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 aimsThe 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 Malaysias multi-ethnic urban lower-income communities. MethodsThis 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 monthly household income [≤]RM6960 (estimated USD 1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life. Multivariable logistic regression was performed for the final analysis. ResultsA 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. Not 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. ConclusionsA higher proportion had reported mild to severe anxiety and depression symptoms in the sampled urban poor population than previous pre-pandemic reports. The psychosocial determinants should inform policy and direct future research within this underserved population.

Effects Of A School-Based Substance Use Prevention Program On Students In Malaysia

Background: The rise in substance-use-related problems among Malaysian adolescents called for a study to assess the efficacy of an anti-drug educational program to improve the knowledge, attitudeand perception (KAP) of Malaysian students regarding substance use. Methods: This study involved 573 students from four Malaysian Chinese schools in Malacca. Each student filled out a Likert-scale mandarin translated questionnaire (KAP-C) on substance use ( Pre-test). Following an educational program on substance use, the KAP-C questionnaire was given again to the students, immediately following the program (PT 1), and after a month (PT 2) and two months (PT3) of the programme. Results: The students showed improvement in knowledge of the types of substance use in PT 1 (p<0.001), PT 2 (p<0.001) and PT 3 (p<0.001). The study also showed persistent changes in their attitude towards drug treatment strategies at two months following the program (p < 0.05). Changes were also noted in their attitudestowards harm reduction strategies. Perceptions towards the substance-related problems changed following the module (p=0.001), and remained even after two months (p<0.001). Conclusion: This module effectively changed the KAP of students on substance use.

Metabolic syndrome and cardiovascular risk among patients with schizophrenia receiving antipsychotics in Malaysia

<p><b>INTRODUCTION</b>This study aimed to determine the prevalence of metabolic syndrome and risk of coronary heart disease (CHD) in patients with schizophrenia receiving antipsychotics in Malaysia.</p><p><b>METHODS</b>This cross-sectional study, conducted at multiple centres, involved 270 patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR diagnostic criteria for schizophrenia, were on antipsychotic medications for at least one year, and were screened for metabolic syndrome. Patients receiving mood stabilisers were excluded. Metabolic syndrome was defined according to the National Cholesterol Education Program ATP III criteria modified for Asian waist circumference. Risk for cardiovascular disease was assessed by using Framingham function (all ten-year CHD events).</p><p><b>RESULTS</b>The prevalence of metabolic syndrome was 46.7% (126/270). Among all the antipsychotics used, atypical antipsychotics (monotherapy) were most commonly used in both the metabolic and non-metabolic syndrome groups (50.8% vs. 58.3%). The ten-year risk for CHD was significantly higher in patients with metabolic syndrome. The proportion of patients with high/very high risk for CHD (Framingham ≥ 10%) was greater in patients with metabolic syndrome than in those with non-metabolic syndrome (31.5% vs. 11.0%, odds ratio 3.9, 95% confidence interval 2.0-7.6; p < 0.001). The mean body mass index was higher in patients with metabolic syndrome than in those without (29.4 ± 5.1 kg/m2 vs. 25.0 ± 5.6 kg/m2; p < 0.001).</p><p><b>CONCLUSION</b>Patients with schizophrenia receiving antipsychotics in Malaysia have a very high incidence of metabolic syndrome and increased cardiovascular risk. Urgent interventions are needed to combat these problems in patients.</p>

Schizophrenia, substance use and aggressions: What are the relationships?

Objectives: The objective of the study is to determine the prevalence of substance abuse for alcohol, cannabis, opiates, stimulants, solvent and other substances among patients with schizophrenia in Hospital Bahagia Ulu Kinta (HBUK), Perak , Central Peninsular of Malaysia. This study also aims to determine the association of substance abuse with aggression, the demographic characteristics and total duration of hospitalization. Methods: This was a retrospective cross-sectional study whereby the first 194 subjects diagnosed to have schizophrenia based on International Classification of Disease, 10th edition (ICD-10) criteria were taken from data registry of patients admitted to HBUK from January until February 2004. The subjects’ medical files were examined for documentation of substances abuse, aggression and accumulative duration of hospitalization. Results: The results showed the prevalence of substances misuse among patients with schizophrenia in general (including alcohol) was 24.7%. Cannabis 16.7%, alcohol 13.4%, opiates(heroin) 6.7%, Amphetamine type stimulants (amphetamine, metamphetamine, ecstacy) 5.7%, and other substances (benzodiazepine, solvents) 1.5%. Conclusion: There is higher prevalence of substance misuse in patients with schizophrenia as compared to general population. Male patients with history of substance misuse are more likely to have aggression than female. This group needs special precaution and probably in need of specialist help.