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The spread of COVID-19 and its subsequent social distancing measures carried a significant psychological burden on many parents worldwide. This study was done to determine the prevalence and factors associated with psychological distress experienced by mothers of children with emotional and behavioral problems (EBP) during the lockdown period in Malaysia. An online survey using purposive sampling technique was conducted. Psychological distress was determined by DASS-21 scores. Prevalence of stress, anxiety, and depressive symptoms among mothers of children with EBP during the pandemic in Malaysia was 36.4%, 43.6%, and 30.9%, respectively. Mothers with a total monthly income of ≤ RM 999 were 25 times more likely to have stress symptoms (OR = 25.275, 95% CI = 1.17 – 547.41) and ten times more likely to have depressive symptoms (OR = 10.289, 95% CI = 1.17 – 90.88). Mothers with lower incomes are more psychologically vulnerable to the pandemic impact.

This study aimed to determine the prevalence of depression, anxiety, and the associated factors among 632 adolescents (age range: 13-17 years, Mage = 14.47, SD = 1.32) staying in sheltered homes in Malaysia. The Malay versions of the Beck Depression Inventory, Beck Anxiety Inventory, Automatic Thoughts Questionnaire, and Rosenberg Self-Esteem Scale were applied. The overall prevalence of mild to severe depression and anxiety in this study was 70.9% and 82.3% respectively, with 64.1% for comorbidity of both symptoms. Specifically, the prevalence rates of minimal, mild, moderate, and severe depressive symptoms were 29.1%, 38.4%, 22.4%, and 10.1% respectively whereas the prevalence rates of minimal, mild, moderate, and severe anxiety symptoms were 17.7%, 27.7%, 33.2%, and 21.4% respectively. The severity of negative automatic thoughts increased with the severity of depression and anxiety. Age, anxiety, negative automatic thoughts, and self-esteem were significantly associated with depression while depression, negative automatic thought, and anger were significantly associated with anxiety. The high rates of depression and anxiety among adolescents residing in the sheltered homes indicate the need to identify these at-risk populations and provide trained personnel who can deliver psychiatric and psychological services at sheltered homes.

The purpose of this study was to evaluate the psychometric properties of the Malay version of the Beck Youth Inventories-Second Edition (BYI-2 Malay) in a sample of adolescents living in the nongovernment-run sheltered homes. In this study, 300 adolescents completed the BYI-2 Malay, the Beck Depression Inventory-Malay (BDI-Malay), the Beck Anxiety Inventory-Malay (BAI-Malay), the Automatic Thoughts Questionnaire-Malay (ATQ-Malay), and the Rosenberg Self-Esteem Scale-Malay (RSES-Malay). The internal consistency estimates for the BYI-2 Malay scales, as measured by Cronbach’s alpha, were excellent: .86 for self-concept, .89 for anxiety, .92 for depression, .92 for anger, and .92 for disruptive behaviours. The five-factor model of the BYI-2 Malay (i.e., Self-Concept, Anxiety, Depression, Anger, and Disruptive Behaviour) showed a good fit to the data. Evidence for concurrent validity was established between the BYI-2 Malay Self-Concept scale and the RSES-Malay (r = .41), between the BYI-2 Malay Anxiety scale and the BAI-Malay (r = .60), and between the BYI-2 Malay Depression scale and the BDI-Malay (r = .69). The evidence for convergent validity was established between the BYI-2 Malay Anger scale and the ATQ-Malay (r = .71), and between BYI- 2 Malay Disruptive Behaviour scale and the ATQ Malay (r =.52). The present findings shed light on the utility of the BYI-2 Malay in aiding clinicians as well as therapists for identifying multiple symptoms of social and emotional problems in adolescents.

Introduction: Although many epidemiological and interventional investigations regarding improving mental health among youth in the Middle East have been performed, there is no systematic review specifically analysing the studies on stigma among adolescents with mental disorders (A-MDs) across all Middle East countries despite their common historical roots, similar cultural backgrounds, and recent widespread problems in the area. Purpose: We will aim to systematically review and analyse the English language studies on stigma among A-MDs in the Middle East published between 2000 and 2019. Method: The Web of Knowledge, Science Direct, PsycINFO and MEDLINE are electronic databases that will be included in this study. Furthermore, the bibliography lists of eligible articles will be manually searched for additional included articles. Descriptive statistics will be represented by mean score and standard deviation for continuous data and number/percentage for categorical data. Discussion: This study may act as a resource for future studies attempting to assess and/or reduce stigma among children and adolescents with mental health issues specifically in the Middle East. Implications: It is important for healthcare providers, including nursing professional, to improve their knowledge and vision towards stigma in their community. The outcomes of this study can be a shortcut reaching this information.

objective: This population-based qualitative study aimed to investigate knowledge, perspective and priorities related to self-care among Iranian healthy adolescents. Study design: Qualitative, population-based/online data collection design Method: A total of 294 male and female adolescents (mean age: 17.49±2.01) participated in the study. Through snowball sampling, the questionnaire forms were shared in available social media/communication application groups. Open coding data analysis was used to detect terms and keywords from the participants' statements. Results: The results showed that 192 participants (64.86%) reported that they had heard about "self-care". Parents/family and school were the most frequent sources of learning about self-care among the male respondents, while school was the main source of learning for girls. Furthermore, analyzing the participants' statements regarding their own understanding of self-care activities, 3 major terms—"taking care of", "avoid" and "respect"—were identified. The results also showed that spending time in cyberspace had the highest repetition rate (100%) among boys' responses, followed by "going to gym", "video games" and "Listening to music". Meanwhile, "cooking-related" words had the lowest ranking among the activities performed by boys. Physical activities were the most common word among the females' answers, with little difference from cyberspace and "listening to music". Cooking, watching movies, vacation and meditation were placed at the bottom. Regarding the desired activities if there were no limitations, both girls' and boys' statements indicated that among leisure activities, "traveling" was the most frequent word, followed by being with friends. The girls showed more interest in attending night clubs or spending time outside the home late at night.

This qualitative study aimed to investigate knowledge, perspectives, and priorities related to self-care among Iranian adolescents. Through snowball sampling, the link to the questionnaire was shared in available social media apps. The results showed that 192 of 294 participants reported that they had heard about “self-care”. Parents/family and school were the most frequent sources of learning about self-care among the male and female respondents, respectively. Analyzing the participants’ statements regarding their own understanding of self-care activities, three major terms— “taking care of”, “avoid”, and “respect” were identified. When being ask about what they do for their own self-care, the results showed spending time on the Internet had the highest repetition rate among boys’ responses, followed by “going to gym”, “video games”, and “listening to music”. Regarding the desired activities, both girls’ and boys’ statements indicated that among leisure activities, “traveling” was the most frequent word, followed by being with friends. The girls showed more interest in attending night clubs or spending time outside the home late at night. Insights from this study identifying preferences in self-care activities can be used to develop intervention programs for Iranian adolescents to improve their lifestyle and, consequently, their well-being based on their needs and situation

The article's abstract is not available.

WHAT IS KNOWN ON THE SUBJECT?: Four out of every five people with mental health disorders face stigma. Mental health and, consequently, mental health stigma are very common among youth living in the Middle East countries. Several studies have investigated mental health among adolescents in the Middle East, but studies on stigma are very scattered. There is no systematic review on stigma among adolescents with mental disorders across all the Middle East countries despite the common historical roots, similar cultural backgrounds, and recent widespread problems in the area. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper will aim to review and analyse the studies on stigma among adolescents with mental disorders in the Middle East countries, from different aspects such as the age rang, kind of stigma and risk factors of stigma. The study will cover studies on all kinds of stigma among Middle Eastern adolescents up to 18 years old published between 2000 and 2019. The study terms are generally focused on four categories: (a) kinds of Stigma, (b) Mental health problems, (c) Age range and (d) Region of study population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Increasing understanding and awareness of different angles of mental health stigma among adolescents may be helpful for better coping with this challenge. Understanding the nature of stigma may give adolescents the ability of ignoring it and avoid starting self-stigma and/or stopping to seek help. ABSTRACT: Introduction Although many epidemiological and interventional investigations regarding improving mental health among youth in the Middle East have been performed, there is no systematic review specifically analysing the studies on stigma among adolescents with mental disorders (A-MDs) across all Middle East countries despite their common historical roots, similar cultural backgrounds, and recent widespread problems in the area. Purpose We will aim to systematically review and analyse the English language studies on stigma among A-MDs in the Middle East published between 2000 and 2019. Method The Web of Knowledge, Science Direct, PsycINFO and MEDLINE are electronic databases that will be included in this study. Furthermore, the bibliography lists of eligible articles will be manually searched for additional included articles. Descriptive statistics will be represented by mean score and standard deviation for continuous data and number/percentage for categorical data. Discussion This study may act as a resource for future studies attempting to assess and/or reduce stigma among children and adolescents with mental health issues specifically in the Middle East. Implications It is important for healthcare providers, including nursing professional, to improve their knowledge and vision towards stigma in their community. The outcomes of this study can be a shortcut reaching this information.

Generally speaking, institutionalised children and adolescents are at greatly increased risk of serious mental and behavioural problems, up to seven times more than their peers. Life skills- based interventions using peer enforcement have been introduced as effective program to improve adolescents' emotional and behavioral health. Therefore, the current randomized control study aimed to determine, if a life skills-based intervention could improve the emotional health and self-esteem among Malaysian adolescents in orphanages. Overall, 271 male and female adolescents (13-18 years old) from 8 orphanages in Klang valley, Malaysia participated in the study. Comparing the intervention to control group within 3 points of time, the finding of the study showed that immediately after finishing the interventional sessions (post-test), the mean scores of depression (F = 33.80, P0.001). These results provide preliminary approve for LSE to enhance emotional health and self-esteem in orphanages.

The aim of the current study was to determine if a life skills-based intervention programme could improve the emotional health, self-esteem and coping skills of Malaysian institutionalised adolescents. This study was a randomized controlled trial with pre-, post- and four-month follow-up tests comprising intervention and control groups which were randomly selected to receive the intervention programme (life skills education) or the placebo education programme (COMBI programme). Overall, 271 adolescents, who experienced a mild to extra severe score in one of the objectives of the DASS21 questionnaire were selected to participate in the study. The findings of this study can be the starting point of continuous, systematic life skills education for Malaysian children and adolescents, and can be used by researchers and educational planners across the country. Trial registration: TCTR20161010003. Registered on: 6-October- 2016.

Anxiety is one of the most common mental health disorders in childhood, and children with anxiety have an increased risk of psychiatric disorders during adulthood. This study aimed to evaluate the effectiveness of a school-based anxiety prevention program for reducing anxiety among primary school students relative to a school-as-usual control group. Secondary to this, the current study aimed to examine the effect of a school-based prevention program on worry coping skills and self-esteem. A two-group parallel cluster randomized controlled trial of a single-blinded study was conducted to evaluate the effectiveness of the program, with schools as the unit of allocation and individual participants as the unit of analysis. The intervention program was conducted between May 2016 and December 2017. The primary outcome was anxiety, whereas the secondary outcomes were worry coping skills and self-esteem measured at three months post-intervention. Data were analyzed by using a generalized linear mixed model, accounting for the clustering effect. Subgroup analyses were performed for children with anxiety. A total of 461 students participated in this study. At baseline, there was no significant difference between groups for anxiety score, worry coping skills score, and self-esteem score (p &gt, 0.05). The intervention was effective in reducing anxiety for the whole sample (p = 0.001) and the anxiety subgroup (p = 0.001). However, it was not effective in improving worry coping skills and self-esteem. These findings suggest that the program could be effective for reducing symptoms of anxiety when delivered in schools and provide some support for delivering this type of program in primary school settings.

Background Children with Autism Spectrum Disorder (ASD) of different levels of symptom severity may exhibit a wide range of behaviours and characteristics. There is a limited nutrition-related study on children with ASD of different severity in Malaysia. Aims This cross-sectional study aims to determine the association between sociodemographic factors, parental factors, and lifestyle factors with autism severity in children with ASD. Methods and procedures A total of 224 children with ASD were included in this study. Their mothers completed a self-administered questionnaire on sociodemographic characteristics, autism severity, parenting style, parental feeding practices, parenting stress, child’s sleep habits and eating behaviours. Outcomes and results As high as 78.1 % of the children with ASD demonstrated a high level of autism severity. Multiple linear regression showed that father’s employment status (B = 6.970, 95 % CI = 3.172, 10.768, p Conclusions and implications Children with ASD in this study had a high level of autism severity. Regular anthropometric measurements by healthcare professionals should be conducted at the autism intervention centres. It is important to have multidisciplinary collaboration in future research to develop customised guidelines for parents with autistic children.

The current study amid to determine whether a life skills-based education could improve coping skills among adolescents in Malaysian orphanages. It was a randomized controlled trial comprising intervention and control groups which were randomly selected to receive the life skills, or the Placebo education programmes. The DASS21 and Brief COPE were used as the study instruments. Results showed the mean scores of self-distraction, active coping, use of emotional support, use of instrumental support, positive reinterpretation, planning and acceptance, at post-test, were significantly increased compared to the pre-test values. Denial, substance abuse, behavioural disengagement and self-blame significantly decreased. The findings provide an opportunity to assess the effects of participation in a life skills education programme on behavioural health in Malaysia orphanages.

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This study aimed to assess the prevalence and risk factors of depression, anxiety, stress and low self-esteem among institutional Malaysian adolescents. This cross-sectional descriptive study included 287 adolescents aged 12-18 years living in six selected orphan homes. Study's instruments included Socio-demographic questionnaire, validated Malay version of Depression Anxiety Stress Scale-21 and Rosenberg Self-Esteem Scale. The findings revealed that 85.2, 80.1 and 84.7% of participants had depression, anxiety and stress respectively. Females were more likely to be depressed. Furthermore, anxiety was significantly associated with race and age but no significant associations between stress and the demographic factors were found. The study also showed that 70.8% of males and 69.2% of females had low self-esteem and the self-esteem was associated with depression, anxiety and stress.Therefore, mental health problems are very common among adolescents in Malaysian orphanages. Results reveal the urgency of immediate actions to reduce the mental health problems among Malaysian institutional adolescents.

Introduction Health issues often differ from one population to another. Assessing different aspects of the health condition is a vital step toward developing and designing appropriate prevention and treatment programs to reduce health problems in any group or population. This study aimed to assess both the prevalence of stress and the coping mechanisms as well as identify the predictors of stress levels among adolescents in Malaysian orphanages. Methods Overall, 307 male and female adolescents (aged 13-18 y old) living in 9 private orphanages located in Klang Valley, Malaysia, participated in this cross-sectional study. Brief COPE scale and Depression, Anxiety and Stress Scale-21 were used as the main instruments in the current study. Results The results of the current study showed female adolescents and participants with a higher level of education were more likely to experience stress. The results also showed significant differences between boys and girls in using of coping mechanisms in self-distraction (t = -2.39, P = .01), substance use (t = 2.12, P = .03), use of emotional support (t = -2.70, P = .001), humor (t = 2.28, P = .02), and religion (t = -2.19, P = .02). Denial, venting, religion, humor, planning, and active coping were identified as predictors of stress among participants. Discussion The results showed a high prevalence of stress and a negative coping pattern among participants. The finding of the current study also showed the urgency of taking immediate action to reduce stress and improve coping methods among Malaysian institutional adolescents.

Suicide is an epidemic issue worldwide and Asian countries are of no exception. In Malaysia, adolescent suicide constituted 10% of the overall reported suicide cases. Aforementioned, the current study examines Snyder’s theory of hope to understand suicidal risk among Malaysian adolescents. A total of 1441 adolescents were recruited using a multistage cluster sampling. Results showed significant relationship between both agency and pathway thinking with risk of suicidal behavior. Specifically, only agency thinking uniquely predicts adolescents’ suicidal risk in a regression model. Adolescents with higher motivation towards accomplishing a goal or plan have lower risk engaging in suicidal behaviors. Thus, suicide prevention focusing on increasing hope is significantly important. Limitations were discussed in the study.

Objective: The 21-item Depression, Anxiety and Stress Scale (DASS-21) is frequently used in non-clinical research to measure mental health factors among adults. However, previous studies have concluded that the 21 items are not stable for utilization among the adolescent population. Thus, the aims of this study are to examine the structure of the factors and to report on the reliability of the refined version of the DASS that consists of 12 items. Method: A total of 2850 students (aged 13 to 17 years old) from three major ethnic in Malaysia completed the DASS-21. The study was conducted at 10 randomly selected secondary schools in the northern state of Peninsular Malaysia. The study population comprised secondary school students (Forms 1, 2 and 4) from the selected schools. Results: Based on the results of the EFA stage, 12 items were included in a final CFA to test the fit of the model. Using maximum likelihood procedures to estimate the model, the selected fit indices indicated a close model fit (χ2 = 132.94, df = 57, p = .000; CFI = .96; RMR = .02; RMSEA = .04). Moreover, significant loadings of all the unstandardized regression weights implied an acceptable convergent validity. Besides the convergent validity of the item, a discriminant validity of the subscales was also evident from the moderate latent factor inter-correlations, which ranged from .62 to .75. The subscale reliability was further estimated using Cronbach's alpha and the adequate reliability of the subscales was obtained (Total = 76; Depression = .68; Anxiety = .53; Stress = .52). Conclusion: The new version of the 12-item DASS for adolescents in Malaysia (DASS-12) is reliable and has a stable factor structure, and thus it is a useful instrument for distinguishing between depression, anxiety and stress.

Life Skills Education for Malaysian Institutionalised Adoles-cents: Knowledge, Needs and Priorities: A Qualitative Pilot Study

The paper examined the quality of life of haematological cancer patients according to their socio-demographic profiles and clinical diagnoses.This cross-sectional study was conducted at the tertiary referral centre of Ampang Hospital, Kuala Lumpur, involving 105 patients. The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) questionnaire was used to measure their quality of life.The study involved patients diagnosed with all types of haematological cancer, including non-Hodgkin lymphoma (NHL), acute myelogenous leukaemia (AML), acute lymphoblastic leukaemia (ALL), Hodgkin lymphoma (HL), and multiple myeloma (MM), with a response rate of 83.3%. The patients with ALL, HL, without NHL, and without MM were younger than other patients. There were significant differences in quality of life scores in different socio-demographic groups and types of cancer diagnosis. The global quality of life of the female patients was much better than that of the male patients. Patients who were 40 years old or younger had a better global quality of life and physical functioning, as well as fewer symptoms of constipation, nausea, and vomiting. Employed patients were in less pain but showed greater impairments of cognitive function than did unemployed patients. Patients who earned a monthly wage of RM1000 or less had reduced physical function, more symptoms of pain, and more financial difficulties compared with patients who earned more. Patients with AML tended to have better physical functioning than did patients with MM, whose physical functioning was impaired. Comparatively, more symptoms of dyspnoea were found in ALL and HL patients than in other types of lymphoma. Compared with other patients, those with ALL had a greater loss of appetite, and other lymphoma patients had fewer symptoms of pain. Patients with NHL had impaired role functioning and more constipation compared with other patients. The results were all statistically significant (P0.05).The quality of life of haematological cancer patients is affected by socio-demographic factors and clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.