Evaluating the Change Process of a Brief Cognitive Behavior Therapy Workshop for Psychological Distress Among Primary Care Self-Referrals in Selangor, Malaysia.

Despite the high prevalence of psychological distress in primary care, only a limited number of individuals can benefit from early and evidenced-based psychological approach. Barriers to help-seeking attributable to stigma, lack of proper care pathway to evidence-based psychological interventions, and a high volume of primary care attendees are among the factors that contribute to the inadequate psychological treatments. This study examined the implementation of a change process using a brief cognitive behavioral therapy (b-CBT) workshop as a potential approach in managing psychological distress among 73 primary care self-referrals using purposive sampling. One-way repeated-measures multivariate analysis of variance (ANOVA) was used to analyze changes in psychological distress within a non-randomized quasi-experimental study. Results revealed significant differences in psychological distress using Depression, Anxiety, and Stress Scale-21 items at three time points (pre-intervention, post-intervention, and 1-month follow-up). Implementation of the b-CBT workshop showed positive changes for psychological distress, suggesting the possibility of integrating brief, non-stigmatized, and evidence-based psychological approach at the primary care level. However, the self-referral characteristics of the attendees remain unknown. Factors such as potential feasibility, participant's usability and satisfaction, and implementation of b-CBT workshop to improve psychological distress are discussed in this study.

Association between perceived parental style and depressive symptoms among adolescents in Hulu Langat District, Malaysia.

Depression among adolescents is increasing and worrying because of its morbidity and mortality from suicide. It has been found to be associated with negative parental styles. The objective of this study was to determine the relationship between perceived negative parental styles and depressive symptoms among adolescents in Hulu Langat District, Selangor, Malaysia. A cross-sectional study was carried out on 1769 secondary school students by using a multistage cluster sampling method. Data were collected by using a set of validated, pre-tested and standardized questionnaires which included the Measures of Parental styles (MOPS) and modified Depression, Anxiety and Stress Scale 12 (DASS-12) for adolescents. Data were analyzed by using the chi-square test, Pearson's correlation coefficient and independent t-tests. Out of 1800, 1769 completed the questionnaire giving a response rate of 98.3%. The prevalence of severe depressive symptoms was about 14% while 18.0% and 36.1% of respondents have moderate and mild depressive symptoms, respectively. There were significantly moderate and positive correlations between perceived indifferent parents (Father: r = 0.367; Mother: r = 0.340, p < 0.05), perceived abusive parents (Father: r = 0.338; Mother: r = 0.331, p < 0.05) and depressive symptoms among the respondents. While perceived over control parents shows a significantly positive but weak correlation (Father: r = 0.206; Mother: r = 0.244, p < 0.05) with depressive symptoms among respondents. All types of parental styles in this study were significantly different among respondents with different categories of depressive symptoms (p < 0.008). Perceived negative parental styles have significant influence on adolescents' depressive symptoms. Intervention on modifying parental style is needed to reduce depressive symptoms.

Fears related to pregnancy and childbirth among primigravidae who requested caesarean versus vaginal delivery in Iran.

Pregnancy- and childbirth-related fears are common psychological concerns and the primary reasons for requesting caesarean section (CS). We aimed to examine the content of maternal fear and the associated demographic factors in a sample of Iranian primigravidae. A randomly selected sample of primigravidae (n = 342) was recruited in four health care centres in Iran. Data were collected using a 30-item questionnaire. Principal components factor analysis was applied to identify the main factors of pregnancy- and childbirth-related fears. All primigravidae reported some degree of fear, 48.2 % presented severe fear, and 62.6 % requested a CS because of childbirth-related fear. Most of the employed primigravidae with higher education level, higher family income, and unplanned pregnancy requested CS. The items constructed to measure maternal fear were subjected to exploratory factor analysis. Six categories were identified, including 'process of labour and childbirth', 'life and well-being of the baby', 'competence and behaviour of maternity ward personnel', 'own capabilities and reactions', 'becoming a parent and family life after delivery' and 'general fear in pregnancy' that cumulatively explained 55.3 % of the variance. The most common factor was 'life and well-being of the baby'. Severe fear was found in 70.6 % of those who chose CS, while 10.9 % of those who chose vaginal delivery reported severe fear. The between-group differences for mean scores and levels of fear were statistically significant. Pregnancy- and childbirth-related fears were frequently experienced by all low-risk primigravidae. Better strategies to address women's psychological needs during pregnancy are necessary.

Mechanisms of hypnosis: toward the development of a biopsychosocial model.

Evidence supports the efficacy of hypnotic treatments, but there remain many unresolved questions regarding how hypnosis produces its beneficial effects. Most theoretical models focus more or less on biological, psychological, and social factors. This scoping review summarizes the empirical findings regarding the associations between specific factors in each of these domains and response to hypnosis. The findings indicate that (a) no single factor appears primary, (b) different factors may contribute more or less to outcomes in different subsets of individuals or for different conditions, and (c) comprehensive models of hypnosis that incorporate factors from all 3 domains may ultimately prove to be more useful than more restrictive models that focus on just 1 or a very few factors.

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.

Religious commitment, attitudes toward suicide, and suicidal behaviors among college students of different ethnic and religious groups in Malaysia.

The variation in suicide patterns across ethnic groups with different religious background is a puzzling social phenomenon. This study sought to examine the impact of religious commitment and attitudes toward suicide on suicidal behaviors of college students across major ethnic and religious groups in a multicultural society of Malaysia. A total of 139 college students completed Religious Commitment Inventory-10, Attitudes Toward Suicide Scale, and Suicidal Behavior Questionnaire-Revised. Findings showed significant discrepancies in attitudes toward suicide, but not suicidal behaviors across ethnic and religious groups. Suicide acceptance significantly affected suicidal behaviors as well. Although religious commitment is not associated with suicidal behaviors, its deviation is reflected in students' acceptance of suicide. Additionally, college students' suicide risk, lifetime, and recent suicide ideation, as well as their likelihood of future suicide attempt can be associated with their acceptance of suicide. The influence of attitudes toward suicide and religion, therefore, should be taken into consideration while implementing suicide prevention programs as it helps shape the norms about suicide among youths.

Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up.

Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive-behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.