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  1. Chhoa KH, Zakaria H, Abd Rahman FN
    Pediatr Int, 2019 Mar;61(3):284-292.
    PMID: 30636372 DOI: 10.1111/ped.13789
    BACKGROUND: Alcohol consumption in the under-aged is one of the main concerns regarding Malaysian adolescents. There is no previous study on problematic alcohol use (PAU) in adolescents in Sarawak. The aim of this study was to determine the prevalence of PAU, its associated variables and its relationship with depression.

    METHODS: This was a cross-sectional study. A total of 327 secondary school students completed the Alcohol Use Disorder Identification Test and Children's Depression Inventory, and a sociodemographic questionnaire. Binary and multivariable logistic regression were used to examine the relationship between the different variables.

    RESULTS: A total of 42.2% of adolescents had PAU. Urban adolescents had a higher prevalence compared with rural adolescents (OR, 1.612; 95% CI: 1.036-2.508 P = 0.034). Female adolescents (56.8%) and Bumiputera Sarawak adolescents (76.8%) comprised a large proportion of the respondents with PAU. Cultural norm (78.3%) and curiosity (68.1%) were the two main reasons for PAU. Only family history of alcohol use (OR, 2.273; 95% CI: 1.013-5.107; P = 0.047), ever consumed alcohol (OR, 57.585; 95% CI: 21.885-151.525; P 

  2. Chua SY, Abd Rahman FN, Ratnasingam S
    Front Psychiatry, 2023;14:1244164.
    PMID: 37965356 DOI: 10.3389/fpsyt.2023.1244164
    OBJECTIVE: Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD.

    METHOD: A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview.

    RESULTS: Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications (p = 0.013), registered with the Social Welfare Department (p = 0.036), and having siblings with ASD (p = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability (r = 0.458, p 

  3. Abd Rahman FN, Lee VY, Shamsuddin AF, Yaakup H
    Pediatr Int, 2015 Oct;57(5):1015-6.
    PMID: 26286660 DOI: 10.1111/ped.12693
    We report the challenges in managing a troubled, medically ill adolescent with end-of-life issues. Our role as multi-professional service providers complemented the family's efforts to help him reconcile with himself before death. The present experience enhances understanding of the biopsychosocial aspects of care. Every child has the right to optimal care.
  4. Abd Rahman FN, Wong YY, Khalib AQ
    Front Psychiatry, 2021;12:772744.
    PMID: 35046852 DOI: 10.3389/fpsyt.2021.772744
    Postnatal depression is a major illness affecting maternal and family health. The rate of postnatal depression among mental health clients is postulated to be higher than in the community due to the added brain assault. Children of parents who are mental health clients are more likely to have psychological problems compared to children from other parents in the community. This study investigates the rate of postnatal depression among mental health clients and their offspring's psychological health. A total of 140 mental health clients were assessed using the Edinburgh Postnatal Depression Scale (EPDS). They subsequently completed the Strength and Difficulties Questionnaire (SDQ) regarding their children. The majority ethnicity was the Kadazan (40.7%). The mean age of mothers was 38.6 (7) years with most having a secondary education (53.6%) and a household income per month of < RM1000 per month (27.1%). The postnatal depression rate was 47.8%. Higher EPDS scores were associated with higher total SDQ scores in their offspring. Model 1 was unadjusted, giving an OR of 5.65 [95% CI (3.74, 7.55)], p < 0.001. After adjustment for confounders, Model 2 had an OR of 5.51 [95% CI (3.57, 7.46)], p < 0.001. More efforts need to be given to the early detection of maternal depression and its prompt treatment in mental health clients because of the relationship with the psychological health of the offspring.
  5. Ang AL, Wahab S, Abd Rahman FN, Hazmi H, Md Yusoff R
    Pediatr Int, 2019 Apr;61(4):404-410.
    PMID: 30597707 DOI: 10.1111/ped.13778
    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.

  6. Goh BS, Tang CL, Hashim ND, Annamalay T, Abd Rahman FN
    PMID: 30578988 DOI: 10.1016/j.ijporl.2018.12.010
    OBJECTIVE: There is a dearth of studies on long term hearing status and behavioural patterns among cleft lip and/or palate children after their primary lip and palate closure in Malaysia. This study describes the audiology status and behavioural patterns in a group of school aged children with cleft lip and/or palate.

    METHOD: A cross sectional study was carried out where caretakers of cleft lip and/or palate were asked to complete the translated Malay language version of Strength Difficulties Questionnaire. The hearing status of the children was analyzed based on recent pure tone audiometric and tympanogram results. The patients' age, gender, type of cleft pathology, age of palatal surgery and behavioural patterns were examined for their potential relationship with hearing status.

    RESULTS: A total of 74 children (148 ears) aged between 7 and 17 years with cleft lip and/or palate were recruited. The result showed 37 ears (25.0%) had hearing loss with majority suffered from mild conductive hearing loss. There were 16 ears (10.8%) that had persistent middle ear effusion. Hearing improvement occurred when palatal repair was performed at the age of less than 1 year old. (p = 0.015) There was no significant relationship between patients' gender, age, type of cleft and history of myringotomy with their hearing status. In terms of behavioural patterns, 16.3% were abnormal for total behavioural score, 39.2% for peer problem and 17.6% for conduct problem. For prosocial behaviour, 16.3% were rated low and very low. There was fair correlation between age and hyperactivity problems (r = 0.44). Patients' gender, type of cleft pathology, had been teased apart and hearing status was found not related to behavioural problems.

    CONCLUSION: Cleft lip and/or palate patients have a good longterm hearing outcome. Majority had normal hearing and if there is hearing impairment, it is only a mild loss. Early palatal repair surgery before the age of 1 year can significantly reduce the risk of hearing loss. Cleft lip and/or palate patients experienced peer problems. There was no significant correlation between behavioural difficulty and hearing status among school-aged children with cleft lip and palate.

  7. Wahab S, Baharom MA, Abd Rahman FN, A Wahab K, Zulkifly MA, Azmi AD, et al.
    Addict Behav Rep, 2021 Dec;14:100359.
    PMID: 34136633 DOI: 10.1016/j.abrep.2021.100359
    INTRODUCTION: Adolescent substance use is a multifactorial social issue that leads to detrimental outcomes. The aim of this study is to understand the association of a lifetime history of substance abuse or dependence with family functioning, childhood victimisation, and depression, among adolescent male inmates in a juvenile detention centre in Malaysia.

    METHODS: This study was cross-sectional involving 230 inmates and was conducted in a juvenile detention centre in Malaysia. The mean age of the participants was 16.65 years, with the highest percentage from the Malay ethnicity (87.8% where n = 202). The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), Adolescent Alcohol and Drug Involvement Scale (AADIS), Family Adaptability and Cohesion Evaluation Scale (FACES) IV and Juvenile Victimization Questionnaire Second Revision (JVQ-R2) were used as instruments.

    RESULTS: The prevalence of a lifetime history of substance abuse and substance dependence is 72.6% and 58.3%, respectively. A lifetime history of substance abuse and dependence had a significant association with age, race, religion, and peer/sibling victimisation. Further analysis reveals that an increase in age can be a predictor of both lifetime history of substance abuse and dependence while peer/sibling victimisation may predict lifetime history of substance abuse. There was no significant association of lifetime substance-use disorder with family functioning and depression in the juvenile offenders.

    CONCLUSIONS: Adolescents exposed to peer/sibling victimisation might be at a higher risk of developing a substance-use disorder. At-risk groups need to be identified, assessed, and have intervention early to prevent adverse outcomes.

  8. Abd Rahman FN, Mohd Daud TI, Nik Jaafar NR, Shah SA, Tan SM, Wan Ismail WS
    Pediatr Int, 2013 Aug;55(4):422-7.
    PMID: 23617604 DOI: 10.1111/ped.12115
    There is a dearth of studies on behavioral and emotional problems in residential care children in Malaysia. This study describes the behavioral and emotional problems in a sample of children in a government residential care home and compares them with their classmates living with their birth parents.
  9. Cham CQ, Ibrahim N, Siau CS, Kalaman CR, Ho MC, Yahya AN, et al.
    Healthcare (Basel), 2022 Nov 30;10(12).
    PMID: 36553947 DOI: 10.3390/healthcare10122423
    Due to the increasing importance of caregivers in the treatment outcomes of patients with mental illness, this study aimed to systematically review studies investigating the former's caregiver burden and determine its prevalence. An open search, without filters, was conducted. Articles were selected from Medline, Scopus, and PubMed from inception to 30 April 2022 using the PRISMA protocol. Subgroup analyses examined the between-group differences by study setting, measurements used, and disorder type. A total of 5034 caregivers from 23 countries were included in this review. Thirty-nine studies were included in the systematic review, and, among them, twenty-six were deemed eligible for meta-analysis. The overall pooled prevalence of caregiver burden among caregivers of individuals with mental illness was 31.67% (95% CI = 26.22-37.12). Pooled prevalence was the highest among care recipients receiving treatment in a hospital setting (36.06%; 95% CI = 22.50-49.63), followed by the community and clinic settings. Caregiver prevalence values were higher for burden measured using the Zarit Burden Interview (38.05%; 95% CI = 27.68-48.43). compared with other instruments, and for carers of care recipients with psychosis (35.88%; 95% CI = 27.03-44.72) compared with those without. Thus, targeted interventions should focus on caregivers of patients in hospital settings and with psychotic symptoms.
  10. Cham CQ, Ibrahim N, Kalaman CR, Ho MC, Visvalingam U, Ahmad Shahabuddin F, et al.
    PMID: 38390253 DOI: 10.1017/gmh.2024.5
    Depression and anxiety are prevalent mental health issues worldwide, especially among parental caregivers. By expanding the family stress model, this cross-sectional study investigated the relevant factors associated with depressive symptoms, anxiety symptoms, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients. Data were collected through questionnaires (N = 207) across five major public hospitals through convenience sampling. Participants answered questionnaires measuring financial strain, caregiver burden, relationship quality, belief in mental illness, perceived COVID-19 stress, satisfaction with health services, depressive symptoms, anxiety symptoms and life satisfaction. Findings revealed that relationship quality among spouses, COVID-19 stress and caregiver burden were significantly correlated with anxiety symptoms, depressive symptoms and satisfaction with life. The multiple regression model also suggested that depressive symptoms (β = .613, p < .001), anxiety symptoms (β= .657, p < .001) and relationship quality among spouses (β = .264, p < .001) were the most influential predictors of anxiety symptoms, depressive symptoms and satisfaction with life respectively. By addressing the mental health needs of parental caregivers, this study can contribute to improving the overall quality of care and support provided to adolescent patients and their caregivers in Malaysia and beyond.
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