Displaying publications 1 - 20 of 31 in total

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  1. O'Connor RC, Worthman CM, Abanga M, Athanassopoulou N, Boyce N, Chan LF, et al.
    Lancet Psychiatry, 2023 Jun;10(6):452-464.
    PMID: 37182526 DOI: 10.1016/S2215-0366(23)00058-5
    Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.
  2. 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.

  3. 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
  4. 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.
  5. Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA, et al.
    EClinicalMedicine, 2022 Sep;51:101573.
    PMID: 35935344 DOI: 10.1016/j.eclinm.2022.101573
    BACKGROUND: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally.

    METHODS: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation.

    FINDINGS: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.

    INTERPRETATION: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.

    FUNDING: None.

  6. 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.
  7. 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.
  8. Tan SM, Jong SC, Chan LF, Jamaludin NA, Phang CK, Jamaluddin NS, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:74-81.
    PMID: 23857841 DOI: 10.1111/appy.12048
    Anxiety among house officers may impair functioning and health care delivery. This study aimed to determine the association between anxiety among house officers at Universiti Kebangsaan Malaysia Medical Center, sociodemographic and work-related factors.
  9. 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.
  10. 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.
  11. 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 
  12. Sahimi HMS, Mohd Daud TI, Chan LF, Shah SA, Rahman FHA, Nik Jaafar NR
    Front Psychiatry, 2021;12:658174.
    PMID: 34025479 DOI: 10.3389/fpsyt.2021.658174
    Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic. Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18-21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9). Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015-347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977-85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005-0.993). Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.
  13. 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 

  14. 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.

  15. 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.
  16. 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.
  17. Tan YK, Siau CS, Chan LF, Kõlves K, Zhang J, Ho MC, et al.
    Asian J Psychiatr, 2023 Nov;89:103772.
    PMID: 37748229 DOI: 10.1016/j.ajp.2023.103772
    This cross-sectional study aimed to validate the Life Events Checklist for DSM-5 (LEC-5) among Malaysian undergraduates (N = 500; mean age = 21.66 ± 1.57), of which 90.4% had ever experienced a lifetime traumatic event. Cronbach's alpha of .87 (95% CI [.86, .89]) and McDonald's omega of .89 (95% CI [.89, .93]) indicated good reliability. Confirmatory factor analysis based on a six-factor structure showed the best fit. The measurement invariance showed that the six-factor structure was similar across sexes. Therefore, the Malay LEC-5 is a valid and reliable instrument to screen for traumatic events among Malaysian undergraduates.
  18. 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.

  19. 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.
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