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Fulltext Exploring burnout among Malaysian junior doctors using the abbreviated Maslach Burnout Inventory

Zuraida Ahmad Sabki, Zainal NZ

Malaysian Journal of Psychiatry, 2015;24(1):23-32.
MyJurnal

Objective: The study aimed to explore the prevalence of burnout among the junior doctors and to examine the psychometric properties of abbreviated Maslach Burnout Inventory (aMBI). Methods: A cross-sectional study was conducted using aMBI self-reported questionnaire and Hospital Anxiety Depression Scale which was carried out on a sample of 117 junior doctors working in a teaching hospital in Malaysia. Results: Exploratory factor analysis of aMBI revealed a three-factor structure labelled as emotional exhaustion, depersonalization and personal accomplishment with Crohnbach’s alpha of 0.85, 0.59 and 0.64 respectively. The total variance was 67%. Prevalence of burnout was found at 26.5%. Emotional exhaustion and depersonalization were positively correlated with depression and anxiety. Shorter duration of residence (less than six months) and being posted to Trauma & Emergency unit were associated with higher mean score of burnout. Conclusion: This study provides the knowledge of level of burnout among the junior doctors and the abbreviated Maslach Burnout Inventory has a satisfied psychometirc properties for screening burnout among junior doctors in Malaysia.
Depressive symptoms in middle-aged women in peninsular Malaysia

Zainal NZ

Asia Pac J Public Health, 2008;20(4):360-9.
PMID: 19124330 DOI: 10.1177/1010539508322538

A household survey was carried out in Peninsular Malaysia to determine the prevalence rate of depressive symptoms in middle-aged women and to explore its associated factors. Women aged 45 to 60 years were assessed on sociodemographic profiles, menopausal status, depressive symptoms, marital dissatisfaction, and coping strategies. A total of 3934 women participated, and the mean age was 51 years. The prevalence rate of depressive symptoms was 54.2%. Of the married women, 38.4% had poor to very severe problems in their marriage. Depressive symptoms were significantly associated with marital status (P < .001), ethnicity (P < .001), educational levels (P < .001), occupational status ( P < .001), domicile (P < .001), and menopausal status ( P < .05). Depressive symptoms were correlated with marital dissatisfaction scores. Women who consulted professionals, shared with relatives, kept problems to themselves, or consulted parents/siblings had higher mean scores on depressive symptoms compared with those who did not use these coping strategies.
Fulltext α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis

Zainal NZ, Alauddin H, Ahmad S, Hussin NH

Malays J Pathol, 2014 Dec;36(3):207-11.
PMID: 25500521

Thalassaemia carriers are common in the Asian region including Malaysia. Asymptomatic patients can be undiagnosed until they present for their antenatal visits. Devastating obstetric outcome may further complicate the pregnancy if both parents are thalassaemia carriers leading to hydrophic fetus due to haemoglobin Bart's disease. However in certain cases where unexplained hydrops fetalis occur in parents with heterozygous thalassaemia carrier,mutated α genes should be suspected. We report a twenty-nine year old woman in her third pregnancy with two previous pregnancies complicated by early neonatal death at 21 and 28 weeks of gestation due to hydrops fetalis. DNA analysis revealed the patient to have heterozygous (--SEA) α-gene deletion, while her husband has a compound heterozygosity for α(3.7) deletion and codon 59 (GGC → GAC) mutation of the α-gene. This mutation, also known as hemoglobin Adana, can explain hydrops fetalis resulting from two alpha gene deletions from the patient (mother) and a single alpha gene deletion with mutation from the father. The third pregnancy resulted in a grossly normal baby boy with 3 α-gene deletions (HbH disease). We postulate that, in view of heterogenisity of the α-thalassaemia in this patient with severely unstable haemoglobin Adana chains from her husband, there will be a 25% possibility of fetal hydrops in every pregnancy.
Depression and psychosocial correlates of liver transplant candidates: a systematic review

Mohamed S, Sabki ZA, Zainal NZ

Asia Pac Psychiatry, 2014 Dec;6(4):447-53.
PMID: 25132651 DOI: 10.1111/appy.12145

Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review.
The treatment outcome of psychotic disorders by traditional healers in central Sudan

Sorketti EA, Zainal NZ, Habil MH

Int J Soc Psychiatry, 2013 Jun;59(4):365-76.
PMID: 22433242 DOI: 10.1177/0020764012437651

Alternative and traditional healing methods are common and popular in Sudan, particularly for treating people with mental disorders, but little information is available about the outcome of theses traditional healing approaches.
The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis

Zainal NZ, Booth S, Huppert FA

Psychooncology, 2013 Jul;22(7):1457-65.
PMID: 22961994 DOI: 10.1002/pon.3171

This study aims to investigate the evidence of the efficacy of mindfulness-based stress reduction (MBSR) in improving stress, depression and anxiety in breast cancer patients.
The characteristics of people with mental illness who are under treatment in traditional healer centres in Sudan

Sorketti EA, Zainal NZ, Habil MH

Int J Soc Psychiatry, 2012 Mar;58(2):204-16.
PMID: 21609984 DOI: 10.1177/0020764010390439

To determine the general characteristics of people with mental disorders in traditional healers centres in Sudan in terms of sociodemographic profile, common clinical presentations and diagnostic features, and to look at the treatment methods and intervention procedures used in these centres for treating people with mental illness.
Characteristics of patients with organic brain syndromes : A cross-sectional 2-year follow-up study in Kuala Lumpur, Malaysia

Chandrasekaran PK, Jambunathan ST, Zainal NZ

Ann Gen Psychiatry, 2005 Apr 15;4(1):9.
PMID: 15876360

BACKGROUND: Organic Brain Syndromes (OBS) are often missed in clinical practice. Determining their varied presentations may help in earlier detection, better management, and, assessing prognosis and outcome. We described the in-patient referrals of patients suffering from the psychiatric effects of organic states and compared the symptomatology and mortality between those with the Acute and Chronic varieties. METHODS: 59 patients referred to our Consultation-Liaison (C-L) Psychiatry services and given a clinical diagnosis of OBS were selected over a 6-month period. Psychiatric and cognitive abnormalities and treatment regimes were recorded and fatality rates determined. Information regarding their condition 24 months after their index hospitalization was recorded. All data were entered into a proforma and analyzed after exclusion. RESULTS: The mean duration of detecting the symptoms by the physician was 3.52 days. The presence of a premorbid psychiatric illness had no influence on the clinical presentation but did on the mortality of patients with OBS (p = 0.029).Patients with the Acute syndrome had significantly more symptom resolution as compared to those with the Chronic syndrome (p = 0.001) but mortalityrates did not differ. Elderly patients and those with symptom resolution upon discharge did not show statistically significant higher mortality rates. The most popular combination of treatment was that of a low-dose neuroleptic and a benzodiazepine (34.7%). The need for maintenance treatment was not significantly different in any group, even in those with a past history of a functional disorder. CONCLUSION: Other than the Acute group having a significantly better outcome in terms of symptom resolution, our findings suggest that there was no significant difference in the clinical presentation between those with Acute or Chronic OBS. Mortality-wise, there was also no difference between the Acute and Chronic syndromes, nor was there any difference between the elderly and the younger group. There was also no significant difference in the need for continued treatment in both groups.
Cognitive dysfunction in Malaysian patients with major depressive disorder: A subgroup analysis of a multicountry, cross-sectional study

Zainal NZ, Kalita P, Herr KJ

Asia Pac Psychiatry, 2019 Mar;11(1):e12346.
PMID: 30511420 DOI: 10.1111/appy.12346

INTRODUCTION: Cognitive dysfunction has been significantly associated with functional impairment in patients with major depressive disorder (MDD).

METHODS: This is a subgroup analysis of 211 Malaysian patients recruited from the multicountry, multicenter, cross-sectional Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Depression severity, cognitive dysfunction, and functional disability were assessed and compared with the overall CogDAD study population. Factors associated with functional disability were also evaluated in this Malaysian patient population.

RESULTS: Approximately half of the Malaysian patients were in their first depressive episode, with the majority being treated for mild-to-moderate depression. Furthermore, Malaysian patients experienced cognitive dysfunction, with self-reported Perceived Deficits Questionnaire (PDQ-D) scores falling within the third quartile of PDQ-D severity. Malaysian patients also reported functional disability evidenced by a mean total Sheehan Disability Scale (SDS) score of 11.47 ± 6.68, with the highest SDS score reported in the "Social Life/Leisure Activities" domain. Compared with the overall CogDAD study population, the Malaysian patient population had comparable patient demographics in terms of marital and working status; outcome scores for PHQ-9 (9-item Patient Health Questionnaire for self-reported depression severity), PDQ-D and SDS; and worst perceived cognitive dysfunction reported in the "Attention/Concentration" domain. Factors found to be significantly associated with functional disability were PDQ-D score, sick leave taken, and antidepressant treatment (P
Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy

Shari NI, Zainal NZ, Ng CG

J Psychosoc Oncol, 2021;39(6):695-714.
PMID: 33287685 DOI: 10.1080/07347332.2020.1856283

PURPOSE: This study examined the efficacy of a brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy.
METHODS: Data collection was carried out in 3-time points: baseline (T1), screening (T2), and post-treatment (T3). Respondents who had significant subjective cognitive impairment were randomly divided into two groups: intervention (n = 30) and waitlist (n = 30). Respondents in the intervention group received 4 sessions of 1 hour of ACT therapy.
FINDINGS: Respondents in the intervention group showed significant improvement in subjective cognitive impairment, depression, anxiety, and psychological inflexibility after the ACT intervention (p
Lack of association between TPH2 gene polymorphisms with major depressive disorder in multiethnic Malaysian population

Nazree NE, Loke AC, Zainal NZ, Mohamed Z

Asia Pac Psychiatry, 2015 Mar;7(1):72-7.
PMID: 24376086 DOI: 10.1111/appy.12118

Numerous association studies of candidate genes studies with major depressive disorder (MDD) have been conducted for many years; however, the evidence of association between genes and the risk of developing MDD still remains inconclusive. In this study, we aimed to investigate the association between the tryptophan hydroxylase 2 (TPH2) gene and MDD in three ethnic groups (Malay, Chinese and Indian) within the Malaysian population.
Association of the functional polymorphism in the catechol-O-methyltransferase gene with schizophrenia in the three ethnic groups of the Malaysian population

Wan CL, Zainal NZ, Lian LH, Mohamed Z

Psychiatry Res, 2011 Aug 30;189(1):67-71.
PMID: 21414668 DOI: 10.1016/j.psychres.2011.02.008

The catechol-O-methyltransferase (COMT) gene is a candidate gene for schizophrenia as its encoded enzyme is involved in the metabolic inactivation of dopamine and noradrenaline. Several molecular genetic studies thus far have demonstrated that the COMT functional polymorphism of Val158Met is susceptible with schizophrenia. Hence, the present study aims to determine this genetic association of this SNP in the three major ethnic groups of the Malaysian population. A total of 317 patients (79 Malays, 154 Chinese and 84 Indians) meeting DSM-IV criteria for schizophrenia and 417 healthy subjects (160 Malays, 164 Chinese and 93 Indians) were recruited. A PCR-RFLP method was used to determine the genotypes and alleles present. We found a significant association of genotypes within the total pooled samples, as well as in the female subgroup, with a higher frequency of heterozygotes in schizophrenia subjects. However, there were no significant differences in allele and genotype frequency between the schizophrenic patients and normal controls in all three ethnic groups. Our current findings suggest that the Val158Met polymorphism has a weak association with schizophrenia in the Malaysian population and does not play a major role in conferring susceptibility to the schizophrenia in any of the three major local ethnicities.
Anxiety and Depression in Cancer Patients: The Association with Religiosity and Religious Coping

Ng GC, Mohamed S, Sulaiman AH, Zainal NZ

J Relig Health, 2017 Apr;56(2):575-590.
PMID: 27287259 DOI: 10.1007/s10943-016-0267-y

There is a lack of studies looking into religiosity and religious coping in cancer patient. In this cross-sectional study, we examined the religiosity using Duke University Religion Index, religious coping using Brief Religious Coping Scale, anxiety and depression based on Hospital Anxiety and Depression Scale among 200 cancer patients. The association between religiosity and religious coping with anxiety and depression was studied. The findings showed that subjects with anxiety or depression used more negative religious coping and had lower non-organization religiosity. Hence, measurements in reducing negative religious coping and encouraging religious activities could help to reduce psychological distress in cancer patients.
Prevalence and correlates of self-reported depression in Malaysian patients with rheumatoid arthritis

Chow SK, Guan YK, Chong HY, Zainal NZ, Yeap SS

Malaysian Journal of Psychiatry, 2002;10(2):9-14.

Objectives: To determine the prevalence of self-reported depression among Malaysian patients with rheumatoid arthritis (RA) and to study the correlates and independent predictors for depression. Methods: The Hospital Anxiety and Depression Scale (HADS) questionnaire wasused to assess depressive symptoms. Disease activity was determined by theduration of morning stiffness, visual analogue scale for pain and fatigue, numberof swollen/tender joint and the modified disease activity score (DAS). The Health Assessment Questionnaire (HAQ) was used to assess the patients' functionalstatus. Results: Depression was recorded in 17.2% of the 93 patients. Painful joints(p<0.001), active disease (p<0.001) and poor joint function (p<0.001) correlatedsignificantly with depression. Poor functional status assessed by the HAO was themost significant Independent predictor for depression in RA patients, (OR=5.4,p=0.028). Conclusion: The prevalence of depression In this cohort of Asian RA patients was17.2%. Painful joints and functional disability were associated with a higherIncidence of depression. RA Patients with severe functional disability should beassessed for depression that may need to be treated Independently.
Use of physical restraint: Nurses' knowledge, attitude, intention and practice and influencing factors

Eskandari F, Abdullah KL, Zainal NZ, Wong LP

J Clin Nurs, 2017 Dec;26(23-24):4479-4488.
PMID: 28233363 DOI: 10.1111/jocn.13778

AIMS AND OBJECTIVES: To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables.
BACKGROUND: A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals.
DESIGN: A cross-sectional study was used.
METHODS: A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur.
RESULTS: Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint.
CONCLUSION: This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint.
RELEVANCE TO CLINICAL PRACTICE: Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals.
The effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint use

Eskandari F, Abdullah KL, Zainal NZ, Wong LP

Nurse Educ Pract, 2018 Sep;32:52-57.
PMID: 30029085 DOI: 10.1016/j.nepr.2018.07.007

The use of physical restraint exposes patients and staff to negative effects, including death. Therefore, teaching nursing staff to develop the improve knowledge, skills, and attitudes regarding physical restraint has become necessary. A quasi-experimental pre-post design was used to evaluate the effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint in 12 wards of a hospital using a self-reported questionnaire and a restraint order form in Malaysia. The educational intervention, which included a one-day session on minimising physical restraint use in hospital, was presented to 245 nurses. The results showed a significant increase in the mean knowledge, attitude sand practice score and a significant decrease in the mean intention score of nurses to use physical restraint after intervention. There was a statistically significant decrease in the incidence rate of physical restraint use in the wards of the hospital except geriatric-rehabilitation wards after intervention.
Incidence Rate and Patterns of Physical Restraint Use Among Adult Patients in Malaysia

Eskandari F, Abdullah KL, Zainal NZ, Wong LP

Clin Nurs Res, 2018 03;27(3):278-295.
PMID: 27856788 DOI: 10.1177/1054773816677807

Incidence rate and patterns of physical restraint use were examined based on a cross-sectional study in 22 wards of a large teaching hospital in Malaysia. Results indicated that the highest rate of physical restraint (19.7%) was reported from neurology-neurosurgery wards. "Un-cooperative for electroconvulsive therapy" and "trying to pull out catheters" were the most commonly reported reasons to use restraint in psychiatric and non-psychiatric wards, respectively. There were some relationships between patterns of physical restraint in this study. Exploring the incidence rate and patterns of physical restraint is important so that effective strategies can be formulated to minimize using restraint in hospitals.
Fulltext Prevalence of Anxiety Symptoms in Women Newly Diagnosed with Breast Cancer in Kazakhstan and Its Associated Factors

Karibayeva I, Turdaliyeva B, Zainal NZ, Bagiyarova F, Kussainova D

Asian Pac J Cancer Prev, 2022 Aug 01;23(8):2813-2819.
PMID: 36037138 DOI: 10.31557/APJCP.2022.23.8.2813

INTRODUCTION: Diagnosis of breast cancer is associated with high psychological distress. There is a lack of studies examining the prevalence of anxiety among newly diagnosed breast cancer patients in Kazakhstan.
OBJECTIVE: This study aims to assess the mean prevalence and associated sociodemographic and clinical factors of anxiety symptoms in women newly diagnosed with breast cancer. It also aims to determine independent predictors of anxiety risk.
METHODS: An analysis of 162 newly diagnosed breast cancer patients at the oncology institute in Almaty was performed. Data were collected using a structured questionnaire on social, demographic, and clinical information, as well as the Beck Anxiety Inventory. In addition, multiple regression analysis was used to model the relationship between anxiety risk and independent predictors.
RESULTS: The average age of the patients was 54.41 years (SD=8.1; min.-max: 32-75). The majority of the patients were married (52%), employed or self-employed (51%), had children (91%), had a bachelor's or a graduate degree (50%), lived in an urban area (54%), did not drink (41%), did not smoke (67%), did not engage in physical activity (54%), and had social support (91%). A total of 48% of patients had symptoms of moderate anxiety, and 33% had symptoms of severe anxiety. Based on the multivariate analysis, factors associated with a lower risk of anxiety symptoms included higher household income (OR -2.21 (95 CI: -1.35, -3.07)) and having reliable social support (OR -2.93 (95% CI: -2.25, -3.61)).
CONCLUSION: The prevalence of anxiety symptoms is very high among newly diagnosed breast cancer patients. Anxiety is more likely to develop in patients from low-income households and those without reliable social support.
Fulltext Prevalence and Associated Factors of Depression Symptoms in Women Newly Diagnosed with Breast Cancer in Kazakhstan

Turdaliyeva B, Karibayeva I, Bagiyarova F, Zainal NZ, Kussainova D

Asian Pac J Cancer Prev, 2022 Jul 01;23(7):2483-2489.
PMID: 35901357 DOI: 10.31557/APJCP.2022.23.7.2483

INTRODUCTION: Diagnosis of breast cancer is associated with the presence of psychological disorders including depression. There is a lack of study examining the prevalence of depression among newly diagnosed breast cancer patients in Kazakhstan.
OBJECTIVE: This study aims to assess the prevalence and associated sociodemographic and clinical factors of depression symptoms in women newly diagnosed with breast cancer.
METHODS: 162 newly diagnosed breast cancer patients at the oncology center in Almaty were recruited for this study. Data were collected using a structured questionnaire on sociodemographic and clinical information and the Beck Depression Inventory-II scale.
RESULTS: The mean age of the patients was 54.41 years (SD=8.1). 95% of participants had unilateral breast cancer, and 79% of participants had stage I or stage II breast cancer. 73% of patients said that they do not have reliable social support. 46% of patients had symptoms of moderate depression, and 31% of patients had symptoms of severe depression. According to the multivariate analysis, factors associated with depression symptoms were: social status, household income level, reliability of social support, and stage of breast cancer.
CONCLUSION: The prevalence of depression symptoms is very high among newly diagnosed breast cancer patients. Unemployed or retired patients, with a lower household income, and no reliable social support diagnosed with an advanced stage of breast cancer are especially at high risk for developing depression.
Fulltext Psychosocial Factors Associated with Depression and Anxiety During COVID-19 Pandemic Among Outpatients with Depression

Zulkifli NA, Guan NC, Zainal NZ, Ling TS

Alpha Psychiatry, 2021 Jul;22(4):185-193.
PMID: 36424937 DOI: 10.5152/alphapsychiatry.2021.21107

OBJECTIVE: Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia.
METHODS: This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP).
RESULTS: One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18-34) are significantly associated with more severe insomnia (P < .001, adjusted OR = 9.101, 95% CI: 3.613-22.924). Furthermore, the high anxiety level is associated with the younger age group (P = .029, Adjusted OR = 2.274, 95% CI: 1.090-4.746), greater severity of insomnia (P < .001, Adjusted OR = 22.9, 95% CI: 6.145-85.343), and higher risk of COVID-19 related social media addiction (P = .011, adjusted OR = 2.637, 95% CI: 1.253-5.550).
CONCLUSION: This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19.

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