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The economic cost of mental disorders in Malaysia

Chua SN

Lancet Psychiatry, 2020 04;7(4):e23.
PMID: 32199512 DOI: 10.1016/S2215-0366(20)30091-2
Regulating food labels in East Asia: A tale of two systems: Commentary on Negowetti et al. (2021)

Chua SN, Berg KC

Int J Eat Disord, 2022 Jan;55(1):55-58.
PMID: 34562037 DOI: 10.1002/eat.23618

The traditional role of food in promoting health and preventing illness is integral to many Asian cultures. This commentary provides a brief overview of health-related food products regulation in Asia. We cover regulations initiated to promote health and prevent chronic diseases and regulations of traditional medicine food products. We focus on specific regulations in Japan and Singapore that encourage the consumption of certain foods to promote population health and prevent chronic diseases. We also examine the complexity and difficulty of regulating traditional medicine food products in Malaysia and Singapore, where these products are important not just for health but also in promoting cultural traditions.
Social media, traditional media, and other body image influences and disordered eating and cosmetic procedures in Malaysia, Singapore, Thailand, and Hong Kong

Chua SN, Craddock N, Rodtanaporn W, Or F, Austin SB

Body Image, 2023 Jun;45:265-272.
PMID: 37011471 DOI: 10.1016/j.bodyim.2023.03.010

In this study, we investigated the association between perceived sociocultural influences and the 3-month prevalence of disordered weight-control behaviors and lifetime prevalence of cosmetic procedures in four Asian countries, and if these associations were modified by gender. We conducted a cross-sectional online survey in September 2020 among adults ages 18-91 years (N = 5294) in Malaysia, Singapore, Thailand and Hong Kong. The 3-month prevalence of disordered weight control behaviors ranged from 25.2 % (Singapore) to 42.3 % (Malaysia), while the lifetime prevalence of cosmetic procedures ranged from 8.7 % (Singapore) to 21.3 % (Thailand). Participants who perceived their body image to be influenced by sociocultural factors were more likely to engage in disordered weight control behaviors (RRs ranged from 2.05 to 2.12) and have cosmetic procedures (RRs ranged from 2.91 to 3.89) compared to participants who perceived no sociocultural influence. Men who were influenced by traditional or social media were more likely to engage in disordered weight control behaviors and have cosmetic procedures than similarly influenced women. The high 3-month prevalence of disordered weight control behaviors and lifetime prevalence of cosmetic procedures in Asia is concerning. More research is needed to develop effective preventive interventions in Asia for men and women to promote a healthy body image.
Fulltext Comparison and optimization of conventional and ultrasound-assisted solvent extraction for synthetization of lemongrass (Cymbopogon)-infused cooking oil

Lim SF, Hamdan A, David Chua SN, Lim BH

Food Sci Nutr, 2021 May;9(5):2722-2732.
PMID: 34026085 DOI: 10.1002/fsn3.2234

The lemongrass plant, which is widely cultivated in Asia, Australia, and Africa, has been reported to have many significant health benefits such as antimicrobial, insecticide, anticancer, fight fever, and disinfection. Therefore, it is an added benefit to have lemongrass compounds in cooking oil. This study was aimed to compare the conventional (CSE), and ultrasound-assisted solvent extraction (UASE) for citral compounds from lemongrass (Cymbopogon) leaves and to optimize the best extraction method using the response surface methodology (RSM) and ANOVA. RSM design of experiments using three types of cooking oils; palm oil, sunflower oil, and corn oil. The effect of three independent variables, which are temperature (48.2-81.8°C), extraction time (4.8-55.2 min), and solvent to leaves ratio (5.3-18.7), was investigated. The characterization of lemongrass-infused cooking oil was evaluated by Fourier transform infrared spectroscopy (FT-IR), Gas Chromatography-Mass Spectrometry (GC-MS) and Scanning Electron Microscopy (SEM) analysis for confirmation of the citral compound extraction. This extraction process is optimized using Response Surface Methodology (RSM) for producing the lemongrass-infused cooking oil. After optimization, the UASE process gives 1.009 × 106 maximum citral area for palm oil and 1.767 × 106 maximum citral area for sunflower oil. CSE process only can give 2.025 × 105 and 2.179 × 105 citral area in the GC-MS spectrum for palm oil and sunflower oil respectively. For both the UASE and the CSE, the optimum operating conditions are 81.8°C of extraction temperature and 55.2 min of extraction time except for lemongrass-infused palm oil in the CSE process with 45 min extraction time. The optimum solvent to leaves ratio varies from 5.3:1 to 12.9:1. This study found that corn oil cannot be used as a solvent to extract lemongrass-infused cooking oil due to the insignificant changes and no citral peak. The lemongrass (Cymbopogon)-infused palm oil and sunflower oil extracted using the UASE have a higher maximum citral area than the CSE process.
For God (or) country: the hydraulic relation between government instability and belief in religious sources of control

Kay AC, Shepherd S, Blatz CW, Chua SN, Galinsky AD

J Pers Soc Psychol, 2010 Nov;99(5):725-39.
PMID: 20954784 DOI: 10.1037/a0021140

It has been recently proposed that people can flexibly rely on sources of control that are both internal and external to the self to satisfy the need to believe that their world is under control (i.e., that events do not unfold randomly or haphazardly). Consistent with this, past research demonstrates that, when personal control is threatened, people defend external systems of control, such as God and government. This theoretical perspective also suggests that belief in God and support for governmental systems, although seemingly disparate, will exhibit a hydraulic relationship with one another. Using both experimental and longitudinal designs in Eastern and Western cultures, the authors demonstrate that experimental manipulations or naturally occurring events (e.g., electoral instability) that lower faith in one of these external systems (e.g., the government) lead to subsequent increases in faith in the other (e.g., God). In addition, mediation and moderation analyses suggest that specific concerns with order and structure underlie these hydraulic effects. Implications for the psychological, sociocultural, and sociopolitical underpinnings of religious faith, as well as system justification theory, are discussed.
Fulltext Estimated prevalence of eating disorders in Malaysia based on a diagnostic screen

Chua SN, Fitzsimmons-Craft EE, Austin SB, Wilfley DE, Taylor CB

Int J Eat Disord, 2022 Jun;55(6):763-775.
PMID: 35366018 DOI: 10.1002/eat.23711

Eating disorders (EDs) are debilitating health conditions and common across cultures. Recent reports suggest that about 14.0% of university students in Malaysia are at risk for developing an ED, and that prevalence may differ by ethnicity and gender. However, less is known about the prevalence of EDs in nonuniversity populations.
OBJECTIVE: The current study seeks to (1) estimate the prevalence of EDs and ED risk status among adults in Malaysia using an established diagnostic screen; (2) examine gender and ethnic differences between ED diagnostic/risk status groups; and (3) characterize the clinical profile of individuals who screen positive for an ED.
METHOD: We administered the Stanford-Washington University Eating Disorder Screen, an online ED screening tool, to adults in Malaysia in September 2020.
RESULTS: ED risk/diagnostic categories were assigned to 818 participants (ages 18-73 years) of which, 0.8% screened positive for anorexia nervosa, 1.4% for bulimia nervosa, 0.1% for binge-ED, 51.4% for other specified feeding or ED, and 4.8% for avoidant/restrictive food intake disorder. There was gender parity in the high risk and the overall ED categories. The point prevalence of positive eating pathology screening among Malays was significantly higher than Chinese but no different from Indians.
DISCUSSION: This is the first study to estimate the prevalence of EDs using a diagnostic screen in a population-based sample of Malaysians. It is concerning that over 50% of Malaysians reported symptoms of EDs. This study highlights the need to invest more resources in understanding and managing eating pathology in Malaysia.
PUBLIC SIGNIFICANCE: This study estimates the prevalence of EDs among adults in Malaysia using an online EDs screen. Over 50% of Malaysians report symptoms of EDs. The study highlights the need for more resources and funding to address this important public health issue through surveillance, prevention, and treatment of EDs in Malaysia.
Toward a memory perspective on eating psychopathology: An investigation of the types of childhood and adolescence memories that are associated with eating disorder symptoms

Philippe FL, Carbonneau N, Fortin A, Guilbault V, Bouizegarene N, Antunes JM, et al.

Appetite, 2024 Jul 01;198:107364.
PMID: 38642722 DOI: 10.1016/j.appet.2024.107364

The cognitive mechanisms through which specific life events affect the development and maintenance of eating disorders (ED) have received limited attention in the scientific literature. The present research aims to address this gap by adopting a memory perspective to explore the type of life events associated with eating psychopathology and how these events are encoded and reconstructed as memories. Two studies (n = 208 and n = 193) were conducted to investigate the relationship between specific memories and eating disorder psychopathology. Study 1 focused on parent-related memories, while Study 2 examined childhood/adolescence memories. Results from both studies revealed that need thwarting and shame in memories were associated with eating disorder symptoms, but only when individuals drew symbolic connections between these memories and food or eating behavior. Moreover, need thwarting and shame in such memories were associated with other eating and body image outcomes, including uncontrolled eating and body esteem. These results also held after controlling for a host of known predictors of eating disorder psychopathology, such as BMI, perfectionism, or thin ideal internalization. Overall, the present findings suggest that the reprocessing of memories symbolically and idiosyncratically linked to food and eating behavior might be a fruitful clinical intervention.
Impact of Digital Advertising Policy on Harmful Product Promotion: Natural Language Processing Analysis of Skin-Lightening Ads

Lu J, Chua SN, Kavanaugh JR, Prashar J, Ndip-Agbor E, Santoso M, et al.

Am J Prev Med, 2024 Dec;67(6):811-819.
PMID: 39306774 DOI: 10.1016/j.amepre.2024.08.006

INTRODUCTION: Starting June 30, 2022, Google implemented its revised Inappropriate Content Advertising Policy, targeting discriminatory skin-lightening ads that suggest superiority of certain skin shades. This study evaluates the ad content changes from 2 weeks before to 2 weeks after the policy's enforcement.
METHODS: Text ads from Google searches in eight countries (Bahamas, Germany, India, Malaysia, Mexico, South Africa, United Arab Emirates, and United States) were collected in 2022, totaling 1,974 prepolicy and 3,262 post-policy ads, and analyzed in 2023. A gold standard database was established by two coders who labeled 707 ads, which trained five natural language processing models to label the ads, covering content and target demographics. The descriptive statistics and multivariable logistic models were applied to analyze content before versus after policy implementation, both globally and by country.
RESULTS: Vertex AI emerged as the best natural language processing model with the highest F1 score of 0.87. There were significant decreases from pre- to post-policy implementation in the prevalence of labels of "Racial or Ethnic Identification" and "Ingredients: Natural" by 47% and 66%, respectively. Notable differences were identified from pre- to post-policy implementation in India, Mexico, and Germany.
CONCLUSIONS: The study observed changes in skin-lightening product advertisement labels from pre- to post-policy implementation, both globally and within countries. Considering the influence of digital advertising on colorist norms, assessing digital ad policy changes is crucial for public health surveillance. This study presents a computational method to help monitor digital platform policies for consumer product advertisements that affect public health.
Sociodemographic Correlates of Mental Health Treatment Seeking Among College Students: A Systematic Review and Meta-Analysis

Pei J, Amanvermez Y, Vigo D, Puyat J, Kessler RC, Mortier P, et al.

Psychiatr Serv, 2024 Jan 31.
PMID: 38291886 DOI: 10.1176/appi.ps.20230414

OBJECTIVE: College students have high rates of mental health problems and low rates of treatment. Although sociodemographic disparities in student mental health treatment seeking have been reported, findings have not been synthesized and quantified. The extent to which differences in perceived need for treatment contribute to overall disparities remains unclear.
METHODS: A systematic search of PubMed, PsycInfo, and Embase was conducted. Studies published between 2007 and 2022 were included if they reported treatment rates among college students with mental health problems, stratified by sex, gender, race-ethnicity, sexual orientation, student type, student year, or student status. Random-effects models were used to calculate pooled prevalence ratios (PRs) of having a perceived need for treatment and of receiving treatment for each sociodemographic subgroup.
RESULTS: Twenty-one studies qualified for inclusion. Among students experiencing mental health problems, consistent and significant sociodemographic differences were identified in perceived need for treatment and treatment receipt. Students from racial-ethnic minority groups (in particular, Asian students [PR=0.49]) and international students (PR=0.63) reported lower rates of treatment receipt than White students and domestic students, respectively. Students identifying as female (sex) or as women (gender) (combined PR=1.33) reported higher rates of treatment receipt than students identifying as male or as men. Differences in perceived need appeared to contribute to some disparities; in particular, students identifying as male or as men reported considerably lower rates of perceived need than students identifying as female or as women.
CONCLUSIONS: Findings highlight the need for policy makers to address barriers throughout the treatment-seeking pathway and to tailor efforts to student subgroups to reduce treatment disparities.
International consensus on patient-centred outcomes in eating disorders

Austin A, De Silva U, Ilesanmi C, Likitabhorn T, Miller I, Sousa Fialho MDL, et al.

Lancet Psychiatry, 2023 Dec;10(12):966-973.
PMID: 37769672 DOI: 10.1016/S2215-0366(23)00265-1

The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.

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