The present study is to determine the level of depression, anxiety and stress among Universiti Kebangsaan Malaysia (UKM) clinical year medical students and their help seeking behaviour in relation to their psychological aspect. A cross-sectional study was conducted in UKM Medical Centre for three months duration. The study population was the third, fourth and fifth year medical students via proportional sampling. They were given questionnaires consisting of socio-demographic items, Depression, Anxiety and Stress Scale 21 – Bahasa Malaysia version BM-DASS21 and questions regarding help-seeking behaviors. Psychometric assessment (BMDASS21) estimated the level of depression, anxiety and stress among medical students. Help-seeking behavior questions assessed the use of medical facilities and other help-seeking sources. Regarding questions on the barriers towards seeking help from the primary health-care, three parts were evaluated: structural barriers, barriers towards perceptions on mental-health disorder and barriers towards use of primary health-care services. There were 380 medical students who were involved in this research. It was found that some students experienced depression (1.3%), anxiety (2.4%) and stress (2.4%). Majority of them preferred to seek help from friends (283; 74.5%) followed by parents (275; 72.4%). There was a significant association between students who were anxious and help seeking behaviour from formal sources: counselor (p=0.001) and religious personnel (p=0.03). Hence, it is essential to increase their awareness on psychological disorders and more efficient screening programme should be used to recognize medical students with possible emotional disorders.
The traditional physical and cosmetic-centered model without paying serious attention on the underlying psychosocial issues of care are ill suited to successful treatment outcome of obesity. The objective of this article is to report a case of a retired Malay army sergeant who presented with night eating syndrome (NES) with morbid obesity and dysthymia, and to discuss the psychobiological aspect of the case including to evaluate the effectiveness of the combination treatment of pharmacotherapy and cognitive behavior therapy along with diet counseling. The diagnosis was made by using the Structured Clinical Interview Diagnosis (SCID) for DSM-III-R diagnosis and the severity of depression was assessed by Hamilton Depressive Rating Scale. The patient’s body mass index was 45, He was found to have dysthymia and the Hamilton Depressive Rating Scale score was 13. We found that the combination of pharmacotherapy, cognitive behavior therapy and nutritional education with the help of the physician proved to be effective in treating morbid obesity with NES and Dysthymia.
Pregnancy is perceived by many pregnant mothers as a period of happiness in anticipation of motherhood. Not all pregnant mothers experience cheerfulness as some may experience a high anxiety and depression level for unknown reasons. The purpose of this study was to determine the level of anxiety and depression among high risk pregnant women and the factors that contribute to their level of anxiety and depression. A descriptive cross-sectional study was conducted on 38 high risk mothers whose stay in hospital exceeded more than three days in the obstetric ward of Hospital Universiti Kebangsaan Malaysia. A self assessment questionnaire “Hospital Anxiety Depression scale” was used to measure the level of anxiety and depression among high risk pregnant women. Of the 38 participants, 16 (42.1%) women experienced a mild level of anxiety and 22 (57.9%) experienced a severe level of anxiety. Seventeen (44.7%) women was classified as having mild depression and 21 (55.3%) severe depression. The factors contributing to the level of anxiety and depression, include those related with “lack of information on disease”, “family matters” and “finance”. High risk pregnant women in this study experienced a significant level of anxiety and depression during their stay in hospital. It is therefore important for nurses and doctors to be aware and sensitive to the influencing factors that cause anxiety and depression as to enable high risk pregnant mothers to enjoy their pregnancy and childbirth.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Pre-hypertension increased the risk of morbidity and mortality from non-communicable diseases. Whereas, psychological factors such as depression, anxiety and stress have been associated with increased in blood pressure. However, previous studies more focuses on psychological determinants of hypertension than prehypertension. Thus, this study aims to determine the association between these psychological factors with pre-hypertension. A cross-sectional study was conducted in 2012 among first year students of a public Malaysian university. A random cluster sampling was used to select 5 out of 15 faculties and a total of 495 students participated in this study. The Malay version of DASS-21 was used to elicit their levels of depression, anxiety and stress. Blood pressures were measured twice using sphygmomanometer and the averages were taken. Data analyses used chi-square test and binary multiple logistic regression. The prevalence of pre-hypertension was 30.1%. The percentage of severe and extremely severe depression was 3.8% and 1.2%; both severe and extremely severe anxiety was 16.4%; and severe and extremely severe stress was 4.2% and 0.2% respectively. Severe/extremely severe depression had more than 3 times higher in getting pre-hypertension than no depression. In conclusions, almost one third of respondents had pre-hypertension and only severe/extremely depression was associated with pre-hypertension.
The population of the world is ageing and Malaysia is no exception. The proportion of those above 60 will be 9.5% by the year 2020. Cognitive impairment and depression are two common problems in this age group. The objective of this study was to determine the prevalence of cognitive impairment and depression and their associated factors in the elderly population in a rural community in Kedah. The study design was descriptive cross sectional study. A standardized questionnaire was used in two villages in Mukim Kota Kuala Muda. Barthels index, geriatric depression scale and elderly cognitive assessment questionnaire were also used. The prevalence rate of cognitive impairment was 18.5%. Cognitive impairment was higher among females (22.6%) than males (12.8%). 34.8% of the widowed were cognitively impaired and it increases with age 15.1% within age groups 60 to 69 years, 42.9% in age groups 80 to 89 years and the one and only participant above 90 years was cognitively impaired. Among those with disability, the only one with very severe disability had cognitive impairment, 40% among the severely disabled and 33. 3% among the moderately disabled (p<0.05). Those with cognitive impairment were living with some functional disabilities involving feeding (p<0.05), bathing (p<0.05), grooming (p<0.05), dressing (p<0.05), bladder control (p<0.05), toilet use (p<0.05), transfer from bed to chair (p<0.05), mobility on level surfaces (p<0.05) and climbing stairs (p<0.05). The prevalence of depression was found to be 46.4%. Higher among males (48.4%) as compared to females (44.7%). Depression was 50.0% among the age groups 80 to 89 and 52.4% among the age groups 70 to 79. 63.6% of those living alone were depressed as were 54.8% of the unemployed. 43.8% of those depressed had functional disability. The only one with severe disability was depressed and 66. 7% of those with severe disability were depressed. 47.5% of those with hypertension were depressed. It is a matter of concern that even in a small population the rate of cognitive impairment and mental depression is very high. Health screening is an important aspect of health promotion and disease prevention in people over 60 years. Although screening for many conditions cannot conclusively prove benefit, special attention to these factors can decrease morbidity and improve quality of life in aging population.
Key words: elderly, cognitive impairment, depression, rural community, Malaysia
Study site: Two villages in Mukim Kota Kuala Muda, Kuala Muda District, Kedah, Malaysia
Device, Questionnaire & Scale: Barthels index; Geriatric Depression Scale (GDS-30); Elderly Cognitive Assessment Questionnaire
Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population.
Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS).
Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE.
Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.
Probiotics are live microorganisms that can be found in fermented foods and cultured milk, and are widely used for the preparation of infant food. They are well-known as "health friendly bacteria", which exhibit various health beneficial properties such as prevention of bowel diseases, improving the immune system, for lactose intolerance and intestinal microbial balance, exhibiting antihypercholesterolemic and antihypertensive effects, alleviation of postmenopausal disorders, and reducing traveller's diarrhoea. Recent studies have also been focused on their uses in treating skin and oral diseases. In addition to that, modulation of the gut-brain by probiotics has been suggested as a novel therapeutic solution for anxiety and depression. Thus, this review discusses on the current probiotics-based products in Malaysia, criteria for selection of probiotics, and evidences obtained from past studies on how probiotics have been used in preventing intestinal disorders via improving the immune system, acting as an antihypercholesterolemic factor, improving oral and dermal health, and performing as anti-anxiety and anti-depressive agents.
Objective. This study aims to highlight the subjective experience of an immigrant Pakistani woman during postnatal depression (PND), with a special emphasis on the husband's knowledge and behaviour towards PND.
Methods. A face-to-face interview was conducted with a woman reporting symptoms of depression on the fourth day after delivery. She was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV)(1) and the Edinburgh Postnatal Depression Rating Scale (EPDRS).(2) The evaluations were completed by a qualified psychiatrist. The demographic information, personal and family medical history and attitude towards the child were the principal issues recorded. In addition, five items were used to evaluate the husband's knowledge about PND. The EPDRS differences before and after counselling were evaluated using a student t-test.
Results. The patient was 32 years old and this was her first experience of delivery by Caesarean section. The evaluation for depression confirmed the diagnosis of PND and she scored 16 on the EPDRS. The husband's knowledge of PND was poor.
Conclusion. This case study suggests that lack of social support and understanding appear to play a vital role in the persistence of symptoms of PND among new mothers. Therefore, counselling of couples may be an effective additional tool in treating PND.
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.
The purpose of this study was to investigate whether there were gender-specific depressive symptom profiles or gender-specific patterns of psychotropic agent usage in Asian patients with depression.
OBJECTIVE: As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries.
METHODS: This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling.
RESULTS: Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose.
CONCLUSIONS: The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.
This is a 4 week, randomized, double-blind, placebo-controlled study to examine the effects of methylphenidate as add-on therapy to mirtazapine compared to placebo for treatment of depression in terminally ill cancer patients. It involved 88 terminally ill cancer patients from University of Malaya Medical Centre, Kuala Lumpur, Malaysia. They were randomized and treated with either methylphenidate or placebo as add on to mirtazapine. The change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to day 3 was analyzed by linear regression. Changes of MADRS and Clinical Global Impression-Severity Scale (CGI-S) over 28 days were analyzed using mixed model repeated measures (MMRM). Secondary analysis of MADRS response rates, defined as 50% or more reduction from baseline score. A significantly larger reduction of Montgomery-Åsberg Depression Rating Scale (MADRS) score in the methylphenidate group was observed from day 3 (B=4.14; 95% CI=1.83-6.45). Response rate (defined as 50% or more reduction from baseline MADRS score) in the methylphenidate treated group was superior from day 14. Improvement in Clinical Global Impression-Severity Scale (CGI-S) was greater in the methylphenidate treated group from day 3 until day 28. The drop-out rates were 52.3% in the methylphenidate group and 59.1% in the placebo group (relative risk=0.86, 95%CI=0.54-1.37) due to cancer progression. Nervous system adverse events were more common in methylphenidate treated subjects (20.5% vs 9.1%, p=0.13). In conclusions, methylphenidate as add on therapy to mirtazapine demonstrated an earlier antidepressant response in terminally ill cancer patients, although at an increased risk of the nervous system side effects.
SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.
"Comfort women" refers to young women and girls who were forced into sexual slavery by the Imperial Japanese military during World War II. They were abducted from their homes in countries under Imperial Japanese rule, mostly from Korea, and the rest from China, Philippines, Malaysia, Taiwan, Indonesia, the Netherlands, etc. "Comfort women" endured extreme trauma involving rape, sexual torture, physical abuse, starvation, threats of death, and witnessed many others being tortured and killed. This article reviews all the studies that have investigated the psychiatric or psychosocial sequelae of the survivors of the Japanese military sexual slavery. Most importantly, a recent study which conducted a psychiatric evaluation on the former "comfort women" currently alive in South Korea is introduced. The participants' unmarried rate was relatively high and their total fertility rate was relatively low. Majority of the participants reported having no education and being the low economic status. They showed high current and lifetime prevalence of posttraumatic disorder, major depressive disorder, somatic symptom disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Participants showed high suicidality and majority of the participants still reported being ashamed of being former "comfort women" after all these years. This article high-lights the fact that the trauma has affected the mental health and social functioning of former "comfort women" throughout their lives, and even to the present day.
The role of marital breakdown in women's mental health is of key concern in Malaysia and internationally. A cross-sectional questionnaire study of married and separated/divorced and widowed women examined insecure attachment style as an associated risk factor for depression among 1002 mothers in an urban community in Malaysia. A previous report replicated a UK-based vulnerability-provoking agent model of depression involving negative evaluation of self (NES) and negative elements in close relationships (NECRs) interacting with severe life events to model depression. This article reports on the additional contribution of insecure attachment style to the model using the Vulnerable Attachment Style Questionnaire (VASQ). The results showed that VASQ scores were highly correlated with NES, NECR and depression. A multiple regression analysis of depression with backward elimination found that VASQ scores had a significant additional effect. Group comparisons showed different risk patterns for single and married mothers. NES was the strongest risk factor for both groups, with the 'anxious style' subset of the VASQ being the best additional predictor for married mothers and the total VASQ score (general attachment insecurity) for single mothers. The findings indicate that attachment insecurity adds to a psychosocial vulnerability model of depression among mothers cross-culturally and is important in understanding and identifying risk.
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.
The study on Clustering of Lifestyle risk factors and Understanding its association with Stress on health and wellbeing among school Teachers in Malaysia (CLUSTer) is a prospective cohort study which aims to extensively study teachers in Malaysia with respect to clustering of lifestyle risk factors and stress, and subsequently, to follow-up the population for important health outcomes.
This article describes the methodology of this bibliography. A search was conducted on the following: (1) bibliographic databases (PubMed, Scopus, and other databases) using search terms that maximize the retrieval of Malaysian publications; (2) Individual journal search of Malaysian healthrelated journals; (3) A targeted search of Google and Google Scholar; (4) Searching of Malaysian institutional repositories; (5) Searching of Ministry of Health and Clinical Research Centre website. The publication years were limited to 2000- 2013. The citations were imported or manually entered into bibliographic software Refworks. After removing duplicates, and correcting data entry errors, PubMed's Medical Subject Headings (MeSH terms) were added. Clinical research is coded using the definition "patient-oriented-research or research conducted with human subjects (or on material of human origin) for which the investigator directly interacts with the human subjects at some point during the study." A bibliography of citations [n=2056] that fit the criteria of clinical research in Malaysia in selected topics within five domains was generated: Cancers [589], Cardiovascular diseases [432], Infections [795], Injuries [142], and Mental Health [582]. This is done by retrieving citations with the appropriate MESH terms, as follow: For cancers (Breast Neoplasms; Colorectal Neoplasms; Uterine Cervical Neoplasms), for cardiovascular diseases (Coronary Disease; Hypertension; Stroke), for infections (Dengue; Enterovirus Infections, HIV Infections; Malaria; Nipah Virus; Tuberculosis), for injuries (Accidents, Occupational; Accidents, Traffic; Child Abuse; Occupational Injuries), for mental health (Depression; Depressive Disorder; Depressive Disorder, Major; Drug Users; Psychotic Disorders; Suicide; Suicide, Attempted; Suicidal Ideation; Substance- Related Disorders).