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  1. Phang CK, Marhani M, Salina AA
    MyJurnal
    Introduction: Help-seeking pathway in psychiatry is the important link between the onset of a mental disorder and mental health service provision. Understanding of the help-seeking pathway can help us to device more effective strategies for early detection and treatment.
    Objectives: To determine the help-seeking pathways and treatment delaying factors of in-patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV - Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and treatment delaying factors were determined through face-to-face interview and semi-structured questionnaires.
    Results: The number of non-psychiatric helpseeking
    contacts prior to first consultation with psychiatric service ranged from 0 to 10. The mean number of contacts was 2.3 ( 2.6), and median was 1 (IQR = 0 to 3). About a third of them (32%) had three or more non-psychiatric contacts. The most common point of first non-psychiatric contact was with traditional healer 24 (48%), followed by general practitioners 12 (24%), and only 14 (28%) of them sought help directly from psychiatric service. The most common reason reported for delay in seeking psychiatric treatment was, “not aware that changes were related to mental illness” (74%).
    Conclusions: History of contacts with traditional healers was common among in-patients with first episode psychosis in HKL. Treatment delay was mainly contributed by factors related to lack of awareness on psychosis. More strategic mental health education program is needed for early detection and treatment of psychosis.
  2. Ghawadra SF, Abdullah KL, Choo WY, Phang CK
    J Clin Nurs, 2019 Nov;28(21-22):4087-4097.
    PMID: 31294501 DOI: 10.1111/jocn.14993
    AIM AND OBJECTIVES: To determine the prevalence of psychological distress and its association with job satisfaction among nurses in a teaching hospital in Malaysia.

    BACKGROUND: Nurses constitute the majority of health care workers, and, compared with other professions, nursing profession is highly stressful and, hence, a cause of anxiety and depression. This may affect nurses' job satisfaction.

    METHOD: Using self-administered questionnaires, Depression Anxiety and Stress Scale (DASS-21) and Job Satisfaction Scale for Nurses (JSS), a cross-sectional study of 932 nurses from the inpatient departments of a teaching hospital was conducted in December 2017. Descriptive analyses and multiple logistic regressions were used for the analysis. The STROBE guideline was used in this study.

    RESULTS: The overall prevalence of psychological distress was 41%. The prevalence of stress, anxiety and depression were 14.4%, 39.3% and 18.8%, respectively. It was found that single and widowed nurses had a higher level of stress, anxiety and depression compared with married nurses. In addition, nurses in the age of 26-30 years had a higher level of depression than nurses in other age groups. Also, nurses who worked in the paediatric departments had a higher level of depression compared with nurses in other departments. The majority of the nurses were satisfied with their job at 92.0%. Those nurses who were not satisfied were found to be significantly associated with a high level of stress and depression.

    CONCLUSION: This study revealed that the level of stress, anxiety and depression is high. Stress and depression were found to be associated with nurses' low job satisfaction.

    RELEVANCE TO CLINICAL PRACTICE: Stress and depression can affect nurses' job satisfaction, it is important for nursing managers to institute strategies to address this issue.

  3. Ghawadra SF, Abdullah KL, Choo WY, Phang CK
    J Clin Nurs, 2019 Nov;28(21-22):3747-3758.
    PMID: 31267619 DOI: 10.1111/jocn.14987
    AIMS AND OBJECTIVES: To explore the studies that used interventions based on the Mindfulness-Based Stress Reduction (MBSR) for decreasing psychological distress among nurses.

    BACKGROUND: Because of the demanding nature of their work, nurses often have significantly high levels of stress, anxiety and depression. MBSR has been reported to be an effective intervention to decrease psychological distress.

    DESIGN: Systematic review.

    METHODS: The databases included were Science Direct, PubMed, EBSCO host, Springer Link and Web of Science from 2002 to 2018. Interventional studies published in English that used MBSR among nurses to reduce their psychological distress were retrieved for review. The PRISMA guideline was used in this systematic review. The included studies were assessed for quality using "The Quality Assessment Tool For Quantitative Studies (QATFQS)."

    RESULTS: Nine studies were found to be eligible and included in this review. Many benefits, including reduced stress, anxiety, depression, burnout and better job satisfaction, were reported in these studies.

    CONCLUSION: The adapted/brief versions of MBSR seem promising for reducing psychological distress in nurses. Future research should include randomised controlled trials with a larger sample size and follow-up studies. There should also be a focus on creative and effective ways of delivering MBSR to nurses.

    RELEVANCE TO CLINICAL PRACTICE: The results of this review are substantial for supporting the use of MBSR for nurses' psychological well-being.

  4. Fadzil NA, Heong WO, Kueh YC, Phang CK
    Malays J Med Sci, 2021 Dec;28(6):121-128.
    PMID: 35002496 DOI: 10.21315/mjms2021.28.6.12
    Background: Among healthcare workers, nurses have a particularly high risk of stress. Stressful conditions in the workplace increase the possibility of burnout and psychological distress. Short mindfulness-based interventions can help to decrease stress, anxiety and depression. This study aimed to explore the effectiveness of a mindfulness-based intervention in reducing perceived stress, anxiety and depression among public teaching hospital staff nurses.

    Methods: Thirty-five nurses from various specialities were recruited from Hospital Universiti Sains Malaysia (HUSM). The intervention comprised a 1-day brief mindfulness-based intervention workshop and 1 h group practice session each month for 3 months together with daily follow-up via WhatsApp group. All the participants completed a self-administered sociodemographic questionnaire validated for use in a Malay population. The Depression, Anxiety and Stress Scale 21 (DASS 21) and Perceived Stress Scale 10 (PSS 10) were used to measure perceived stress, anxiety and depression before the intervention, and 3 months later upon completion of the intervention.

    Results: There was a statistically significant reduction in the scores for stress perception (95% confidence interval [CI]: 0.06, 2.92; P = 0.04) and anxiety (95% CI: 0.06, 2.34; P = 0.04) post-intervention.

    Conclusion: A brief mindfulness-based intervention was effective in reducing perceived stress and anxiety among nurses.

  5. Phang CK, Mukhtar F, Ibrahim N, Keng SL, Mohd Sidik S
    Adv Health Sci Educ Theory Pract, 2015 Dec;20(5):1115-34.
    PMID: 25697124 DOI: 10.1007/s10459-015-9591-3
    Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f (2) = 0.05), perceived stress (β = -0.26, ΔR2 = 0.07, p = .009, f (2) = 0.10); mental distress (β = -0.28, ΔR2 = 0.10, p = .003, f (2) = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f (2) = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f (2) = 0.08); but there was no difference in other outcome measures. More than 90% of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.
  6. Ghawadra SF, Lim Abdullah K, Choo WY, Danaee M, Phang CK
    J Nurs Manag, 2020 Jul;28(5):1088-1097.
    PMID: 32432795 DOI: 10.1111/jonm.13049
    AIM: To assess the effect of a 4-week mindfulness-based training intervention on improving stress, anxiety, depression and job satisfaction among ward nurses.

    BACKGROUND: Previous literature showed that mindfulness-based training is useful for helping nurses cope with stress.

    METHOD: Nurses who have mild to moderate levels of stress, anxiety and depression identified from a teaching hospital were invited to a randomized control trial. The intervention group had a 2-hr Mindfulness-Based Training workshop, followed by 4 weeks of guided self-practice Mindfulness-Based Training website. Both the intervention group (n = 118) and the control group (n = 106) were evaluated pre- and post-intervention, and 8 weeks later (follow-up) using the Depression, Anxiety, and Stress Scale-21, Job Satisfaction Scale and Mindful Attention Awareness Scale.

    RESULTS: There was a significant effect over time on stress, anxiety, depression and mindfulness level (p 

  7. Lee PF, Kan DPX, Croarkin P, Phang CK, Doruk D
    J Clin Neurosci, 2018 Jan;47:315-322.
    PMID: 29066239 DOI: 10.1016/j.jocn.2017.09.030
    BACKGROUND: There is an unmet need for practical and reliable biomarkers for mood disorders in young adults. Identifying the brain activity associated with the early signs of depressive disorders could have important diagnostic and therapeutic implications. In this study we sought to investigate the EEG characteristics in young adults with newly identified depressive symptoms.

    METHODS: Based on the initial screening, a total of 100 participants (n = 50 euthymic, n = 50 depressive) underwent 32-channel EEG acquisition. Simple logistic regression and C-statistic were used to explore if EEG power could be used to discriminate between the groups. The strongest EEG predictors of mood using multivariate logistic regression models.

    RESULTS: Simple logistic regression analysis with subsequent C-statistics revealed that only high-alpha and beta power originating from the left central cortex (C3) have a reliable discriminative value (ROC curve >0.7 (70%)) for differentiating the depressive group from the euthymic group. Multivariate regression analysis showed that the single most significant predictor of group (depressive vs. euthymic) is the high-alpha power over C3 (p = 0.03).

    CONCLUSION: The present findings suggest that EEG is a useful tool in the identification of neurophysiological correlates of depressive symptoms in young adults with no previous psychiatric history.

    SIGNIFICANCE: Our results could guide future studies investigating the early neurophysiological changes and surrogate outcomes in depression.

  8. Ibrahim N, Sherina MS, Phang CK, Mukhtar F, Awang H, Ang JK, et al.
    Med J Malaysia, 2017 08;72(4):221-227.
    PMID: 28889133 MyJurnal
    No abstract available.
  9. Kader Maideen SF, Mohd Sidik S, Rampal L, Mukhtar F, Ibrahim N, Phang CK, et al.
    JMIR Res Protoc, 2016;5(2):e112.
    PMID: 27329333 DOI: 10.2196/resprot.4622
    Mental disorders are a major public health problem and are debilitating in many nations throughout the world. Many individuals either do not or are not able to access treatment. The Internet can be a medium to convey to the community accessible evidenced-based interventions to reduce these burdens.
  10. Tan SM, Jong SC, Chan LF, Jamaludin NA, Phang CK, Jamaluddin NS, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:74-81.
    PMID: 23857841 DOI: 10.1111/appy.12048
    Anxiety among house officers may impair functioning and health care delivery. This study aimed to determine the association between anxiety among house officers at Universiti Kebangsaan Malaysia Medical Center, sociodemographic and work-related factors.
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