During a psychiatric survey in Sarawak, subjects demonstrating latah were examined separately, both clinically and with a questionnaire. Latah occurred only in females, mainly Malays, occasionally Ibans, and never Chinese. Fifty latah subjects were examined, seven were firmly diagnosed as being mentally ill, and another 13 demonstrated mild psychiatric disorders. Dream content indicated an overt sexual component
In an attempt to discover how the phenomenon of amok is viewed within its indigenous culture, the authors studied and interviewed 21 subjects in West Malaysia who were labeled as amok. This investigation showed that both the subjects and the Malay culture view amok as psychopathology, that amok cases are disposed of in line with this view, and that the behavior of the amok person conforms to social expectations of the phenomenon. Despite cultural proscriptions, however, the act is purposive and motivated and is subtly sanctioned by Malay society.
This study examines the usefulness of the "CAGE", (which is an acronym for "cut down", "annoyed", "guilty" and "eye-opener"), a 4-question screening test to identify excessive drinkers among Malaysian inpatients. The CAGE questionnaire after translation and back translation was administered to all inpatients in the General Hospital, Kuala Lumpur. The author interviewed 'blindly' all who score positive on the CAGE score and 10% of all negatives using the DSM III interview schedule for alcohol abuse dependence. The results show that the CAGE performs best at a cut-off point of 2 and above, with a sensitivity of 92%, specificity of 62%, positive predictive values of 38% and Kappa (K) of 0.37 with a DSM III R diagnosis for alcohol abuse/dependence. The poor agreement with a DSM III diagnosis indicates that the CAGE is not useful in the Malaysian population. Reasons suggested for this are: cultural factors in the Malaysian population resulting in the overrating of the question of 'guilt' by Muslims and translations into the local languages which are only the closest approximations.
Two hundred and seventy schizophrenia patients were interviewed using the Present State Examination to elicit the phenomenological symptoms of the illness. Cultural factors and ethnicity were found to be significant variables associated with the symptoms. Higher prevalence of religious and other subculturally related delusions were common in Kelantan patients. Our general belief that Malaysian culture influences symptomatology of mental illness seems to be proven.
An analysis is presented of psychiatric research interviews conducted among the Iban, a longhouse dwelling people of Sarawak, Malaysia. It draws on transcripts of interviews recorded in the course of carrying out research into schizophrenia in this group. The article examines three different interview spaces within the longhouse--public, family, and private--in order to explore the interplay between ethnographic context and interview conversation. The public setting is notable for the number of relatives who join in and transform the communication from dyadic to collective interlocution; the role of repetition in recruiting them into the conversation is explored. Indirect contrast is the private space, which allows for a level of confidentiality commensurate with Western psychiatric research practice. Intermediate between the two is the family space. The communicative forms that correspond to these settings influence the way symptoms of schizophrenia are experienced and expressed in the Iban. Implications for the practice of psychiatry cross-culturally are examined.
OBJECTIVES:
Postpartum depression (PPD), a major health concern, produces insidious effects on new mothers, their infant, and family. This literature review aims to explore risk factors for postpartum depression among women in Asian cultures, which has not been fully elaborated.
DATA SOURCES:
A literature search was undertaken by using various electronic research databases. Studies were eligible for this review if they (a) examined risk factors for PPD, (b) were conducted in Asian countries using quantitative or qualitative methodologies, and (c) were published in English in peer-reviewed journals between 1998 and 2008. A total of 64 studies from 17 countries were reviewed, summarised, and synthesised.
RESULTS:
The prevalence of postpartum depression in Asian countries ranged from 3.5% to 63.3% where Malaysia and Pakistan had the lowest and highest, respectively. Risk factors for postpartum depression were clustered into five major groups: biological/physical (e.g., riboflavin consumption), psychological (e.g., antenatal depression), obstetric/paediatric (e.g., unwanted pregnancy), socio-demographic (e.g., poverty), and cultural factors (e.g., preference of infants' gender). Traditional postpartum rituals were not found to provide substantial psychological benefits for the new mothers.
CONCLUSIONS:
This review informs a current state of knowledge regarding risk factors for postpartum depression and has implications for clinical practice. Health care professionals should be aware that the phenomenon is as prevalent in Asian cultures as in European cultures. Women should be screened for potential risk factors and depressive symptoms during pregnancy and postpartum periods so that appropriate interventions, if needed, can be initiated in a timely fashion.
The Pacific War and the Japanese Occupation were traumatic periods in the lives of people now over seventy years old in Malaysia and Singapore. This study traces why individuals interviewed for oral history of the Pacific War and the Japanese Occupation have often been able to tell stories of trauma without being overwhelmed by their reminiscences. It emphasizes that memories of traumatic experiences of the Pacific War and the Japanese Occupation in Malaysia and Singapore are mediated and eased by supportive social networks that are part of the interview subject's community. The individual's personal memories of traumatic war experiences are positioned in the context of the collective memory of the group and, thus, are made easier to recall. However, for individuals whose personal memories are at variance with the collective memory of the group they belong to, recalling traumatic experiences is more difficult and alienating as they do not have the support in their community. The act of recalling traumatic memories in the context of the collective memory of a group is particularly relevant in Malaysia and Singapore. These countries have a long history of being plural societies, where although the major ethnic groups -- the Malays, Chinese, and Indians -- have lived side by side peacefully, they have lived in culturally and socially separate worlds, not interacting much with the other groups. The self -- identity of many older people who lived through the Pacific War and the Japanese Occupation is inextricably bound up with their ethnicity. Oral history on war trauma strongly reflects these identities.
Background: Circumcision though not mentioned in the Quran is believed to be a compulsory practice among the Muslims. In Malaysia, although there are several methods of circumcision available and traditional circumcision is still popular.
Methods: A cross-sectional survey was carried out in a small fishing village of Kedah to study the methods of circumcision available to the villagers. This was followed with an in-depth interview conducted with ‘Tok Mudim’, a practitioner of traditional method of circumcision.
Results: Forty three of the eligible 71 subjects participated in the study giving the response rate as 60.5%. The most common age for circumcision was 9 years old. Despite private clinics being the most common place of circumcisions, there was an increasing number of boys going to the ‘Tok Mudim’ for circumcision. A Mass Circumcision Ceremony is traditionally practiced. The ‘Tok Mudim’ described the procedure in detail and was of the opinion that the reason traditional method is still popular was because of the fear of injections and impotency among the parents. Most common complication faced by the ‘Tok Mudim’ was bleeding and infection.
Discussion and Conclusion: Till the community shifts entirely to using modern medicine, there is a need to integrate traditional practitioners into the system. Training the ‘Tok Mudim’ to use modern instruments and aseptic techniques should be considered.
Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.
BACKGROUND:
Home blood pressure monitoring (HBPM) is gaining popularity among hypertensive patients. This study aimed to explore the influence of self-initiated HBPM on primary care patients with hypertension.
METHODS:
Six in-depth interviews and two focus group discussions were conducted, taking into consideration the experiences of 24 primary care patients with hypertension. These patients had been using HBPM as part of their hypertension management. The overriding influences were grouped under themes which emerged from analyzing the data using the grounded theory approach.
RESULTS:
There are both positive and negative influences of self-initiated HBPM. Patients used the readings of their HBPM to decide on many aspects of their hypertension management. The HBPM readings both influenced their adherence to diet and exercise and provided certain reassurance when they experienced symptoms. In addition, the act of discussing their HBPM readings with their health care providers resulted in an enhanced doctor-patient therapeutic relationship. Nevertheless, HBPM created confusion at times in some patients, particularly with regard to the target blood pressure level and the need for medication. This led to some patients making their own medical decisions based on their own standards.
CONCLUSIONS:
HBPM is becoming an integral part of hypertension management. Primary care patients who self-initiated HBPM reported being more self-efficacious, but lack of participation and guidance from their doctors created confusion, and hindered the true benefit of HBPM.
Study site: urban primary care clinic, located within the University Malaya Medical Centre
Research has found that physical health decline in later life is associated with poor psychological well-being. This study aimed to examine the possible moderating effect of Islamic religiosity on the relationship between chronic medical conditions and psychological well-being.
To determine the risk of hypoactive sexual desire (HSD) in depressed female patients treated with selective serotonin reuptake inhibitors, comparing escitalopram and fluoxetine. The associated factors were also examined.
Introduction: Anxiety is a common mental health disorder in primary care, with a higher prevalence among women compared to men.
Aim: This is the first study to validate the Generalised Anxiety Disorder-7 questionnaire (GAD-7) as a case-finding instrument for anxiety in a primary care setting in Malaysia. The objective was to determine the diagnostic accuracy of the Malay version of the GAD-7 in detecting anxiety among women.
Methods: This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive women participants attending the clinic during data collection were given self-administered questionnaires including the GAD-7 (Malay version). Participants then were selected using systematic weighted random sampling for Composite International Diagnostic Interviews (CIDI). The GAD-7 was validated against the CIDI reference standard.
Results: The response rate was 87.5% for the questionnaire completion (895/1023), and 96.8% for diagnostic interviews (151/156). The prevalence of anxiety was 7.8%. The GAD-7 had a sensitivity of 76% (95% CI 61%–87%), a specificity of 94% (88%–97%), positive LR 13.7 (6.2–30.5) and negative LR 0.25 (0.14–0.45).
Discussion: The Malay version of the GAD-7 was found to be valid and reliable in case-finding for anxiety in this study. Due to its brevity, it is a suitable case-finding instrument for detecting anxiety in primary care settings in Malaysia.
Keywords: Validation; anxiety; primary care; women; Malaysia
Questionnaire: Generalised Anxiety Disorder questionnaire; GAD-7; Composite International Diagnostic Interviews; CIDI; Patient Health Questionnaire; PHQ-9; General Health Questionnaire; GHQ-12
Delay in help-seeking behaviour which is potentially preventable has a major effect on the prognosis and survival of patients with breast cancer. The objective of this study was to explore reasons for delay in seeking help among patients with breast cancer from the East Coast of peninsular Malaysia. A qualitative study using face- to-face in-depth interview was carried out involving 12 breast cancer patients who had been histo-pathologically confirmed and were symptomatic on presentation. Respondents were selected purposely based on their history of delayed consultation, diagnosis or treatment. All were of Malay ethnicity and the age range was 26-67 years. Three were in stage ll, seven in stage lll and two in stage lV. At the time of interview, all except one respondent had accepted treatment. The range of consultation time was 0.2-72.2 months with a median of 1.7 months, diagnosis time was 1.4-95.8 months( median 5.4 months )and treatment time was 0-33.3 months (median 1.2 months). The themes derived from the study were poor knowledge or awareness of breast cancer, fear of cancer consequences, beliefs in complementary alternative medicine, sanction by others, other priorities, denial of disease, attitude of wait and see and health care system weakness. Help-seeking behaviour was influenced by a complex interaction of cognitive, environmental, beliefs, culture and psycho-social factors. Breast cancer awareness and psychological counselling are recommended for all patients with breast symptoms to prevent delay in seeking clinical help.
BACKGROUND: The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public-private) health system.
METHODS: In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010-11. Healthcare professionals consisting of general practitioners (n = 11), medical officers (n = 8), diabetes educators (n = 3), government policy makers (n = 4), family medicine specialists (n = 10) and endocrinologists (n = 2) were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach.
RESULTS: Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients' peer group sessions; increasing awareness and demystifying insulin via public campaigns; and subsidising glucose monitoring equipment. Finally, the healthcare professionals proposed the establishment of multidisciplinary teams as a strategy to increase the rate of insulin initiation. Having team members from different ethnic backgrounds would help to overcome language and cultural differences when communicating with patients.
CONCLUSION: The challenges faced by a dual-sector health system in delivering insulin initiation may be addressed by greater collaborations between the private and public sectors and governmental and non-government organisations, and among different healthcare professionals.
Study site: Healthcare professionals from three states (Wilayah Federal Territory, Negeri Sembilan and Selangor) and from both urban and semi-rural locations (including Klinik Kesihatan), Malaysia
Leisure involvement is an essential element in the daily life of the elderly people. Little is known, however, about the perceived leisure constraints among them, especially among the increasing elderly population in Malaysia. This study aims to explore constraints perceived by the elderly that prevent them from actively involved in leisure. In depth interviews were conducted, involving a total of 20 elderly aged 60 years and above with stratification by background characteristics. Each interview was conducted for an average of 15 to 30 minutes and discontinued when a saturation point was achieved. They were purposively selected from two health clinics located in two different districts in the state of Selangor, representing an urban and a rural area. Elderly participation in leisure activities was constrained by many factors. These factors can be divided into individual, family and community factors such as increasing age and related physical deterioration , education level, health status and the existence of chronic illness, absence of family member or friends to perform the activity together and non-conducive environment. The constraints should be endorsed and acknowledged by the relevant agencies and authorities in order to facilitate effective implementation of related policies, strategies and programmes to improve the health of the elderly people. These include the provision of appropriate services and facilities to cater senior citizens from various health and demographic perspectives.
INTRODUCTION: Hospital-based community psychiatric service (HCPS) is a developing intervention in Malaysia targeted for patients with severe mental illnesses (SMIs). Its effectiveness had not been systematically measured. This study aimed to assess the outcome of HCPS with respect to re-hospitalization and factors associated with low re-hospitalization among patients with schizophrenia in the metropolitan city of Kuala Lumpur.
METHODS: A naturalistic and retrospective cohort study was conducted using within-subject pre-post design on 155 patients with schizophrenia who received HCPS in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The hospital admission profiles were obtained from clinical records. The socio-demographic and relevant clinical data were also assessed through clinical interviews.
RESULTS: One hundred and forty (90%) of 155 respondents had low rate of hospital admission with significant reduction of being hospitalized within 1 year after receiving HCPS (p