This paper examines four drug rehabilitation systems in Malaysia from an organizational perspective. It focuses on authority structures in rehabilitation centres and their impact on rehabilitees' identities. The findings show that there are important differences between government-run and private centres in terms of administration and approach to therapy. Some policy implications are derived from a comparison of these systems.
Sixty four percent (104 patients) of Malay patients attending the Psychiatric Clinic for the first time were interviewed. A similar number from the general Out-patients Department (O.P.D.) randomly chosen, served as the control group. Seventy six (73.1%) psychiatric patients had consulted a bomoh prior to their visit to the clinic as compared to 26 (25%) O.P.D. patients. The number of bomohs consulted was significantly higher among the psychiatric patients than the O.P.D. patients. The strength of social support, the availability of a bomoh and the belief of the patients, friends and/or relatives in the bomoh have been suggested as the main factors that influenced the Malay patients in seeking bomoh treatment. The belief that mental illness is due to supernatural causes is firmly held by bomohs who reinforce this notion in those who seek their advice. The importance of understanding the patient's cultural background in treating psychiatric patients is highlighted.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
This is a study of the prevalence of dementia in elderly Malays living in the Eunos district of Singapore. The subjects included all Malays 65 years and more living in public housing, and they were first interviewed and screened for any cognitive deficit using the Malay version of the Elderly Cognitive Assessment Questionnaire (ECAQ). All those who scored 5 or less in the ECAQ were assessed again with a more detailed questionnaire called the Geriatric Mental State (GMS) schedule. This is the preliminary results of 149 subjects interviewed--77 men and 72 women. Data from the GMS were analysed by a computer diagnostic programme, AGECAT. There were only 6 cases of dementia and the overall prevalence of dementia in the sample was estimated as 4.0%. In the age group 65 to 74 years the rate was 2.5% and this increased to 10.3% in those 75 years and more. The prevalence of dementia in elderly Malays is higher than elderly Chinese in Singapore, but it is similar to the results of studies in New York and Liverpool. All the subjects with dementia were living with their families and they had good social resources.
All 79 patients who attended a University Systemic Lupus Erythematosus (SLE) Clinic over a 6 month period were assessed using the Clinical Interview Schedule for psychiatric disorder. Using the ICD-9 Classification, 40 were found to have psychiatric disorder, 26 having depressive neurosis, six anxiety neurosis, five endogenous depression and three dementia. The group with psychiatric disorder had significantly poor family support as well as lack of a confidant compared to the group without psychiatric disorder (P < 0.01). There was no difference between the group with psychiatric disorder and those without psychiatric disorder in terms of age, duration of illness, ethnicity and severity of SLE. Psychiatric disorder is common affecting more than half the subjects and depression was the most frequent diagnosis.
Study site: SLE clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The compliance with drug regimens and follow-up visits of 225 known cases of relapsed schizophrenia was assessed. About 27% of the patients met the criteria for good compliance. The compliance was found to be significantly related to the patients' view of usefulness of the medication, treatment duration of less than 5 years, dosage schedule of once or twice per day and the supervision of medication at home. Patients with poor compliance who were prescribed drug dosage of not more than twice per day throughout follow-up and underwent counseling to enhance treatment compliance had a significantly lower relapse rate than the controlled group at the end of 1 year of follow-up. The importance of family support and understanding patients' cultural background in ensuring good compliance was highlighted.
In this paper we discuss a number of hypotheses about motives for intergenerational transfers within the family. We use data on time and money transfers between generations in Malaysia, where there is neither Social Security nor Medicare, to explore these hypotheses empirically. We find evidence supporting the hypotheses that children are an important source of old age security and that old age security is, in part, children's repayment for parental investments in their education. This repayment is partly a function of the children's income and, in the case of females, a function of their spouse's income. We also find evidence supporting the hypotheses that parents and children engage in the exchange of time help for money.
The present study aims to compare the family's social environment, social supports and mental health of Malay women from rural and urban areas. Equal number (n-184) of Malay women from similar socio-economic back grounds were chosen from the rural areas of Kedah and urban areas of Pulau Pinang using the stratified random sampling method. The results indicated significantly higher level of mental health problems among the rural respondents when compared with the urban subjects. Among the family related variables included in the present study, cohesiveness, moral religious emphasis and organization and intellectual and cultural orientation were found to be significantly associated with the mental health problems of rural respondents. Whereas, only one variable, namely, active recreational orientation was found to be having an impact on the mental health of urban respondents. Similarly, deficiencies in the social support perceived from family and other members of the community were found to be significantly associated with the mental health problems of rural samples when compared to the social support perceived from the others for the urban subjects. The implications of these observations are discussed.
We tested the applicability of the stress buffering hypothesis in a developing country setting with data from the Senior Sample of the Malaysian Family Life Survey-2. Using ordered logistic regression methods, we examined whether having daily contact with adult children moderates the effect of low socioeconomic status (SES; conceptualized as a chronic stressor) on self-assessed health status. We found that low SES is associated with poorer health for all three ethnic groups--Malay, Chinese, and Indian. Further, for Malays and Chinese, we found that the negative effects of low SES on health tend to be stronger for older people with less frequent contact with adult children than for those who have daily contact. These results provide general support for the buffering model and suggest that, as found in developed countries, active intergenerational relationships in developing country settings may have protective effects on the health of older people experiencing chronic stressors.
Rapid participatory research and project development is possible within a tightly controlled social context such as a prison. Having gained access, based on trust and mutual respect, external agents may then facilitate significant change. Given adequate support, incarcerated people with HIV/AIDS and limited medical access may be able to develop mutual care, social support and income-generating activities. In the Malaysian context, we estimated in 1998 that up to one-quarter of prisoners with HIV had indicators of significant disease. We estimated that significant indicators remained unrevealed among between one-half and two-thirds of these. Given prevailing conditions, these would probably only be amenable to peer-based care.
This study aims to examine selected factors of dementia patients and their caregivers that were associated with the burden of family caregivers. This cross sectional study involves face-to-face interview with family caregivers of patients with dementia. Participants were recruited through convenient sampling from geriatric and psychiatry outpatient clinics from three government hospitals, one university hospital, one rural health centre and Alzheimer Disease caregivers' support groups. 70 caregivers took part in the study. Measures included patient and caregiver demographic variables and caregiver burden using the Zarit Burden Interview (ZBI). Caregiver burden was found to be significantly associated with both ethnicity and informal support. Chinese caregivers were found to have a higher level of burden compared to Indians and Malays. Informal support, in particular assistance from family members, was significantly associated with a lower burden perceived by the caregivers. However, the study shows that formal support such as assistance from maids and private nurses did not alleviate the burden of caregivers. Results highlighted the importance of improving the coping skills in burdened caregivers particularly among family members with dementia relatives. Interventions should be designed for specific needs of caregivers of different ethnicities.
Aim: To evaluate the psychometric performance of the Malay version of the Medical Outcome Study (MOS) Social Support Survey among a sample of postpartum Malay women in Kedah, North West of Peninsular Malaysia.
Materials and methods: 354 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay versions of the MOS Social Support Survey, the Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the participants, who were bilingual, were also given the original English version of the instrument. A week later, these women were again asked to complete the Malay version of MOS Social Support Survey.
Results: The median number for item 1 (the single item measure of structural support) was 3 (inter-quartile range = 2 - 4). Extraction method of the remaining 19 items (item 2 to item 20) using principle component analyses with direct oblimin rotation converged into 3 dimensions of functional social support (informational support, affectionate support / positive social interaction and instrumental support) with reliability coefficients of 0.93, 0.74 and 0.72 respectively. Overall the scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). Its validity was confirmed by the negative correlations between the overall support index (total social support score) and all the three dimensions of functional support with the Malay versions of EPDS and BDI-II. The overall support index also displayed low but significant correlations with the single measure structural social support in the instrument (Spearman's rho = 0.14; p <0.01).
Conclusions: The MOS Social Support Survey demonstrated good psychometric properties in measuring social support among postpartum Malay women in Kedah, North West of Peninsular Malaysia and could potentially be used as a simple instrument in primary care settings.
We present results of a study of treated rates of schizophrenia among the Iban of Sarawak, Malaysia. Most Iban live in longhouses, each comprising a kindred group of up to 300 individuals. Cultural practices such as minimal intermarriage with members of adjacent ethnic groups and in-depth genealogical knowledge make them a population suitable for genetic investigation. Iban culture is conducive to a focus on symptoms and illness, and to patterns of treatment-seeking behaviour that are enthusiastic and persistent.
This study investigated the prevalence of depression 3-6 months poststroke and examined specific factors associated with depression in a stroke population of the University Malaya Medical Centre, Kuala Lumpur, Malaysia. It was hypothesised that poststroke depression (PSD) is prevalent in the poststroke population of University Hospital Malaysia and that PSD is significantly correlated with demographics, educational background, medical history, rehabilitation attendance, traditional medicine use, prestroke and poststroke activities, religiousness, activities of daily living, and social support. The study group comprised 80 patients admitted to the hospital with stroke of any etiology. Mean patient age was 56.8 years (standard deviation +/- 12.5 years). The results were derived by comparing the 80 stroke patients with 80 controls matched for age, sex, race, and medication use. Results were also derived from comparisons between depressed and nondepressed members of the stroke population (n = 80). The diagnosis of depression was based on the Zung Self-Rating Scale and confirmed by a psychiatrist, based on DSM-IV criteria. Interviews were conducted based on a 26-item questionnaire, modified Barthel Index, and Social Resources Scale were used to assess which factors correlated with depression. Depression was found to be common among Malaysians 3-6 months after stroke. A total of 66% of the patients were depressed, with depression considered mild in 51% and moderate to severe in 15%. It was demonstrated that the occurrence of depression was significantly correlated with age, ethnicity, noncontinuance of prestroke lifestyles, and poor performance in the activities of daily living rating.
Background: Community based epidemiological data on postpartum depression in Malaysia is scarce. Aim: To determine the prevalence and risk factors for developing postpartum depression among Malay women from a rural area in Kedah, North West of Peninsular Malaysia. Method: We screened 185 women at 4-12 weeks postpartum attending the selected health centers using the Malay versions of Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory II (BDI-11). Those scoring 12 and / or 9/10 on BDI-11 were interviewed using the Composite International Diagnostic Interview (CIDI) and the 17-items Hamilton Rating Scale for Depression (HDRS-17). All diagnoses were based on the Tenth Edition of the International Classification for Disease: Diagnostic Criteria for Research (ICD-I0: DCR-10). Results: The prevalence of postpartum depression was 21.08%. The condition was found to be significantly linked to polygamous marriages, high number of life events and financial problems over the last one year prior to delivery, and low scores on the Malay version of the MOS Social Support Survey and all its components (overall support index, informational support, affectionate support/ positive social interactions and instrumental support). Conclusions: Postpartum depression is indeed a reality among Malay women in rural areas In Kedah, North West of Peninsular Malaysia. These findings have implications for policies regarding maternal and childcare programs.
AIM: To document the perception of terminally ill patients and their family members on the care provided to them, and to look at the components of holistic care that are viewed as inadequate.
METHODS: Thirty cancer patients from a 10-bed palliative ward and their family members who were the chief carers were interviewed. They were asked to give their perceptions on four major areas of care: physical, social, psychological and spiritual. The participants were asked to report which area(s) of the service were inadequate.
RESULTS: Most patients and family members perceived that they received adequate physical care. However, the psychosocial and spiritual aspect of care were perceived as inadequate by the majority of patients and their families. None of the patients interviewed had ever been asked about spiritual distress.
CONCLUSION: The holistic model of care in caring for terminally ill patients is not practised fully. Further development in the psychosocial and spiritual aspects of care is necessary. There is a need to conduct further research to address these domains.
The JCQ has been shown to be a valid and reliable instrument to assess job stress in many occupational settings worldwide. In Malaysia, both the English and validated Malay versions have been employed in studies of medical professionals and laboratory technicians, respectively. The present study assessed the reliability and construct validity of the Malay version of the JCQ among automotive workers in Malaysia. Fifty workers of a major automotive manufacturer in Kota Bharu, Kelantan consented to participate in the study and were administered the Malay version of the JCQ. Translation (English-Malay) and back translation (Malay-English) of the JCQ was made to ensure the face validity of the questionnaire. Reliability was determined using Cronbach's alpha for internal consistency, whilst construct validity was assessed using exploratory factor analysis (principal component with varimax rotation). The results indicate that the Cronbach's alpha coefficients were acceptable for decision latitude (job control or decision authority) (0.74) and social support (0.79); however, it was slightly lower for psychological job demand (0.61). Exploratory factor analysis showed 3 meaningful common factors that could explain the 3 theoretical dimensions or constructs of Karasek's demand-control-social support model. In conclusion, the results of the validation study suggested that the JCQ scales are reliable and valid for assessing job stress in a population working in the automotive industry. Further analyses are necessary to evaluate the stability and concurrent validity of the JCQ.
This study was conducted to assess the reliability and construct validity of the Malay version of Job Content Questionnaire (JCQ) among secondary school teachers in Kota Bharu, Kelantan. A total of 68 teachers consented to participate in the study and were administered the Malay version of JCQ. Reliability was determined using Cronbach's alpha for internal consistency whilst construct validity was assessed using factor analysis. The results indicated that Cronbach's alpha coefficients revealed decision latitude (0.75), psychological job demand (0.50) and social support (0.84). Factor analysis showed three meaningful common factors that could explain the construct of Karasek's demand-control-social support model. The study suggests the JCQ scales are reliable and valid tools for assessing job stress in school teachers.