Displaying publications 161 - 180 of 422 in total

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  1. Nehzat F, Huda BZ, Tajuddin SH
    PMID: 24968690
    Job Content Questionnaire (JCQ) has been proven a reliable and valid instrument to assess job stress in many countries and among various occupations. In Malaysia, both English and Malay versions of the JCQ have been administered to automotive workers, schoolteachers, and office workers. This study assessed the reliability and validity of the instrument with research laboratory staff in a university. A cross sectional study was conducted among 258 research laboratory staff in Universiti Putra Malaysia (UPM). Malaysian laboratory staff who have worked for at least one year were randomly selected from nine faculties and institutes in the university that have research laboratory. A self-administered English and Malay version of Job Content Questionnaire (JCQ) was used. Three major scales of JCQ: decision latitude, psychological job demands, and social support were assessed. Cronbach's alpha coefficients of two scales were acceptable, decision latitude and psychological job demands (0.70 and 0.72, respectively), while Cronbach's alpha coefficient for social support (0.86) was good. Exploratory factor analysis showed five factors that correspond closely to the theoretical construct of the questionnaire. The results of this research suggest that the JCQ is reliable and valid for examining psychosocial work situations and job strain among research laboratory staff. Further studies should be done for confirmative results, and further evaluation is needed on the decision authority subscale for this occupation.
    Matched MeSH terms: Stress, Psychological/diagnosis*
  2. Natrah Rani, Faiz Daud, Hamidah Alias
    Int J Public Health Res, 2018;8(2):988-997.
    MyJurnal
    Introduction. The care of children with leukemia requires a high degree of observation and attention to ensure that the recommended treatment by the specialists is well implemented. This could somehow affect the social functionality, increase stress, anxiety and depression among caregivers of children with leukemia. Thus, this cross-sectional study was conducted to examine the prevalence and factors influencing stress, depression and anxiety among caregivers of
    children with leukemia.
    Methods. Number of sample is 54 respondents. Data were measured using the Bahasa Malaysia version of DASS-21 which was validated in previous study.
    Results The results showed that prevalence of low level stress among caregivers to children with leukemia was 88.9% while prevalence of high level stress was 11.1%. The prevalence of low level anxiety was 90.7% and the prevalence of
    high level anxiety was 9.3%. The prevalence of low level depression was 96.3% and the prevalence of high level depression was 3.7%. There were several factors that significantly influenced the stress and depression among
    the caregivers (p <0.05). Among the factors associated with stress status were the religion of caregivers and gender of the patients (p <0.05). Factors associated with depression status were the sex of caregivers and the relationship between caregivers and family members (p <0.05).
    Conclusions. In conclusion, socio demographic factors and the relationship between caregivers and family members affect stress and depression among caregivers while factors of knowledge-level do not affect stress, anxiety and depression among caregivers. Strategies are needed to help reduce stress, anxiety and depression among caregivers of children with leukemia.
    Keywords: Stress - Anxiety - Depression - Caregivers - Children with leukemia.
    Matched MeSH terms: Stress, Psychological
  3. Nathan AM, Muthusamy A, Thavagnanam S, Hashim A, de Bruyne J
    Pediatr Pulmonol, 2014 May;49(5):435-40.
    PMID: 24482322 DOI: 10.1002/ppul.23001
    To investigate the impact of chronic suppurative lung disease (CSLD) on growth and lung function in the child as well as quality of life of the child and parent.
    Matched MeSH terms: Stress, Psychological/psychology
  4. Narkunam N, Hashim AH, Sachdev MK, Pillai SK, Ng CG
    Asia Pac Psychiatry, 2014 Jun;6(2):207-16.
    PMID: 23857633 DOI: 10.1111/j.1758-5872.2012.00216.x
    Attention deficit hyperactivity disorder (ADHD) is a chronic debilitating illness with onset in early childhood. The objective of this study was to look at the impact of children with ADHD on their parents.
    Matched MeSH terms: Stress, Psychological/psychology*
  5. Nachiappan M, Bikramjit P, Aung WT, Htoo HKS, Sudipta P
    Med J Malaysia, 2020 05;75(3):209-215.
    PMID: 32467534
    INTRODUCTION: Simulation of the clinical setting incorporates an educational approach connecting a learner to a particular environment of learning. Undergraduate students in the health sector experience anxiety during simulation that influences their performance which ultimately affects their learning outcome. This study attempts to correlate the impact of stressors on learning outcome of high-fidelity patient simulation (HFPS) in undergraduate medical education.

    OBJECTIVE: This research is to analyze the impact of stressors and its relevance on the learning outcome of HFPS as a teaching-learning tool for the management of emergency surgical conditions including trauma.

    MATERIALS AND METHODS: This study is a Quasi-experimental time series design. A total number of 347 final-year undergraduate (MBBS) students of Melaka-Manipal Medical College, Malaysia. They were grouped and assessed individually by pre-test and post-tests on their knowledge, performance and associated stressor scores. The one-way repeated measure of Analysis of Variance (ANOVA) was used to determine the statistically significant differences in total score at pre-test simulation and post-test-simulation sessions. Friedman test was used for assessment of individual components of stressors. Pre-test and post-tests scores were compared to note progress in confidence and stress reduction. P value <0.001 was considered statistically significant.

    RESULTS: ANOVA with Bonferroni post hoc analysis showed a statistically significant (p <0.001) difference in stressor score over time. The drop-in stress was significant initially but flattened out later.

    CONCLUSION: Stress significantly decreased as the students were exposed to more sessions of HFPS which ultimately translated into better learning outcome.

    Matched MeSH terms: Stress, Psychological*
  6. Myint K, Jacobs K, Myint AM, Lam SK, Henden L, Hoe SZ, et al.
    PLoS One, 2021;16(6):e0252668.
    PMID: 34081742 DOI: 10.1371/journal.pone.0252668
    The effects of stress on the neuroendocrine, central nervous and immune systems are extremely complex. The kynurenine pathway (KP) of the tryptophan metabolism is recognised as a cross-link between the neuroendocrine- and immune systems. However, the effects of acute stress from everyday life on KP activation have not yet been studied. This study aims to investigate changes in the levels of the KP neuroactive metabolites and cytokines in response to stress triggered by academic examinations. Ninety-two healthy first year medical students benevolently participated in the study. Parameters were measured pre- examination, which is considered to be a high-stress period, and post-examination, as a low-stress period. Stress induced by academic examinations significantly increases the perceived stress scores (p<0.001), serum cortisol levels (p<0.001) and brain-derived neurotrophic factor (BDNF) levels (p<0.01). It decreased IL-10 levels (p<0.05) but had no effect on IL-6 and TNF-alpha levels. Only the KP neuroactive metabolite, 3-hydroxykynurenine (3-HK) significantly increased (p<0.01) in the post-examination period. In addition, the stress scores positively correlated with the levels of cortisol (r2 = 0.297, p<0.01) at post examination. Acute stress triggered by academic examinations increases cortisol and BDNF production and suppresses the anti-inflammatory cytokine, IL-10, but did not increase significantly the levels of other pro-inflammatory cytokines, tryptophan, kynurenine and downstream KP metabolites. The concomitant increased levels of BDNF under the duress of acute examination stress appear to limit the levels pro-inflammatory markers, which may attenuate the action of cortisol and the neuroinflammatory branch of the KP.
    Matched MeSH terms: Stress, Psychological*
  7. Mutang JA, Chua BS, Hon KY, Siau CS, Wider W, Ismail R
    Int J Environ Res Public Health, 2022 Sep 07;19(18).
    PMID: 36141527 DOI: 10.3390/ijerph191811258
    The COVID-19 pandemic has had a huge impact not only on healthcare systems and economic threats but also on relationships. Due to the massive measures of the Movement Control Order, such as social distancing, strictly limited physical activities, and making adjustments to working from home-merged with the pandemic's fear-romantic partners may face challenges that affect the quality of their relationships. The purpose of this study was to (i) identify stressors experienced by participants during the COVID-19 lockdown, (ii) evaluate participants'psychological well-being before and during the lockdown, and (iii) see if participants' perceived relationship quality differed before and during the lockdown. An online self-report questionnaire was used to recruit 334 adults (58.1 percent female, 41.9 percent male) with partners (married = 304, engaged = 12, and in committed relationships = 17). Participants were asked about stressors they encountered as a result of COVID-19 using an open-ended question. The Depression Anxiety Stress Scales (DASS-21) were used to assess mental health, and the Perceived Relationship Quality Component (PRQC) Inventory was used to assess relationship quality. According to the findings, the top three common stressors reported by participants were financial problems, restricted movement, and fear of COVID-19 infection. Participants reported significantly higher levels of stress, anxiety, and depression during the lockdown than before. The findings also revealed that participants' relationship quality improved during the lockdown compared to before the lockdown. The current study contributes by providing information on the impact of the COVID-19 pandemic on mental health and the quality of couples' relationships during the pandemic.
    Matched MeSH terms: Stress, Psychological/epidemiology; Stress, Psychological/psychology
  8. Musa R, Ramli R, Yazmie AW, Khadijah MB, Hayati MY, Midin M, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S65-9.
    PMID: 23433218 DOI: 10.1016/j.comppsych.2013.01.001
    Studies from Western countries have observed that couples undergoing infertility treatment suffer various physical and psychological difficulties at a higher frequency than the comparable general population. These relate to treatment challenges and other psychosocial stressors, often influenced by coping style, personality factors and available support systems. There is paucity of studies in non-Western populations.
    Matched MeSH terms: Stress, Psychological/psychology
  9. Musa R, Draman S, Jeffrey S, Jeffrey I, Abdullah N, Halim NA, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S13-6.
    PMID: 23318005 DOI: 10.1016/j.comppsych.2012.12.002
    In 2004, the province of Aceh, Indonesia was rocked by tsunami and in September 2009, West Sumatra, Indonesia was hit by an earthquake. The aim of this study was to determine the long-term psychological impact on the residents inhabiting these regions and to identify factors associated with it.
    Matched MeSH terms: Stress, Psychological/etiology; Stress, Psychological/epidemiology*
  10. Murthy KD, George MC, Ramasamy P, Mustapha ZA
    Indian J Exp Biol, 2013 Dec;51(12):1070-8.
    PMID: 24579372
    Mother-offspring interaction begins before birth. The foetus is particularly vulnerable to environmental insults and stress. The body responds by releasing excess of the stress hormone cortisol, which acts on glucocorticoid receptors. Hippocampus in the brain is rich in glucocorticoid receptors and therefore susceptible to stress. The stress effects are reduced when the animals are placed under a model wooden pyramid. The present study was to first explore the effects of prenatal restraint-stress on the plasma corticosterone levels and the dendritic arborisation of CA3 pyramidal neurons in the hippocampus of the offspring. Further, to test whether the pyramid environment would alter these effects, as housing under a pyramid is known to reduce the stress effects, pregnant Sprague Dawley rats were restrained for 9 h per day from gestation day 7 until parturition in a wire-mesh restrainer. Plasma corticosterone levels were found to be significantly increased. In addition, there was a significant reduction in the apical and the basal total dendritic branching points and intersections of the CA3 hippocampal pyramidal neurons. The results thus suggest that, housing in the pyramid dramatically reduces prenatal stress effects in rats.
    Matched MeSH terms: Stress, Psychological*
  11. Mulud ZA, McCarthy G
    Arch Psychiatr Nurs, 2017 Feb;31(1):24-30.
    PMID: 28104054 DOI: 10.1016/j.apnu.2016.07.019
    The association between the socio-demographic characteristics of caregivers, such as gender and caregiver burden, is well documented; however, the process underlying this relationship is poorly understood. Based on the stress process model, we designed a cross-sectional study to examine the mediating and moderating effect of resilience on the relationship between gender and caregiver burden. Caregivers of individuals with severe mental illness (n=201) were recruited in two psychiatric outpatient clinics in Malaysia. The relationship between the gender of the caregiver and caregiver burden was mediated by resilience, thus supporting the stress process model. The findings from the present research contribute to the growing evidence of the interaction between socio-demographic variables of caregivers and resilience, and caregiver burden.

    Study site:Two clinics in West Malaysia Clinic A is located in the Klang administrative district, while clinic B is underthe Petaling administrative district
    Matched MeSH terms: Stress, Psychological/psychology
  12. Muhamad Saiful Bahri Yusoff
    ASEAN Journal of Psychiatry, 2010;11(2):143-157.
    MyJurnal
    Objective: In the process of growing, adolescents experience stress either good or bad depending on how they cope. School training further adds to this stressful situation. It is noteworthy that persistent over stress will impair students’ academic achievement, personal and professional development. This preliminary study is meant to obtain initial data on the stress prevalence, stressors, and coping strategies among secondary school children in Malaysia. Data gained from this preliminary study provides valuable data for subsequence research in the future. Methods: This is a cross-sectional study involving 100 secondary school students from a Malaysian government secondary school. The validated Malay version 12-item General Health Questionnaire (GHQ-12), Soalselidik Stressor Sekolah Menengah (SSSM) and Malay version of Brief COPE were used to identify stress level, stressors, and coping strategies. Results: A number of 90 (90%) students participated in this study. The prevalence of stress among secondary school students was 26.1%. It was found that the main stressors were related to academic. The top five coping strategies were religion, positive reinterpretation, active coping, planning, and use of instrumental support. Conclusion: The prevalence of stress among secondary school students in a Malaysian
    stressor among the students. The most frequent coping strategies being used by the students were positive coping strategies.
    Matched MeSH terms: Stress, Psychological
  13. Muhamad Saiful Bahri Yusoff, Ahmad Fuad Abdul Rahim, Abdul Aziz Baba, Shaiful Bahari Ismail, Hatta Sidi, Ab Rahman Esa
    Sains Malaysiana, 2013;42:423-428.
    The study of medicine is often regarded by students as a stressful environment particularly during examination period. Studies found a high percentage of medical students experience significant psychological distress during the examination period. This study compared percentage and level of psychological distress between two batches of first year medical students who underwent different selection admission processes during a stressful examination period. A comparative
    cross-sectional study was done on two batches of first year medical students; one group selected based on academic merit (2008/2009 batch) and the other selected based on academic merit, psychometric tests and interview (2009/2010 batch). The psychological distress was measured by the 12-item general health questionnaire (GHQ-12). The data were collected right after the final examinations. A total of 99 (46.05%) medical students of the 2008/2009 batch and 196 (100%) medical students of the 2009/2010 batch participated. The percentage of medical students who had psychological distress of the 2008/2009 and the 2009/2010 batches were 58.59% and 42.3%, respectively. The mean GHQ-12 score and percentage of psychological distress were significantly different between the two batches (p< 0.01). The older batch had 2.01 times higher risk for developing psychological distress compared with the newer batch (p< 0.01). The newer batch
    of medical students had better psychological health status and was less likely to develop psychological distress during the stressful period compared with older batch.
    Matched MeSH terms: Stress, Psychological
  14. Muhamad M, Afshari M, Kazilan F
    Asian Pac J Cancer Prev, 2011;12(6):1389-97.
    PMID: 22126470
    This paper raises issues about the role of family members in providing support for breast cancer survivors. Data were collected from 400 breast cancer survivors in Peninsular Malaysia through a custom-designed questionnaire fielded at hospitals and support group meetings. The data were analyzed using descriptive statistics. The analyses show that all family members could be supportive, especially in decision making and help with emotional issues. The spouse was the main support provider among the family members (others were children, parents, siblings and more distant relatives). The results also indicated that a significant percentage practiced collaborative decision-making. Breast cancer survivors needed their family members' support for information on survivorship strategies such as managing emotions, health, life style and dietary practice. The family members' supportive role may be linked to the Malaysian strong family relationship culture. For family members to contribute more adequately to cancer survivorship, it is suggested that appropriate educational intervention also be provided to them.
    Matched MeSH terms: Stress, Psychological
  15. Moy FM, Hoe VC, Hairi NN, Buckley B, Wark PA, Koh D, et al.
    BMC Public Health, 2014;14:611.
    PMID: 24938383 DOI: 10.1186/1471-2458-14-611
    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.
    Matched MeSH terms: Stress, Psychological/etiology*; Stress, Psychological/epidemiology
  16. Moy FM, Ng YH
    Sci Prog, 2021;104(3):368504211029812.
    PMID: 34260295 DOI: 10.1177/00368504211029812
    The COVID-19 pandemic has disrupted the lives of all including university students. With the preventive measures to reduce the transmission of COVID-19, all face-to-face teaching and learning are converted to e-learning. The COVID-19 pandemic and the implementation of e-learning may influence these students' mental conditions. This study aimed to determine the association of factors with mental health status (depression, anxiety and stress) among university students in Malaysia. Study participants were tertiary education students from both the private and public universities in Malaysia. Participants were recruited via university emails and social media. The survey was administered via the online REDCap platform, from April to June 2020, during the movement control order period in the country. The questionnaire captured data on socio-demographic characteristics, academic information, implementation of e-learning, perception towards e-learning and COVID-19; as well as DASS 21 to screen for depression, anxiety and stress. The levels of stress, anxiety and depression were 56.5% (95% CI: 50.7%, 62.1%), 51.3% (95% CI: 45.6%, 57.0%) and 29.4% (95% CI: 24.3%, 34.8%) respectively. Most participants had good perception towards e-learning but negative perception on COVID-19. From the multivariate analysis, participants with positive perception on COVID-19 were protective towards stress (aOR: 0.96; 95% CI: 0.92, 0.99), anxiety (aOR: 0.94, 95% CI: 0.90, 0.98) and depression (aOR: 0.95; 95% CI: 0.91, 0.99). Older students were 14% (aOR: 0.86, 95% CI: 0.79, 0.94) and 11% (aOR: 0.89: 95% CI: 0.80, 0.99) less likely for anxiety and depression, respectively. Students originated from the Malay ethnicity had higher odds (aOR: 1.93; 95% CI: 1.05, 3.56) for depression. These findings demonstrated that the mental status of university students was greatly affected during the COVID-19 pandemic. Timely and credible information should be disseminated to alleviate their negative perception towards COVID-19.
    Matched MeSH terms: Stress, Psychological/epidemiology*
  17. Mohd Yusoff H, Mohd Tamil A, Mohd Fauzi MF, Mat Saruan NA
    MyJurnal
    Pre-hypertension, a classification of blood pressure ranging from 120–139 mm Hg systolic and/or 80–89 mm Hg diastolic, has been introduced to identify those high-risk group of developing hypertension to implement early intervention to halt disease progression. This study determines the prevalence of pre-hypertension and its determinants among undergraduate preclinical medical students in Malaysia.
    Materials & Methods: This was a cross-sectional study conducted among 158 registered second year medical students at one research university in central Malaysia from January to April 2018.
    Results: The prevalence of pre-hypertension was 20.6% among undergraduate preclinical medical students. The most respondent was female (69.9%), Malay ethnic (50.6%) who had normal body mass index (67.3%), no depression (79.5%), no anxiety (60.3%), no stress (68.6%), low physical activity level (44.9%), never smoked (95.5%), and never consumed alcohol (87.8%). Some respondents had positive family history of hypertension (43.6%) and diabetes mellitus (31.4%). After adjusted for all variables, gender (AOR=14.45, 95% CI 5.58-37.43) and depression status (AOR=6.37, 95% CI 1.29-31.49) were significantly associated with pre-hypertension.
    Conclusion: The prevalence of pre-hypertension among preclinical medical students was lower compared to other country, predicted by gender and depression status. However, further comprehensive multicentered studies in Malaysia with larger sample size is recommended to get more precise results in identifying determinants for pre-hypertension so that early intervention could be implemented nationwide.
    Matched MeSH terms: Stress, Psychological
  18. Mohd Sidik S, Arroll B, Goodyear-Smith F
    Br J Gen Pract, 2011 Jun;61(587):e326-32.
    PMID: 21801511 DOI: 10.3399/bjgp11X577990
    Background: This is the first study investigating Anxiety among women attending a primary care clinic
    in Malaysia.
    Aim: The objective was to determine the factors associated with anxiety among these women.
    Design: This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive female patients attending the clinic during the data-collection period were invited to participate in the study.
    Method: Participants were given self-administered questionnaires, which included the validated Generalised Anxiety Disorder-7 questionnaire (GAD-7) Malay version to detect anxiety.
    Results: Of the 1023 patients who were invited, 895 agreed to participate (response rate 87.5%). The prevalence of anxiety in this study was 7.8%, based on the GAD-7 (score ≥8). Multiple logistic regression analysis found that certain stressful life events and the emotional aspect of domestic violence were significantly associated with anxiety (P<0.05).
    Conclusion: The prevalence of anxiety among women in this study is similar to that found in other countries.
    Factors found to be associated with anxiety, especially issues on domestic violence, need to be addressed andmanaged appropriately.
    Keywords: anxiety; Malaysia; prevalence; primary care; women.
    Questionnaire: Generalized Anxiety Disorder scale; GAD-7 (Malay version); Hark questionnaire
    Matched MeSH terms: Stress, Psychological/etiology; Stress, Psychological/epidemiology
  19. Mohd Shukri NH, Wells J, Eaton S, Mukhtar F, Petelin A, Jenko-Pražnikar Z, et al.
    Am J Clin Nutr, 2019 07 01;110(1):121-130.
    PMID: 31161202 DOI: 10.1093/ajcn/nqz033
    BACKGROUND: Biological signaling and communication between mothers and infants during breastfeeding may shape infant behavior and feeding. This signaling is complex and little explored in humans, although it is potentially relevant for initiatives to improve breastfeeding rates.

    OBJECTIVES: The aim of this study was to investigate physiological and psychological aspects of mother-infant signaling during breastfeeding experimentally, testing the effects of a relaxation intervention on maternal psychological state, breast milk intake, milk cortisol levels, and infant behavior and growth.

    METHODS: Primiparous breastfeeding mothers and full-term infants were randomly assigned to receive relaxation therapy [intervention relaxation group; n = 33 (RG)] or to the control group [n = 31 (CG); no relaxation therapy] at 2 wk postpartum. Both groups received standard breastfeeding support. Home visits were conducted at 2 (HV1), 6 (HV2), 12 (HV3) and 14 (HV4) wk to measure maternal stress and anxiety, breast milk intake and milk cortisol, and infant behavior and growth.

    RESULTS: RG mothers had lower stress scores postintervention than the CG (HV3 ∆ = -3.13; 95% CI: -5.9, -0.3) and lower hindmilk cortisol at HV1 (∆ = -44.5%; 95% CI: -76.1%, -12.9%) but not at HV2. RG infants had longer sleep duration (∆ = 82 min/d; 95% CI: 16, 149 min/d) at HV2 and higher gains in weight and body mass index standardized deviation score than the CG infants (∆ = 0.76; 95% CI: 0.3, 1.22; and ∆ = 0.59; 95% CI: 0.09, 1.1, respectively). RG infants had a mean milk intake at HV3 that was 227 g/d higher than that of the CG infants (P = 0.031) after controlling for gender and milk intake at HV1.

    CONCLUSIONS: The trial shows the effectiveness of a simple relaxation intervention for improving maternal and infant outcomes and identifies some potential signaling mechanisms for investigation in future and larger studies, especially in settings where mothers are more stressed, such as those with preterm or low birth weight infants. This trial was registered at clinicaltrials.gov as NCT01971216.

    Matched MeSH terms: Stress, Psychological/epidemiology
  20. Mohd Nordin NA, Hui Shan E, Zanudin A
    PMID: 31888294 DOI: 10.3390/ijerph16245145
    The overall care for children with cerebral palsy (CP) is challenging to the family which causes significant impacts to their livelihood. There is limited qualitative research that reports the unmet needs of parents with physically disabled children, especially highly dependent CP. The aim of this study was to explore the unmet needs of parents of highly dependent children with CP. A qualitative study using semi-structured face to face interviews was carried out among nine parents of children with CP with gross motor classification function score (GMFCS) levels III, IV, and V. The interviews were tape-recorded and transcribed verbatim. Transcribed data was analysed using thematic analysis method. Several unmet needs were highlighted by the parents; namely the needs in receiving information regarding CP conditions, getting psychological and financial support and explaining the child's condition to strangers. In addition, parents expressed the need for better support from the social welfare department, as well as in effectively organising family functioning. The findings of this study indicate that there is a need for the healthcare professionals to develop suitable strategies to assist the parents of highly dependent children with CP in fulfilling their specific needs. The role of relevant agencies should be optimised in addressing this area of concern.
    Matched MeSH terms: Stress, Psychological
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