Displaying publications 1 - 20 of 31 in total

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  1. Abd Hadi NH, Midin M, Tong SF, Chan LF, Mohd Salleh Sahimi H, Ahmad Badayai AR, et al.
    Front Public Health, 2023;11:992863.
    PMID: 37033063 DOI: 10.3389/fpubh.2023.992863
    INTRODUCTION: Global implementation of social and emotional learning (SEL) has been suggested to incorporate a systematic cultural adaptation process which relies on ground-up empirical data of a target cultural group in tailoring a culturally sensitive SEL intervention. Preliminary formative studies among local parents and educators were done to explore the conceptualization of social and emotional competencies (SECs) in various cultural settings, such as the continent of Africa and among the indigenous and refugee groups. Unfortunately, little scholarship has been devoted to studying the SEL adaptation process in Southeast Asian regions. This formative study aimed to explore Malaysian parents' and teachers' cultural conceptualization of adolescent SECs.

    METHODS: This qualitative study interviewed 12 Malaysian parents and 10 Malaysian teachers comprising of Malay (82%), Chinese (9%) and Indian (9%) races in an online focus group discussion. Sampling is purposive to parents of adolescents and teachers at secondary school only. Data were analyzed thematically to determine the culturally sensitive SEL constructs for Malaysian adolescents.

    RESULTS: All themes and sub-themes of SEC regarded as crucial for Malaysian adolescents are aligned with CASEL's five domains of competencies. Our findings extended the conceptualization of subskills under CASEL's relationship skills and responsible decision-making domains, which reflect Asian cultural values. The main themes of social competency: (a) preserving interpersonal relationships, (b) utilizing intrapersonal skills, and (c) communicating effectively, are shared with the established CASEL constructs. However, the underlying subthemes denote the unique cultural manifestation of social competency in Malaysia. Two of the emotional competency themes represent the established CASEL constructs: (a) practicing self-regulation, (b) demonstrating help-seeking behavior, and the other two themes signify Asian values: (c) upholding altruism, and (d) maintaining cultural display rules.

    DISCUSSIONS: This formative study revealed the habitual use of experiential and expressive suppressions as adaptive emotion regulation strategies in Malaysian collectivist culture and offered a potential alternative emotion regulation pathway suitable for Malaysian adolescents. It also informed the feasibility of implementing SEL modules developed based on the CASEL framework in Malaysia and suggested two key lessons to enhance the cultural sensitivity of SEL in Malaysia: effective, respectful communication and expressive writing.

  2. Ali IM, Chan LF, Daud TIM, Othman AR, Ng YP, Pheh KS, et al.
    PMID: 37854427 DOI: 10.1017/gmh.2023.32
    Given the high prevalence rate of suicidal ideation amongst medical students, medical lecturers and specialists as gatekeepers should be well-trained in suicide prevention. There is a need for validated measures to assess gatekeeper training gains for suicide prevention. The psychometric properties of the Advanced C.A.R.E. Suicide Prevention Gatekeeper Training Questionnaire (AdCARE-Q) were evaluated for a sample of medical lecturers and specialists in Malaysia. A total of 120 participants completed 24 items in the AdCARE-Q. Analysis of variance of perceived knowledge scores was performed. Exploratory factor analysis (EFA) was conducted. Reliability was calculated. The AdCARE-Q was reduced to 15 items that fit into two factors, "self-efficacy" and "declarative knowledge." Overall internal consistency was good with Cronbach's alpha = 0.84. The intraclass correlation coefficient between groups from the psychiatry department and non-psychiatry departments was good at 0.80. The oldest age group and participants from the Psychiatry department scored significantly higher than other groups in perceived knowledge of suicide prevention. This study found that the AdCARE-Q has adequate psychometric properties to assess suicide prevention gatekeeper training gains amongst medical lecturers and specialists. Confirmatory factor analysis is recommended for future studies.
  3. Ashcroft R, Seko Y, Chan LF, Dere J, Kim J, McKenzie K
    Int J Public Health, 2015 Nov;60(7):827-37.
    PMID: 26298442 DOI: 10.1007/s00038-015-0713-8
    OBJECTIVES: We conducted a scoping review to identify and summarize the current state of knowledge regarding the mental health effects associated with bed bugs.

    METHODS: We employed a five-stage scoping review framework, to systematically identify and review eligible articles. Eligibility criteria included a focus on bed bug infestations and reference to mental health impacts. Descriptive information was then extracted from each article, including the specific mental health effects cited.

    RESULTS: An initial search yielded 920 unique articles on the topic of bed bugs. Of these, 261 underwent abstract review, and 167 underwent full-text review. Full-text review and subsequent review of reference lists yielded a final sample of 51 articles. Numerous mental health effects were linked to bed bug infestations, including severe psychiatric symptoms. However, the majority (n = 31) of the articles were commentary papers; only five original research articles were identified.

    CONCLUSIONS: Although significant mental health effects are often linked to bed bugs, such discussions remain largely anecdotal. Despite recognition that the impact of bed bugs constitutes an important public health concern, little empirical evidence currently exists on this topic.

  4. Buji RI, Abdul Murad NA, Chan LF, Maniam T, Mohd Shahrir MS, Rozita M, et al.
    Lupus, 2018 Apr;27(5):744-752.
    PMID: 29161964 DOI: 10.1177/0961203317742711
    Background Systemic lupus erythematosus (SLE) patients are a high-risk population for suicide. Glutamatergic neurosystem genes have been implicated in the neurobiology of depression in SLE and suicidal behaviour in general. However, the role of glutamate receptor gene polymorphisms in suicidal behaviour among SLE patients remains unclear in the context of established clinical and psychosocial factors. We aimed to investigate the association of NR2A gene polymorphism with suicidal ideation in SLE while accounting for the interaction between clinical and psychosocial factors. Methods A total of 130 SLE patients were assessed for mood disorders (MINI International Neuropsychiatric Interview), severity of depression (Patient Health Questionnaire-9), suicidal behaviour (Columbia-Suicide Severity Rating Scale), socio-occupational functioning (Work and Social Adjustment Scale), recent life events (Social Readjustment Rating Scale) and lupus disease activity (SELENA-SLE Disease Activity Index). Eighty-six out of the 130 study participants consented for NR2A genotyping. Results Multivariable logistic regression showed nominal significance for the interaction effect between the NR2A rs2072450 AC genotype and higher severity of socio-occupational impairment with lifetime suicidal ideation in SLE patients ( p = 0.038, odds ratio = 1.364, 95% confidence interval = 1.018-1.827). However, only the association between lifetime mood disorder and lifetime suicidal ideation remained significant after Bonferroni correction ( p 
  5. Chai YC, Mahadevan R, Ng CG, Chan LF, Md Dai F
    Int J Soc Psychiatry, 2018 09;64(6):578-588.
    PMID: 30074421 DOI: 10.1177/0020764018792585
    BACKGROUND: Depression has been well studied as part of caregiver burden among patients with severe mental illnesses. Curiously, though, there has been little data in terms of caregiver burden with specific focus on depression among caregivers of patients with major depressive disorder (MDD).

    AIM: This study aims to determine the rate of depression among caregivers of person with depression and its psychosocial correlates, which include stigma, perceived social support, religious commitment and the severity of the patient's symptoms.

    METHODS: A cross-sectional study was conducted among 165 patients diagnosed with MDD using the Mini-International Neuropsychiatric Interview (M.I.N.I.) together with their caregivers. Apart from gathering social demographic data, patients were administered the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated Version (QIDS-SR 16), whereas the caregivers were required to answer Patient Health Questionnaire-9 (PHQ-9), Multidimensional Scale of Perceived Social Support (MSPSS), Duke University Religion Index (DUREL) and Depression Stigma Scale (DSS). Those who scored ⩾5 on PHQ-9 were further assessed with interviewer-rated M.I.N.I. to diagnose the presence of depression.

    RESULTS: A total of 47 (28.5%) caregivers were found to have depressive symptoms. Out of that total, 13 (7.9%) were diagnosed to have MDD using M.I.N.I. From univariate analysis, factors associated with depression in caregivers were the severity of symptoms in patients ( p 

  6. Chan LF, Shamsul AS, Maniam T
    Psychiatry Res, 2014 Dec 30;220(3):867-73.
    PMID: 25240940 DOI: 10.1016/j.psychres.2014.08.055
    Our study aimed to examine the interplay between clinical and social predictors of future suicide attempt and the transition from suicidal ideation to suicide attempt in depressive disorders. Sixty-six Malaysian inpatients with a depressive disorder were assessed at index admission and within 1 year for suicide attempt, suicidal ideation, depression severity, life event changes, treatment history and relevant clinical and socio-demographic factors. One-fifth of suicidal ideators transitioned to a future suicide attempt. All future attempters (12/66) had prior ideation and 83% of attempters had a prior attempt. The highest risk for transitioning from ideation to attempt was 5 months post-discharge. Single predictor models showed that previous psychiatric hospitalization and ideation severity were shared predictors of future attempt and ideation to attempt transition. Substance use disorders (especially alcohol) predicted future attempt and approached significance for the transition process. Low socio-economic status predicted the transition process while major personal injury/illness predicted future suicide attempt. Past suicide attempt, subjective depression severity and medication compliance predicted only future suicide attempt. The absence of prior suicide attempt did not eliminate the risk of future attempt. Given the limited sample, future larger studies on mechanisms underlying the interactions of such predictors are needed.
  7. Chan LF, Maniam T, Saini SM, Shah SA, Loh SF, Sinniah A, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:123-6.
    PMID: 23857848 DOI: 10.1111/appy.12057
    INTRODUCTION: The aim of this study was to determine the association between sexual abuse, substance abuse and socio-demographic factors with suicidal ideation (SI), plans (SP) and deliberate self-harm (DSH) and propose steps to prevent youth suicidal behavior.
    METHODS: This was a cross-sectional study of 6786 adolescents aged 17-18 years, selected randomly from all Malaysian adolescents to undergo compulsory youth camps located in Selangor, Malaysia (2008-2009). Participants were assessed using self-administered questionnaires developed to reflect the local cultural setting. However, only 4581 subjects were analyzed after excluding incomplete data.
    RESULTS: The rates of SI, SP and DSH were 7.6%, 3.2% and 6.3%, respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 1.99 (95% CI: 1.56-2.55), SP 1.57 (95% CI: 1.09-2.27) and DSH 2.26 (95% CI: 1.75-2.94); illicit drug use was associated with SI 4.05 (95% CI: 2.14-7.67), SP 2.62 (95% CI: 1.05-6.53) and DSH 2.06, (95% CI: 1.05-4.04); for alcohol use DSH was 1.34 (95% CI: 1.00-1.79). Being female was associated with all suicidal behaviors: SI 2.51 (95% CI: 1.91-3.30), SP 2.07 (95% CI: 1.39-3.08) and DSH 1.59 (95% CI: 1.19-2.11).
    DISCUSSION: Given the well-founded concern of increasing risk of suicidal behavior among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and substance abuse, and their sequelae, especially in girls.
    KEYWORDS: adolescent; risks; sexual abuse; substance abuse; suicidal behavior
  8. Chan LF, Maniam T, Shamsul AS
    Crisis, 2011;32(5):283-7.
    PMID: 21940256 DOI: 10.1027/0227-5910/a000088
    Depressed inpatients constitute a high-risk population for suicide attempts.
  9. Chan LF, Tan SM, Ang JK, Kamal Nor N, Sharip S
    J Child Sex Abus, 2012;21(6):613-20.
    PMID: 23194137 DOI: 10.1080/10538712.2012.719597
    Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of unique cultural and belief systems.
  10. Chan LF, Mohamad Adam B, Norazlin KN, Siti Haida MI, Lee VY, Norazura AW, et al.
    J Adolesc, 2016 10;52:162-9.
    PMID: 27572955 DOI: 10.1016/j.adolescence.2016.08.006
    Pregnant adolescents are a high-risk population for suicide. However, a knowledge gap still exists on how sexual and religious knowledge, attitudes and practices (KAP) influence suicidal ideation (SI) in teenage pregnancy. We aim to explore the interplay between psychiatric diagnoses, sociodemographic factors and KAP of sexual and religious issues as risk factors of SI among 114 pregnant Malaysian adolescents from 6 rehabilitation centers and a tertiary hospital. Single sexual partner was an independent predictor of SI, suggesting the role of less sexual experience as a risk factor for SI after controlling for major depression. Participants who were unsure versus those who agreed with the statement that most religions' viewed sex outside marriage as wrong had a lower risk of SI after controlling for major depression. Pregnant adolescents with a single sexual partner were significantly associated with current SI. Ambivalence towards religious prohibitions on premarital sex may protect against suicidal ideation.
  11. Chan LF, Eu CL, Soh SY, Maniam T, Shahidii Kadir Z, Chong BTW, et al.
    J Psychiatr Pract, 2018 07;24(4):279-291.
    PMID: 30427812 DOI: 10.1097/PRA.0000000000000316
    Ketamine has shown effectiveness as a rapid-acting antidepressant with antisuicidal effects in terms of reduction of suicidal ideation in the short term. However, the evidence for long-term maintenance ketamine therapy for treatment-resistant depression (TRD) and suicidal behavior is limited. This case series (N=13) highlights the role of adjunctive serial maintenance ketamine infusions in restoring functionality in treatment-resistant unipolar and bipolar (mixed) depression with significant suicide risk and multiple comorbidities, including alcohol dependence. Two cases of TRD achieved functional remission with long-term maintenance ketamine treatment. The first case illustrates the potential synergistic interaction between ketamine and lamotrigine to achieve a sustained antidepressant response in the patient for 7 months. The second case may possibly be the longest reported case of maintenance ketamine therapy, with treatment continuing for 5 years to date. Ketamine treatment showed acute effectiveness in another 7 cases, especially in terms of reduction of suicidal ideation, albeit without significant long-term antidepressant effect. Factors that may contribute to lack of effectiveness of serial ketamine include inadequate mood stabilization in TRD in bipolar spectrum diagnoses, concomitant benzodiazepine use, complex comorbidities, and adverse effects such as significant hypertension and severe dissociation. Future systematic controlled studies are warranted to establish the efficacy and safety profile of long-term ketamine as maintenance therapy for TRD with suicidal behavior.
  12. Chan LF, Chin SJ, Loo TH, Panirselvam RR, Chang SS, Chang HY, et al.
    BMC Psychiatry, 2023 Jun 28;23(1):472.
    PMID: 37380953 DOI: 10.1186/s12888-023-04974-8
    BACKGROUND: Previous studies have shown that pesticide bans were associated with reduced fatal pesticide self-poisoning cases in high, and low-and-middle-income countries. We aimed to investigate the characteristics of pesticide poisoning patients admitted to two Malaysian hospitals and the early impact of the national paraquat ban implemented on 1st January 2020 in a culturally heterogenous South-East-Asian upper-middle-income setting.

    METHODS: Data were collected from an East (Bintulu) and a West (Ipoh) Malaysian hospital medical records in 2015-2021 and 2018-2021, respectively. Logistic regression analyses were conducted to investigate the association of aspects such as socio-demographic and clinical characteristics, paraquat ban with the types of pesticides involved (paraquat versus non-paraquat versus unknown) ,and the outcomes (fatal versus non-fatal).

    RESULTS: From the study sample of 212 pesticide poisoning patients aged 15 years or above, the majority were self-poisoning cases (75.5%) with a disproportionate over-representation of Indian ethnic minority (44.8%). Most pesticide poisoning cases had socio-environmental stressors (62.30%). The commonest stressors were domestic interpersonal conflicts (61.36%). 42.15% of pesticide poisoning survivors had a psychiatric diagnosis. Paraquat poisoning accounted for 31.6% of all patients and 66.7% of fatalities. Case fatality was positively associated with male gender, current suicidal intent, and paraquat poisoning. After the paraquat ban, the proportion of pesticide poisoning cases using paraquat decreased from 35.8 to 24.0%, and the overall case-fatality dropped slightly from 21.2 to 17.3%.

    CONCLUSIONS: Socio-environmental stressors in specific domestic interpersonal conflicts, seemed more prominent in pesticide poisoning compared to psychiatric diagnosis. Paraquat accounted for the majority of pesticide-associated deaths occurring in hospitals in the study areas. There was preliminary evidence that the 2020 paraquat ban led to a fall in case fatality from pesticide poisoning.

  13. Hu J, Chan LF, Souza RP, Tampakeras M, Kennedy JL, Zai C, et al.
    Neurosci Lett, 2014 Jan 24;559:39-43.
    PMID: 24275212 DOI: 10.1016/j.neulet.2013.11.025
    Evidence has shown that attempted suicide in psychiatric disorders is a complex interplay of genes and environment. Noradrenergic dysfunction due to abnormalities in the tyrosine hydroxylase (TH) gene has been implicated in the pathogenesis of suicidal behavior in mood disorders. However, suicide is a leading cause of mortality in schizophrenia too. Recent evidence suggests that TH gene variants may also increase the risk of suicide attempts in schizophrenia patients, although the interaction with established clinical risk factors is unclear. This study aimed to identify TH gene variants conferring risk for suicide attempt in schizophrenia while accounting for the interaction between this gene and clinical risk factors. We performed analysis on four TH SNPs (rs11564717, rs11042950, rs2070762, rs689) and the common TCAT repeat (UniSTS:240639) for 234 schizophrenia patients (51 suicide attempters and 183 non-attempters). Clinical risk factors and ethnic stratification were included as covariates. Single marker analysis identified the SNP rs11564717 (p=0.042) and the TCAT(6) (p=0.004) as risk variants for suicide attempt. We also identified the haplotype A-A-A-G as a risk factor for suicide attempt (p=0.0025). In conclusion, our findings suggest that TH polymorphisms may contribute to the risk of attempted suicide in schizophrenia even after accounting for established clinical risk factors and ethnic stratification. Further larger scale studies are needed to confirm these findings and to understand the mechanisms underlying the role of TH gene variants in suicide attempt in schizophrenia.
  14. Kanapathy A, Nik Jaafar NR, Shaharir SS, Chan LF, Rozita M, Ch'ng SS
    Lupus, 2019 Jun;28(7):854-861.
    PMID: 31159651 DOI: 10.1177/0961203319852153
    INTRODUCTION: Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden.

    AIMS: This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia.

    METHODS: A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong-Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI).

    RESULTS: The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender (p = 0.04), educational level (p = 0.00), WBFPS score (p = 0.035) and anticardiolipin IgM (p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06-52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47-13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45-32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment.

    CONCLUSION: Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.

  15. Keng SL, Mohd Salleh Sahimi HB, Chan LF, Woon L, Eu CL, Sim SH, et al.
    BMC Psychiatry, 2021 10 04;21(1):486.
    PMID: 34607589 DOI: 10.1186/s12888-021-03500-y
    AIM/BACKGROUND: Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia.

    METHODS: Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention.

    RESULTS: There were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants' feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial.

    CONCLUSION: These preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.

  16. Lai MH, Maniam T, Chan LF, Ravindran AV
    J Med Internet Res, 2014;16(1):e30.
    PMID: 24472876 DOI: 10.2196/jmir.2973
    Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people's lives, both negative and positive, including an impact on suicidal behaviors.
  17. Lew B, Kõlves K, Lester D, Chen WS, Ibrahim NB, Khamal NRB, et al.
    Front Psychiatry, 2021;12:770252.
    PMID: 35069279 DOI: 10.3389/fpsyt.2021.770252
    Background: Suicide is a preventable cause of death. Examining suicide rates and trends are important in shaping national suicide prevention strategies. Therefore, the objectives of this study were to analyze age-standardized suicide trends of Malaysia between 2000 and 2019 using the WHO Global Health Estimates data, and to compare the 2019 rate with countries from the Association of South-East Asian Nations (ASEAN), Muslim majority countries, and the Group of Seven (G7). Methods: The age-standardized suicide rates data were extracted from the WHO Global Health Estimates. We calculated the average age-standardized suicide rates of the last 3 years from 2017 to 2019. Joinpoint regression analysis was conducted to calculate the average annual percentage change (APC) of the age-standardized suicide rates in Malaysia from 2000 to 2019. Results: Between 2000 and 2019, the minimum and maximum suicide rates for both sexes in Malaysia were 4.9 and 6.1 per 100,000 population respectively, whilst the past 3-year (2017-2019) average rates were 5.6, 8.8, and 2.4 for both sexes, males, and females, respectively. The suicide rates decreased significantly for both sexes between 2000 and 2013. Between 2014 and 2019, the suicide rates increased significantly for males. In 2019, Malaysia recorded the rate of 5.8 per 100,000 population, with an estimated 1,841 suicide deaths, i.e., ~5 deaths per day. The Malaysian suicide rate was the second highest amongst selected Muslim majority countries, in the middle range amongst ASEAN countries, and lower than all G7 countries except Italy. Conclusions: There is a need to further explore factors contributing to the higher suicide rates among Malaysian males. In light of the rising suicide rates in Malaysia, national mental health and suicide prevention initiatives are discussed and the importance of high-quality suicide surveillance data is emphasized.
  18. Lim JTY, Cheng Q, Ng YP, Pheh KS, Panirselvam RR, Tay KW, et al.
    Front Psychol, 2021;12:666027.
    PMID: 34975604 DOI: 10.3389/fpsyg.2021.666027
    Background: Suicide remains an important cause of premature deaths and draws much media attention. However, unsafe reporting and portrayal of suicides by the media have been associated with increased risk of suicidal behavior. Current evidence suggests that media capacity-building could potentially prevent suicide. However, there are still knowledge gaps in terms of a lack of data on effective strategies for improving awareness and safe reporting of suicide-related media content. This study aims to investigate the effectiveness of a workshop conducted with members of the media community on the safe reporting of suicide-related content. Methods: An interventional single-arm pre and post pilot study was conducted on a sample of the Malaysian media community recruited through purposive and snowball sampling. The media safe reporting workshop was conducted by a suicide prevention expert with a media industry background. Thirty participants completed a self-reported evaluation questionnaire on their awareness and knowledge of reporting on suicide-related media content; before and after the interventional workshop. Results: There was a significant difference between the total scores before and after the intervention, with a large effect size. Post-intervention scores were significantly improved in 8 items, namely those related to the reporting of: (i) the content of any suicide note; (ii) headlines with methods of suicide; (iii) headlines with the location of suicide; (iv) cases of suspected suicide despite the unconfirmed cause of death; (v) suicide news to cater to readers' interests; (vi) cause of suicide; (vii) details of the location of suicide; and (viii) the negative impact to media community when reporting suicide stories. In particular, there was an improvement in the majority of items for people from the media community with no lived experience of suicidal behavior. Conclusion: The media safe reporting workshop is a potentially effective intervention for improving awareness and knowledge measures relating to safe reporting on suicide among the media community, with a more pronounced effect in those without lived experience of suicidal behavior. Limitations in the sample size, generalizability, short-term evaluation, and lack of a control group warrant future larger, longer-term controlled, and more representative studies.
  19. Loo JL, Mohamad Kamal NA, Goon JA, Ahmad Damanhuri H, Tan JAC, Abdul Murad NA, et al.
    Front Psychiatry, 2021;12:698911.
    PMID: 34916966 DOI: 10.3389/fpsyt.2021.698911
    Background: Oxidative stress markers are found to be linked with depression and suicide attempts in bipolar disorder (BD), although the role of DNA damage as a marker of suicidal ideation and attempt has yet to be determined. We aim to investigate the association between DNA damage and suicidal behaviour, i.e., suicidal ideation and suicide attempt, among suicidal ideators in BD patients while accounting for clinical and psychosocial risk factors. Methods: A cross-sectional study was conducted in the Universiti Kebangsaan Malaysia Medical Centre on 62 consecutive BD patients diagnosed using the M.I.N.I. Neuropsychiatric Interview and 26 healthy control participants. Socio-demographic and clinical assessments were performed using the Columbia Suicide Severity Rating Scale (C-SSRS) for lifetime suicidal ideation and attempt, Quick Inventory of Depressive Symptomatology (QIDS) for depression severity, Clinical Global Impression for Bipolar Disorder (CGI-BD) for illness severity [both mania (CGI-Mania) and major depressive episode (CGI-MDE)], Social Readjustment Rating Scale (SRRS) for change in life events, and Barratt Impulsiveness Scale (BIS) for behavioural impulsivity. The degree of DNA damage in peripheral blood samples was determined using a standard protocol of comet assay. Results: Multivariable logistic regression revealed higher scores of CGI-MDE as the sole significant factor for lifetime suicidal ideation (OR = 1.937, 95% CI = 1.799-2.076). Although initial bivariate analysis showed a significant association between DNA damage, malondialdehyde (MDA), catalase (CAT), and suicidal behaviour, the findings were not seen in multivariable logistic regression. Bivariate subgroup analysis showed that moderate and severe DNA damage (p = 0.032 and p = 0.047, respectively) was significantly associated with lifetime suicide attempts among lifetime suicidal ideators. The study is the first to look at the connexion between DNA damage and suicidal risk in bipolar patients. It is limited by the small sample size and lack of information on illicit substance use. Conclusions: More severe DNA damage was significantly associated with lifetime suicide attempts among lifetime suicidal ideators in BD. However, the severity of depression was found to be independently associated with lifetime suicidal ideation per se rather than DNA damage in BD. Larger prospective studies are required to ascertain the potential of DNA damage as a biomarker for the transition from suicidal ideation to a suicide attempt.
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