth for four weeks. In the couple group, the wife did mindfulness based on the information in the MIESRA mHealth together with her husband. In a single group, the wife sees the video as an initial guide to doing mindfulness. In the control group, respondents received programme interventions from hospitals which included education and consultation with obstetricians. Husband-wife relationship is evaluated using Compatibility of Husband-and-Wife Relationships / Kesesuaian Hubungan Suami Istri (KHSI) questionnaire and the generalised estimating equations (GEE) was used to analyse the data. The women's KHSI scores in the couple and single intervention groups (ß = -7.46, p = 0.002; ß = -9.11, p = 0.001) were better than the control group. The husbands' KHSI scores in the paired and individual intervention groups (ß = -7.04, p<0.001; ß = -3.74, p = 0.024) were better than the control group. Nursing interventions to build emotional bonds between parents and foetuses based on mHealth can be a promising intervention for marital harmony during the perinatal period. MIESRA m-Health is a promising intervention on marital satisfaction during pregnancy and can be implemented as a part of the antenatal care programme to increase marital satisfaction.

The effectiveness of mental health nursing promotive and preventive model on protective factors, risk factors and adolescents' mental health.

Adolescents are at risk in experiencing mental health problems if the risk factors owned are more than the protective factors. This study aims to identify the effectiveness of Mental Health nursing promotive and preventive models on protective factors, risk factors and Adolescents' Mental Health. This research was with quasi-experiment, design employed randomization control group pre and post-test design conducted on 240 adolescents, which was divided into both groups equally. The study found that protective factors (self-esteem, family relationship, and prosocial ability) has increased after intervention model by 10.2%; 4.4%; 15.7%, respectively, risk factors (bullying behavior, anxiety, emotional problems, behavioral problems, and peer problems) has decreased after the intervention model by 9.8%; 26.1%; 25.9%; 17.5%; 22.4%, respectively. The model also increased the adolescents' mental health after intervention model by 14.9%. The mental health nursing promotive and preventive model is effective to increase the mental health of adolescents by 21.3%. Mental health nursing' promotive and preventive model could be used as basic needs to implement early detection regarding mental health of adolescents in the UKS scope and involving teachers' role, as well as parents in maintaining mental health.

Psychosocial factors associated with mother-infant bonding in Indonesian samples.

BACKGROUND: Mother-infant bonding is an important factor that supports an infant's socio-emotional development. Therefore, every family member should acknowledge these processes, especially in an extended family set-up like in Indonesia. The general study objective was to predict several socio-demographic factors associated with mother-infant bonding in Indonesian samples. METHOD: This is a cross-sectional study. The participants included 168 mothers who had infants aged 0 to 36 months and willingly joined the study by signing the informed consent form. The Indonesian version of mother-infant bonding scale and a socio-demographic questionnaire were administered to all mothers. Logistic regression was applied to identify the socio-demographic factors that had any association with the mother-infant bonding scale. The data were analyzed using the SPSS program version 21 for Mac. RESULTS: The study showed that 13.1% of the participants were categorized as having a moderate-to-high level of impaired mother-infant bonding. Logistic regression analysis showed that vaginal or normal delivery mode was 4.07 (95% CI [1.27, 13.09]) times more likely to exhibit low levels of impaired mother-infant bonding compared to a cesarean section. The model explained 18.6% (Nagelkerke R2) of the variance in impaired mother-infant bonding and accurately classified 86.9% of cases. CONCLUSION: The findings support prior studies that have been conducted in several countries. Psychoeducation on supporting mother-infant bonding may consist of several topics, such as the advantages of vaginal delivery mode and the importance of family support. It may be delivered in the early adulthood period and, hopefully, basic knowledge during those periods may help strengthen the understanding of mother-infant dyad issues among all family members.

Effectiveness of Internet-Based Group Supportive Psychotherapy on Psychic and Somatic Symptoms, Neutrophil-Lymphocyte Ratio, and Heart Rate Variability in Post COVID-19 Syndrome Patients.

BACKGROUND: COVID-19 can have serious long term health consequences, which is called Post-COVID-19 Syndrome (PCS). Currently, the available evidence and understanding of PCS management is limited. Because one of the symptoms of PCS is associated to psychological symptoms, psychotherapy is believed to have a role in the management of PCS. This study aimed to identify the effectiveness of supportive psychotherapy in PCS patients at Cipto Mangunkusumo National General Hospital. METHODS: This study was a single blind randomized clinical trial using a pre-and post-test with control group study design. Participants were randomly divided into two groups: a psychotherapy group with 40 participants and an education group with 37 participants. Each group was given internet-based psychotherapy or education three times a week in a form of group consisting of 6-8 participants. Symptom Checklist-90 questionnaire was used to evaluate somatic and psychological symptoms. Heart rate variability and neutrophil lymphocyte ratio were also investigated. Data analysis was performed using the independent T test. RESULTS: An improvement in the SCL-90 score was found to be 17.51 (SD 30.52) in the psychotherapy group and 19.79 (SD 35.10) in the education group, although there was no significant difference between the two groups (p = 0.771). There was no significant difference between the two groups in decreasing NLR (p = 0.178) and improving HRV (p = 0.560). CONCLUSION: Both internet-based group supportive psychotherapy and education improved psychological and somatic symptoms in PCS patients, although there was no significant difference between the two groups. There was no significant difference between the two groups in decreasing NLR and improving HRV. Suggestions for further research regarding adding frequency of internet-based group psychotherapy in PCS patients and held in the morning to achieve more optimal results.

Developing attention deficits/hyperactivity disorder-virtual reality diagnostic tool with machine learning for children and adolescents.

The traditional diagnosis of Attention Deficits/Hyperactivity Disorder (ADHD) is through parent-child interviews and observations; therefore, innovative ADHD diagnostic tools that represent this digital era are needed. Virtual reality (VR) is a significant technology that can present a virtual immersive environment; it can provide an illusion of participation in an artificial milieu for children with ADHD. This study aimed to develop an ADHD-VR diagnostic tool construct (Research Domain Construct/RDC) based on the DSM5 ADHD diagnostic criteria, and using the RDC to develop a diagnostic tool with a machine learning (ML) application that can produce an intelligent model to receive some complex and multifaceted clinical data (ADHD clinical symptoms). We aimed to expand a model algorithm from the data, and finally make predictions by providing new data (output data) that have more accurate diagnostic value. This was an exploratory qualitative study and consisted of two stages. The first stage of the study applied the Delphi technique, and the goal was to translate ADHD symptoms based on DSM 5 diagnostic criteria into concrete behavior that can be observed among children in a classroom setting. This stage aimed to gather information, perceptions, consensus, and confirmation from experts. In this study, three rounds of Delphi were conducted. The second stage was to finalize the RDC of the ADHD-VR diagnostic tool with ML, based on the first-stage results. The results were transformed into concrete activities that could be applied in the programming of the ADHD-VR diagnostic tool, followed by starting to input data that were required to build the diagnostic tool. The second stage consisted of more than ten focus-group discussions (FGDs) before it could be transformed into the ADHD-VR diagnostic tool with the ML prototype. First-stage data analysis was performed using Microsoft Excel for Mac. Qualitative data were analyzed using conceptual content analysis with a manifest/latent analysis approach. From the first stage of the study, there were 13 examples of student behaviors that received more than 75% totally agreed or agreed from the experts. The RDC of the ADHD-VR diagnostic tool with machine learning application consisted of three domains and was divided into six sub-domains: reward-related processing, emotional lability, inhibitory, sustained attention, specific timing of playing in order, and arousal. In conclusion, the results of this study can be used as a reference for future studies in a similar context and content, that is, the ADHD-VR diagnostic tool with machine learning based on the constructed RDC.

Supportive Psychotherapy for Healthcare Professionals in The Management of Acute Coronary Syndrome: The Use of Delphi Technique.

BACKGROUND: Supportive psychotherapy (SP) may increase the benefit of acute coronary syndrome (ACS) management, but there is no structured SP as a guideline for healthcare professionals. This study aimed to develop structured SP as a guideline for implementing psychotherapy in the management of ACS patients in intensive cardiac care unit (ICCU). METHODS:  This qualitative study used Delphi technique as a modified Delphi method to reach a consensus among experts of structured SP for healthcare professionals in the management of ACS during hospitalized in ICCU. This was developed using self-reflection, observation, and interview of SP implementation in daily psychosomatic practice, gathering literature reviews, doing focus group discussion (FGD) and interview with ACS survivors. During the Delphi rounds, we interviewed 50 informants as source people using valid questionnaires, to proceed a draft of the SP framework and the structured sessions. The SP framework draft and the structured sessions were evaluated and corrected by experts anonymously until the consensus was reached. The validity of the consensus was tested, using Likert psychometric scale to reach an agreement. Cronbach alpha test was used to assess construct validity with SPSS 20. RESULTS:  All of preparations conducted before the Delphi rounds showed that ACS patients had psychosomatic disorders during in ICCU, that required support. SP is very helpful to reduce the negative impact of this disorders.Off 50 informants answered a valid and reliable questionnaire which supports the above statement. The draft was made based on the above process. The development of SP for healthcare professionals of ACS managements was reached in a consensus of expert panelists in the second round of the Delphi with Cronbach alpha of 0.9. CONCLUSION: Supportive psychotherapy (SP) for healthcare professionals in the management of ACS in ICCU were developed and may be applied in clinical practice and research.

Psychometric properties of the Indonesian Ten-item Internet Gaming Disorder Test and a latent class analysis of gamer population among youths.

Internet gaming disorder (IGD) is a rising health concern. Indonesia has yet to have any validated instrument specifically designed to screen for this disorder. This study aims to validate the Indonesian version of the Ten-item Internet Gaming Disorder Test (IGDT-10) and conduct a latent class analysis of gamers among the youth. An online survey was conducted between October and December 2020 at two universities in Depok and Jakarta, Indonesia. In total, 1233 respondents (62.6% female and 20.3±1.90 years old) gave valid responses and played video games. Confirmatory factor analysis (CFA) confirmed the unidimensional structure of the scale. Cronbach's alpha was 0.72 and composite reliability was 0.92. The latent class analysis yielded three distinct classes of gamers. The continuation and negative consequences were highly distinctive for the group at high risk of IGD (class 3). Deception had the lowest endorsement rate (41.7%); while, the continuation domain had the highest endorsement, 91.2%. The IGD prevalence estimate was 1.90% among the respondents. Approximately 70.2% of the gamers did not show IGD symptoms. The adapted Indonesian IGDT-10 was demonstrated as valid and reliable among Indonesian youths. Consistent with previous studies, the deception domain had a low endorsement rate. The detected IGD rates were comparable to the global range. The majority of the current sample disclosed no symptoms; however, a considerable proportion would benefit from early preventive measures.

The Red and Orange Complex Subgingival Microbiome of Cognitive Impairment and Cognitively Normal Elderly with Periodontitis.

Increasing evidence has shown an association between periodontitis and cognitive impairment. Subgingival microbiota play a great role in periodontitis pathogenesis. However, the correlation between the subgingival microbiome and cognitive impairment remains unclear. This study aimed to evaluate the red and orange complex subgingival microbiome of cognitively impaired and cognitively normal elderly Indonesian subjects with periodontitis. Twenty-eight elderly subjects diagnosed with periodontitis underwent two cognitive examinations using the Hopkins Verbal Learning Test and the Mini-Mental State Examination. Gingival crevicular fluid taken from the periodontal pocket, at a depth between 5 and 7 mm, using a paper point was used as the subgingival samples. The subgingival microbiome in the cognitive impairment group (n = 14) and cognitively normal group (n = 14) was compared using the 16S rRNA Metagenomic iSeq™ 100 Sequencing System. There was ß-diversity in the subgingival microbiota between the cognitively impaired and cognitively normal subjects. The metagenomic analysis showed a higher abundance of Porphyromonas and Treponema bacteria in the cognitive impairment group than in the normal cognitive group (p < 0.05). The abundance of Porphyromonas gingivalis and Treponema denticola was higher in the cognitively impaired elderly subjects. The role of P. gingivalis and T. denticola in the pathogenesis of cognitive impairment needs further investigation.

The Effect of Cyberbullying, Abuse, and Screen Time on Non-suicidal Self-Injury Among Adolescents During the Pandemic: A Perspective From the Mediating Role of Stress.

Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a "crowdsourcing" sample collection method to recruit 464 adolescents aged 11-17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t-value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t-value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI (R 2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time.

The Role of Online Psychotherapy in COVID-19: An Evidence Based Clinical Review.

BACKGROUND: COVID-19 is an infectious disease that is easily widespread and has clinical manifestations as mild, moderate, or severe disease. COVID-19 patients are required to be isolated during treatment to reduce transmission. This can cause anxiety and depression, which in turn worsens the patient's illness. Providing supportive psychotherapy can help provide a feeling of safety, comfort and calm for patients. The choice of method in providing supportive psychotherapy can be done online/teleconsultation or internet-based. This clinical review aims to determine the effect of online teleconsultation or internet-based psychotherapy on COVID-19 patients. METHODS: A systematic search was performed using online databases, such as PubMed, Cochrane, EBSCO/CINAHL and ProQuest. The identified articles were screened using eligibility criteria. There were 2 studies (Zhou et al, and Wei et al) which were analyzed critically using the Newcastle Ottawa Scale. RESULTS: Both studies showed that management of psychotherapy through teleconsultation or internet-based on COVID-19 patients can help relieve the patient's psychological symptoms. Zhou et al studied 63 suspected COVID-19 with 23.8% (n = 15) having a Hospital Anxiety Depression Scale (HADS) score of 8 or more. There was a significant decrease in HADS-A nxiety (HADS-A) scores (p <0.01) and HADS-Depression (HADS-D) scores (p <0.01) in 15 patients, and from the overall HADS scores (p < 0.01). Wei et al. Showed 17-HAMD and HAMA scores in the online psychological intervention group also showed a significant reduction in symptoms of depression and anxiety compared to controls. CONCLUSION: Psychotherapy through online teleconsultation or internet-based on COVID-19 patients can help relieve symptoms of anxiety and depression and teleconsultation and also effective in dealing with psychological complications in patients with COVID-19.

Empathy Quotient and Systemizing Quotient in Elementary School Children with and without Attention-Deficit/Hyperactivity Disorder: A Comparative Study.

This study compares the Empathy Quotient (EQ) and Systemizing Quotient (SQ) scores of elementary school children with and without ADHD. The study also examined their brain types and, because sex plays a big role in empathy and systemizing ability, compared the results of the boys and girls. This cross-sectional study involved 122 participants, including 61 parents of children with ADHD and 61 parents of children without ADHD. The EQ, SQ and brain types were obtained using the Empathy and Systemizing Quotient in children (EQ-/SQ-C), validated in the Indonesian language. Data was analyzed using the SPSS program version 20 for Windows, with a p-value < 0.05 for statistical significance. There was a significant difference in EQ between children with and without ADHD, the score being lower in children with ADHD. There was also a significant difference in SQ among girls with and without ADHD, but not in boys. The brain types in both groups were not significantly different. The results indicate that children with ADHD have a lower ability to empathize compared to children without ADHD. Systemizing abilities were significantly lower in girls with ADHD than in girls without. Therefore, an intervention program focusing on improving empathy and systemizing ability needs to be developed in the community.

Developing and feasibility testing of the Indonesian computer-based game prototype for children with attention deficit/hyperactivity disorder.

The aim of this study was to develop an Indonesian computer-based game prototype, including feasibility testing, targeted on attention deficit/hypersensitivity disorder (ADHD) clinical symptoms and executive function. The study comprised five steps. The first to third steps used an exploratory qualitative research design. The Delphi technique with FGD was applied to collect qualitative data. During the study, seven experts participated in ten FGDs. Feasibility testing was conducted as a one group pre- and post-test design that included ten children with drug-naïve ADHD without other mental or physical disorders. Feasibility data were collected before and after 20 training sessions with the Indonesian computer-based game prototype. The framework analysis was performed for qualitative data. Quantitative data were analyzed using the paired t-test, Pearson's correlation and Spearman's rank-order correlation. Outputs of the exploratory qualitative study were the Indonesian computer-based game prototype constructs and general agreements of the prototype,. The Indonesian computer-based game prototype construct comprised six components: reward-related processing, control inhibition, improved sustained attention, specific timing, increased arousal, and improved emotional regulation. After 20 sessions of training, several indicators decreased significantly, such as CATPRS-teacher rating (18.5 [5.31] vs. 12.9 [5.51], p = 0.047), BRIEF-GEC (64.80 [10.21] vs. 57.50 [7.51], p = 0.02), BRIEF-MI (66.1 [7.61] vs. 58.4 [7.56], p = 0.014), BRIEF-Initiate (66.6 [10.15] vs. 54.1 [6.49], p = 0.008), BRIEF-Working Memory (68.0 [6.89] vs. 60.9 [10.05], p = 0.02), and BRIEF-Organization of Material (60.7 [12.88] vs. 49.3 [11.79], p = 0.04). There was a low to moderate correlation between CATPRS-teacher and -parent rating and several BRIEF domains. Feasibility testing output also included the training procedure guideline. The present study indicated that the Indonesian computer-based game prototype could be used as a framework to develop a fixed computer-based game intervention for children with ADHD. However, further randomized controlled studies need to be conducted to show its effectiveness.

Anxiety and Its Associated Factors During the Initial Phase of the COVID-19 Pandemic in Indonesia.

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus which has not been identified previously in humans. The disease leads to respiratory problems, systemic disorders, and death. To stop the virus transmission, physical distancing was strongly implemented, including working and school from home (WFH & SFH). The limitation altered daily routines and needs advanced to adapt. Many have felt uncomfortable and this could have triggered anxiety symptoms. This study aimed to evaluate the proportion of significant anxiety symptoms and its association with COVID-19-related situations in an Indonesian context during the initial months of the pandemic. Methods: An online community survey was distributed through social media and communication platforms, mainly WhatsApp, targeting people >18 years old in Indonesia. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (Indonesian Version). Demographical data and information on social situation related to the COVID-19 pandemic were collected. The proportion of clinically significant anxiety symptoms was calculated and the association with demographic and social factors was assessed using chi square test (χ2) and logistic regression for multivariate analysis. Results: Out of 1215 subjects that completed the survey, 20.2% (n = 245) exhibited significant anxiety symptoms. Several factors, such as age (AOR = 0.933 CI 95% = 0.907-0.96), sex (AOR = 1.612 CI 95% = 1.097-2.369), medical workers (AOR = 0.209 CI 95% = 0.061-0.721), suspected case of COVID-19 (AOR = 1.786 CI 95% = 1.001-3.186), satisfaction level of family support (AOR = 3.052 CI 95% = 1.883-4.946), and satisfaction level of co-workers (AOR = 2.523 CI 95% = 1.395-4.562), were associated with anxiety. Conclusion: One out of five Indonesian people could have suffered from anxiety during the COVID-19 pandemic. The riskiest group being young females, people who had suspected cases of COVID-19, and those with less satisfying social support. Nevertheless, health workers were found to have a lesser risk of developing anxiety. Accessible information and healthcare, social connection, supportive environment, and mental health surveillance are important to prevent bigger psychiatric problems post-pandemic.

Mental Health Problems and Needs among Transitional-Age Youth in Indonesia.

"Transitional-age youth" describes those whose ages range from 16-24 years old. In this phase, the youth face new challenges and new experiences which may increase the risk for having mental health problems, yet not very many seek help from mental health professionals. In Indonesia, no data are available about mental health problems and the needs of transitional-age youth. This study explores common mental health problems experienced during this stage and assesses how they cope with problems and their expectations from health services. This was a cross-sectional study involving 393 Indonesians aged 16-24 years in May 2020. More than 90% of students had financial and academic difficulties and felt lonely. The most prevalent mental health problem among students was anxiety (95.4%). Most of the students, ranging from 90% to 96.4%, had positive coping strategies. However, around 50% of respondents reported self-harming and having suicidal thoughts. The results of subcategories analysis between ages and faculties were similar. Their most important expectations from mental health services included confidentiality (99.2%) and being welcoming and friendly (99.2%). In conclusion, this study highlighted the most common problems transitional-age youth experience in Indonesia. While some of them already knew how to deal with their problems, not all the participants had good coping mechanisms. Their healthcare expectations were also explored, thereby providing a useful background to revise and amend the current conditions.

Brief Research Report on Adolescent Mental Well-Being and School Closures During the COVID-19 Pandemic in Indonesia.

The COVID-19 pandemic does not affected only physical but also mental health and socioeconomic part. The social distancing, social quarantine, school from home, and work from becomes a new normal these days. Being adolescence, the above conditions may be challenging due to their developmental milestones. Therefore, this brief report aimed to preliminary identify proportion of adolescents' emotional and behavior problems and several factors related to it during COVID-19 pandemic in Indonesia. The findings might raise some understanding of youth mental well-being and programs that can be applied in schools and community in general to overcome the issues. The study was designed as cross sectional and used online survey that started on April 2020. During April 15-May 10, 2020, there were 113 adolescents participated on this survey. Strength and Difficulties Questionnaire (SDQ) 11-17 years old was used to assess adolescent emotional and behavior problems; and specific life experience questionnaire was designed to collect other independents variables (Cronbach's α = 0.75). All participants fulfilled the online informed consent before they started to complete the questionnaire. All data was analyzed by using SPSS version 20 for Mac. The average age of research subjects were 14.07 (2.18) years old; 98.2% was school from home. There was 14.2% of the total research subject at risk on total difficulties problems; 38.1% of adolescent was at risk on peer-relationship problems, 28.3% at risk on pro-social behavior problems, 15% at risk on conduct behavior and 10.6% at risk on emotional problems. The number of adolescent that perceived worse to significantly worse self-mental well-being prior COVID-19 increased during COVID-19 pandemic in Indonesia (p < 0.05). There was significantly association between having mental health information and conduct behavior (OR = 10.34, 95%CI = 1.27-78.86); Subjective anxiety due to COVID-19 pandemic and pro-social behavior problems (OR = 2.37, 95% CI = 1.00-5.63), parental support and total difficulties (OR = 0.09, 95% CI = 0.14-0.60) and pro-social behavior problems (OR = 0.09, 95% CI = 0.01-0.82); friends support during COVID-19 pandemic and conduct behavior (OR = 0.20, 95% CI = 0.04-1.00) and pro-social behavior problems (OR = 0.14, 95% CI = 0.02-0.75). To be concluded, during phase 1 and 2 COVID-19 pandemic and school closures in Indonesia, adolescents were at risk for having emotional and behavior problems. Therefore, maintain clear mental health information, keep them on connection with school by designing an optimal tele-education, tele-consultation, and virtual activity programs to accommodate adolescents' biopsychosocial needs in the near future.

The fight against stigma: Multilevel stigma interventions in schizophrenia patients.

Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts. Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months. Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%. Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung.

A Four-Step Method for the Development of an ADHD-VR Digital Game Diagnostic Tool Prototype for Children Using a DL Model.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children resulting in disturbances in their daily functioning. Virtual reality (VR) and machine learning technologies, such as deep learning (DL) application, are promising diagnostic tools for ADHD in the near future because VR provides stimuli to replace real stimuli and recreate experiences with high realism. It also creates a playful virtual environment and reduces stress in children. The DL model is a subset of machine learning that can transform input and output data into diagnostic values using convolutional neural network systems. By using a sensitive and specific ADHD-VR diagnostic tool prototype for children with DL model, ADHD can be diagnosed more easily and accurately, especially in places with few mental health resources or where tele-consultation is possible. To date, several virtual reality-continuous performance test (VR-CPT) diagnostic tools have been developed for ADHD; however, they do not include a machine learning or deep learning application. A diagnostic tool development study needs a trustworthy and applicable study design and conduct to ensure the completeness and transparency of the report of the accuracy of the diagnostic tool. The proposed four-step method is a mixed-method research design that combines qualitative and quantitative approaches to reduce bias and collect essential information to ensure the trustworthiness and relevance of the study findings. Therefore, this study aimed to present a brief review of a ADHD-VR digital game diagnostic tool prototype with a DL model for children and the proposed four-step method for its development.

Validation study of Indonesian mother-infant bonding scale.

Mother-infant bonding scale (MIBS) is a questionnaire that can be used to elaborate the quality dyad between mother and infant; however it is not validated in Indonesian language optimally. This study aimed to identify the validity and reliability of the MIBS-Indonesian (MIBS-I) version based on Japanese MIBS (MIBS-J) that could be used in general population and hospital setting. Design of the study was cross sectional and involving 150 mother-infant dyads recruited from Growth and Developmental Clinic dr. Cipto Mangunkusumo General Hospital-Jakarta and Beji Volunteer-Staffed Integrated Health Service (Posyandu)-Depok/West Java. Infant was categorized as children from 0-36 months old. Mother with at least junior high-school background fulfilled MIBS-Indonesian version and also demographic data. SPSS version 21 for Mac and Lisrel 8.8 program for Windows was applied to analyze the data. Results of the study demonstrated that the content validity was good with I-CVI=0.9875 and S-CVI=0.99; and EFA results of 3 components total variance was 57.90% and CFA results showed three factors structure out of eight items and it fullfiled an adequate goodness of fit with each factor CR >0.7; factor 1:'desire to love and denial', factor 2: 'hate and being closed', and factor 3: 'rejection feeling'. Cronbach's alpha for the eight items of MIBS-I was 0.535. To be concluded, MIBS-I was a multidimentional scale with three-factor model and it was confirmed valid and reliable to be implemented in Indonesian children from 0-36 months old.