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Fulltext Cross-Cultural Adaptation and Validation of the Attitudes Toward Suicide Questionnaire Among Healthcare personnel in Malaysia

Siau CS, Wee LH, Ibrahim N, Visvalingam U, Wahab S

Inquiry, 2017 01 01;54:46958017707295.
PMID: 28486042 DOI: 10.1177/0046958017707295

Understanding attitudes toward suicide, especially among healthcare personnel, is an important step in both suicide prevention and treatment. We document the adaptation process and establish the validity and reliability of the Attitudes Toward Suicide (ATTS) questionnaire among 262 healthcare personnel in 2 major public hospitals in the Klang Valley, Malaysia. The findings indicate that healthcare personnel in Malaysia have unique constructs on suicide attitude, compared with the original study on a Western European sample. The adapted Malay ATTS questionnaire demonstrates adequate reliability and validity for use among healthcare personnel in Malaysia.
Gatekeeper Suicide Training's Effectiveness Among Malaysian Hospital Health Professionals: A Control Group Study With a Three-Month Follow-Up

Siau CS, Wee LH, Ibrahim N, Visvalingam U, Yeap LLL, Wahab S

J Contin Educ Health Prof, 2018;38(4):227-234.
PMID: 30036213 DOI: 10.1097/CEH.0000000000000213

INTRODUCTION: There is a lack of suicide-related training in the nonpsychiatric health professional's basic education. We suggest that a continuing education through a brief gatekeeper suicide training program could be a suitable platform to improve suicide-related knowledge, self-efficacy, and attitudes. This study aimed at examining the effectiveness of the Question, Persuade, Refer gatekeeper program on improving the knowledge, self-efficacy in suicide prevention, and understanding of/willingness to help suicidal patients of Malaysian hospital health professionals.
METHODS: The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later.
RESULTS: Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up.
DISCUSSION: This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.
Health-Care Workers' Perception of Patients' Suicide Intention and Factors Leading to It: A Qualitative Study

Wee LH, Ibrahim N, Wahab S, Visvalingam U, Yeoh SH, Siau CS

Omega (Westport), 2020 Dec;82(2):323-345.
PMID: 30482086 DOI: 10.1177/0030222818814331

This study explored health-care workers' perception of patients' suicide intention and their understanding of factors leading to particular interpretations. Semistructured face-to-face in-depth interviews were conducted with 32 health-care workers from a general hospital in Klang Valley, Malaysia. Interview data were transcribed verbatim and analyzed using the interpretative phenomenological analysis. The health-care workers were found to have four types of perceptions: to end life, not to end life, ambivalence about intention, and an evolving understanding of intention. Factors leading to their perceptions of patients' suicide intention were patient demographics, health status, severity of ideation/attempt, suicide method, history of treatment, moral character, communication of suicide intention, affective/cognitive status, availability of social support, and health-care workers' limited knowledge of patients' condition/situation. Insufficient knowledge and negative attitudes toward suicidal patients led to risk minimization and empathic failure, although most health-care workers used the correct parameters in determining suicide intention.
The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers' attitudes towards suicide and suicidal patients: a qualitative study

Siau CS, Wee LH, Wahab S, Visvalingam U, Yeoh SH, Halim NAA, et al.

J Res Nurs, 2021 Dec;26(8):723-740.
PMID: 35251280 DOI: 10.1177/17449871211008520

BACKGROUND: There has been mixed findings on whether a healthcare workers' religious beliefs contribute positively or negatively to their attitudes towards suicidal patients.
AIMS: This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers' attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population.
METHODS: Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers' acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient's religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice.
RESULTS: Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support.
CONCLUSIONS: The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.
Fulltext Caregiver Burden among Caregivers of Patients with Mental Illness: A Systematic Review and Meta-Analysis

Cham CQ, Ibrahim N, Siau CS, Kalaman CR, Ho MC, Yahya AN, et al.

Healthcare (Basel), 2022 Nov 30;10(12).
PMID: 36553947 DOI: 10.3390/healthcare10122423

Due to the increasing importance of caregivers in the treatment outcomes of patients with mental illness, this study aimed to systematically review studies investigating the former's caregiver burden and determine its prevalence. An open search, without filters, was conducted. Articles were selected from Medline, Scopus, and PubMed from inception to 30 April 2022 using the PRISMA protocol. Subgroup analyses examined the between-group differences by study setting, measurements used, and disorder type. A total of 5034 caregivers from 23 countries were included in this review. Thirty-nine studies were included in the systematic review, and, among them, twenty-six were deemed eligible for meta-analysis. The overall pooled prevalence of caregiver burden among caregivers of individuals with mental illness was 31.67% (95% CI = 26.22-37.12). Pooled prevalence was the highest among care recipients receiving treatment in a hospital setting (36.06%; 95% CI = 22.50-49.63), followed by the community and clinic settings. Caregiver prevalence values were higher for burden measured using the Zarit Burden Interview (38.05%; 95% CI = 27.68-48.43). compared with other instruments, and for carers of care recipients with psychosis (35.88%; 95% CI = 27.03-44.72) compared with those without. Thus, targeted interventions should focus on caregivers of patients in hospital settings and with psychotic symptoms.
Depression and Anxiety Predict Healthcare Workers' Understanding of and Willingness to Help Suicide Attempt Patients

Siau CS, Chan CMH, Wee LH, Wahab S, Visvalingam U, Chen WS, et al.

Omega (Westport), 2023 Jun;87(2):469-484.
PMID: 34096373 DOI: 10.1177/00302228211021746

We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation, self-efficacy in preventing suicide and demographic factors predicted the understanding of and willingness to help suicidal patients among hospital healthcare workers. A total of 368 healthcare workers from the major surgical and medical departments in a general hospital setting were recruited. Participants responded to the Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and Understanding Suicide Attempt Patient Scale. Those from the psychiatric department, with higher suicide prevention self-efficacy, and lower personal accomplishment indicated more understanding and helpful attitudes; doctors, depressed and anxious healthcare workers reported less understanding and helpful attitudes. Suicide prevention efforts must be conducted in tandem with equipping and supporting the healthcare workers who manage suicidal patients.
Factors associated with depression, anxiety, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients: A cross-sectional study

Cham CQ, Ibrahim N, Kalaman CR, Ho MC, Visvalingam U, Ahmad Shahabuddin F, et al.

Glob Ment Health (Camb), 2024;11:e12.
PMID: 38390253 DOI: 10.1017/gmh.2024.5

Depression and anxiety are prevalent mental health issues worldwide, especially among parental caregivers. By expanding the family stress model, this cross-sectional study investigated the relevant factors associated with depressive symptoms, anxiety symptoms, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients. Data were collected through questionnaires (N = 207) across five major public hospitals through convenience sampling. Participants answered questionnaires measuring financial strain, caregiver burden, relationship quality, belief in mental illness, perceived COVID-19 stress, satisfaction with health services, depressive symptoms, anxiety symptoms and life satisfaction. Findings revealed that relationship quality among spouses, COVID-19 stress and caregiver burden were significantly correlated with anxiety symptoms, depressive symptoms and satisfaction with life. The multiple regression model also suggested that depressive symptoms (β = .613, p < .001), anxiety symptoms (β= .657, p < .001) and relationship quality among spouses (β = .264, p < .001) were the most influential predictors of anxiety symptoms, depressive symptoms and satisfaction with life respectively. By addressing the mental health needs of parental caregivers, this study can contribute to improving the overall quality of care and support provided to adolescent patients and their caregivers in Malaysia and beyond.