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A group mental health randomized controlled trial for female refugees in Malaysia

Shaw SA, Ward KP, Pillai V, Hinton DE

Am J Orthopsychiatry, 2019;89(6):665-674.
PMID: 30035560 DOI: 10.1037/ort0000346

Forcibly displaced persons confront multiple stressors while awaiting permanent asylum or resettlement and often experience high levels of emotional distress. This study assessed an 8-week somatic-focused culturally adapted cognitive-behavioral therapy (CBT) group intervention with 39 female refugees from Afghanistan living in Kuala Lumpur, Malaysia. Twenty-nine participants were randomly assigned to treatment conditions, resulting in 20 participants in two separate treatment groups and 9 in a waitlist control group. An additional 10 participants were not randomly assigned and therefore were treated as an additional treatment group and analyzed separately. A three-group piecewise linear growth model was specified in Mplus using Bayesian estimation. Dependent variables included emotional distress, anxiety, depression, posttraumatic stress, and social support. From baseline to posttreatment assessments, initial intervention participants experienced significant declines in emotional distress (b = -16.90, p < .001), anxiety (b = -.80, p < .001), depression (b = -.59, p < .001), and posttraumatic stress (b = -.24, p < .05). Gains were maintained three months posttreatment, with similar trends observed among nonrandomized participants. Subsequent to receiving treatment, the waitlist control participants also showed significant declines in emotional distress (b = -20.88, p < .001), anxiety (b = -1.10, p < .001), depression (b = -.79, p < .001), and posttraumatic stress scores (b = -.82, p < .001). Comparing the treatment groups to the waitlist control group revealed large effect sizes: Cohen's d was 2.14 for emotional distress, 2.31 for anxiety, 2.42 for depression, and 2.07 for posttraumatic stress. Relevant public health findings include low drop out, group format, and facilitation by a trained community member. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
"You Have to Keep Yourself Hidden": Perspectives From Malaysian Malay-Muslim Men Who Have Sex With Men on Policy, Network, Community, and Individual Influences on HIV Risk

Lim SH, Brown SE, Shaw SA, Kamarulzaman A, Altice FL, Beyrer C

J Homosex, 2020;67(1):104-126.
PMID: 30307803 DOI: 10.1080/00918369.2018.1525946

Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.
A Randomized Clinical Trial Testing a Parenting Intervention Among Afghan and Rohingya Refugees in Malaysia

Shaw SA, Ward KP, Pillai V, Ali LM, Karim H

Fam Process, 2021 09;60(3):788-805.
PMID: 32981083 DOI: 10.1111/famp.12592

Refugee families experience uncertainty and stress when residing in countries of first asylum, such as Malaysia, and may benefit from supportive parenting interventions. In the greater Kuala Lumpur, Malaysia area we piloted an eight-week parenting program with 79 Rohingya and Afghan mothers in nine separate groups. Participants were randomized to an intervention group or a waitlist control group and those in each arm completed a 3-month follow-up assessment. Program content addressed positive discipline, strengthening family relationships, adapting to a new environment, and improving health and emotional well-being. Measures assessed included child intensity and parenting self-efficacy from the Child Adjustment and Parent Efficacy Scale; positive parenting, inconsistent discipline, and poor supervision from the Alabama Parenting Questionnaire-Short Form; family intimacy and family conflict from the Family Functioning Scale, and emotional well-being from the Refugee Health Screening-15. Participating in the intervention led to beneficial changes in child intensity, parenting self-efficacy, family intimacy, family conflict, and emotional distress for the treatment group, and all changes except for emotional distress were maintained over time. However, the intervention did not lead to changes in positive parenting, inconsistent discipline, or poor supervision in the treatment group. Findings point to the potential benefits of parenting programs for refugee communities in transitory settings and contribute to the limited body of literature examining such programs.
Fulltext Acceptability of a microfinance-based empowerment intervention for transgender and cisgender women sex workers in Greater Kuala Lumpur, Malaysia

Lall P, Shaw SA, Saifi R, Sherman S, Azmi NN, Pillai V, et al.

J Int AIDS Soc, 2017 08 02;20(1):21723.
PMID: 28782331 DOI: 10.7448/IAS.20.1.21723

INTRODUCTION: Cisgender and transgender woman sex workers (CWSWs and TWSWs, respectively) are key populations in Malaysia with higher HIV-prevalence than that of the general population. Given the impact economic instability can have on HIV transmission in these populations, novel HIV prevention interventions that reduce poverty may reduce HIV incidence and improve linkage and retention to care for those already living with HIV. We examine the feasibility of a microfinance-based HIV prevention intervention among CWSW and TWSWs in Greater Kuala Lumpur, Malaysia.
METHODS: We conducted 35 in-depth interviews to examine the acceptability of a microfinance-based HIV prevention intervention, focusing on: (1) participants' readiness to engage in other occupations and the types of jobs in which they were interested in; (2) their level of interest in the components of the potential intervention, including training on financial literacy and vocational education; and (3) possible barriers and facilitators to the successful completion of the intervention. Using grounded theory as a framework of analysis, transcripts were analysed through Nvivo 11.
RESULTS: Participants were on average 41 years old, slightly less than half (48%) were married, and more than half (52%) identified as Muslim. Participants express high motivation to seek employment in other professions as they perceived sex work as not a "proper job" with opportunities for career growth but rather as a short-term option offering an unstable form of income. Participants wanted to develop their own small enterprise. Most participants expressed a high level of interest in microfinance intervention and training to enable them to enter a new profession. Possible barriers to intervention participation included time, stigma, and a lack of resources.
CONCLUSION: Findings indicate that a microfinance intervention is acceptable and desirable for CWSWs and TWSWs in urban Malaysian contexts as participants reported that they were ready to engage in alternative forms of income generation.
A randomized controlled trial testing the feasibility, acceptability, and preliminary effects of a mental health Screening, Brief Intervention, and Referral to Treatment among refugees in Malaysia

Shaw SA, Lee C, Ahmadi M, Karim Shor Muluk H, Mohamed Jibril Z, Ahmadi L, et al.

Int J Soc Psychiatry, 2023 Jun 16.
PMID: 37326111 DOI: 10.1177/00207640231179323

BACKGROUND: Among refugees residing in countries of first asylum, such as Malaysia, high rates of psychological distress call for creative intervention responses.
AIMS: This study examines implementation of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model promoting emotional well-being and access to services.
METHOD: The one-session intervention was implemented in community settings by refugee facilitators during 2017 to 2020. 140 Participants including Afghan (n = 43), Rohingya (n = 41), and Somali (n = 56) refugees were randomized to receive either the intervention at baseline, or to a waitlist control group. At 30 days post-intervention, all participants completed a post-assessment. Additionally, after completing the intervention, participants provided feedback on SBIRT content and process.
RESULTS: Findings indicate the intervention was feasible to implement. Among the full sample, Refugee Health Screening-15 emotional distress scores reduced significantly among participants in the intervention group when compared to those in the waitlist control group. Examining findings by nationality, only Afghan and Rohingya participants in the intervention condition experienced significant reductions in distress scores compared to their counterparts in the control condition. Examining intervention effects on service access outcomes, only Somali participants in the intervention condition experienced significant increases in service access compared to the control condition.
CONCLUSIONS: Findings indicate the potential value of this SBIRT intervention, warranting further research.