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Background: Migrant children and adolescents face a significantly increased risk of mental health issues. Focusing on this population's mental health issues is fundamental and requires more attention to detect and reduce these burdens in adulthood. Nevertheless, life skills intervention can improve mental health. Its effects on Arab migrant adolescents have not been tested. Here, an evaluation protocol of the effect of an online life skills-based intervention for improving depression, anxiety, stress, self-efficacy, and coping skills among Arab adolescents in Malaysia will be examined. Material and methods: This cluster randomised controlled trial (RCT) will involve 207 Arab students (14–18 years old) from 12 Arabic schools in the Klang Valley. The schools will be assigned randomly to an intervention (online life skills programme) or control group at a 1:1 ratio. The researcher will deliver eight one-hour sessions to the intervention group weekly. The control group will receive the intervention at the evaluation end. Both groups will complete assessments at baseline, and immediately and three months after the intervention. The primary outcome is anxiety, depression, and stress [Depression Anxiety and Stress Scale-21 (DASS-21)]. The secondary outcomes are self-efficacy (General Self-Efficacy Scale) and coping skills (Brief COPE Inventory). Data analysis will involve the Generalised Estimation Equation with a 95% confidence interval. P <.05 will indicate significant inter- and intra-group differences. Discussion: This will be the first cluster RCT of an online life skills education programme involving Arab adolescent migrants in Malaysia. The results could support programme effectiveness for improving the participants' mental health problems (depression, anxiety, stress), increasing their self-efficacy, and enhancing their coping skills. The evidence could transform approaches for ameliorating migrant children and adolescents' mental well-being. Trial registration: The study is registered with the Clinical Trial Registry (Identifier: NCT05370443). [ABSTRACT FROM AUTHOR]

Atypical eating behaviors displayed by children with autism spectrum disorder (ASD) predispose them to unhealthy weight gain. We determined the factors associated with body weight status among 261 children with ASD (3–18 years) at nine autism intervention centers. Their mothers completed a self-administered questionnaire on sociodemographic background, parenting style, parental feeding practices, parenting stress, sleep habits, eating behaviors, and autism severity. Children with older age, non-full term gestational age, high maternal perceived weight, high maternal concern about child weight, and low pressure to eat were more likely to be overweight and obese. Obesity is a major concern among children with ASD. Healthy weight management programs for parents should incorporate appropriate feeding practices and a healthy perception of body weight. [ABSTRACT FROM AUTHOR]

Parenting programs often train parents in improving their parenting practices and parent-child relationship to reduce behavioral problems in children. However, the children's prosocial behaviors are less examined as an intervention outcome in these programs. This study aimed to evaluate the effectiveness of the Incredible Years parenting program (IYPP) for Malaysian parents of school-going children and its sustainability in improving the children's prosocial behaviors. This randomized controlled study involved pre- and post-intervention assessments at 2 and 14 weeks. Mothers of children aged 6-12 years (n = 70) recruited through the pediatrics and the child and adolescent psychiatric clinics were randomly assigned to the parenting program or a waitlist control condition. The mothers rated their children's prosocial behaviors using a self-administered questionnaire. The program ran two to three hours weekly for 14 weeks. Several modifications were made to the program to accommodate public health control during the pandemic. Children in the intervention group showed a notable but non-significant increase in prosocial skills. However, subsequent score decline at follow-up may suggest a lack of evidence that the program is potentially effective in improving prosocial behaviors among school children who are at risk of or already having behavioral problems. [ABSTRACT FROM AUTHOR]

Objective: Most adolescents do not meet national recommendations for healthy lifestyle and reducing depressive symptom. A comprehensive educational program with its specified questionnaire is needed to improve healthy lifestyle to assess the lifestyle components. This study aimed to confirm the validity of a healthy lifestyle questionnaire to assess depressive symptoms among adolescents. Method: A descriptive predictive study using simple random sampling was performed in a secondary school in Kuala Lumpur, Malaysia, among 235 school-going adolescents (13-15 years old) with Malaysian nationality. The instrument consisted of a set of dual language (English and Malay) for both researcher-administered questionnaires (knowledge, attitude, eating behavior, and relaxation activities) and standard-validated questionnaires (Physical Activity questionnaire for Adolescents, Depression, Anxiety, and Stress Scale- 21, and Brief Copping). Data were analyzed using the kappa statistics (k) and the intraclass correlation coefficient test for reliability and Partial Least Squares (PLS) for validity. Results: The reliability of all variables was over the substantial level (ICC and/or k > 0.61). The model and construct variables were predictive of depressive symptoms by 49.4%. To analyze the validity of the questions, 11 questions were removed from the initial model for factorial loading less than 0.5. In convergent validity of theory of information-motivation-behavioral skills, AVE (average variance construct), the outer loading, was higher than 0.5. Conclusion: PLS confirmed the existence of sufficient correlations between different items of the construct. Thus, the weights of indicators appeared to be appropriate indicators for the model. The results proved that the information, motivation, and behavioral skills model was efficient for healthy lifestyle and can be a good base for further research. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Summary Background/objective Missing main meals and an unhealthy snacking pattern can lead to poor diet quality and consequently to the presence of chronic diseases among which mental disorder is no exception. Since there is little research on diet, skipping meals and psychological status in Asian countries, this study tries to determine eating behaviour and predicting symptoms of stress and depression of adolescents in Pasir Gudang, Malaysia. Subjects and methods A cross-sectional study was conducted among Form 1 secondary school-going adolescents ( n 1565, response rate: 90%) in southern Malaysia from April to May 2013. A self-administered structured and validated questionnaire (socio-demographic, eating behaviour questionnaire, and depression, anxiety and stress scales (DASS-21)) was used for data collection. Results Among respondents, 803 (51.3%) were female, 1125 were Malay (71.9%) with a mean age of 13.7 (SD = 0.8) years. Logistic regression analysis indicated that students who were underweight (OR = 3.07, 95% CI 1.21, 7.76), obese (OR = 2.64, 95% CI 1.01, 6.87), used to eat out of home (OR = 1.37, 95% CI 1.28, 2.13), eat dinner (>4 days/week) (OR = 1.59, 95% CI 1.04, 2.43) were more likely to have depression or stress symptoms. Moreover, participants with 4–7 days/week eating breakfast (OR = 0.88, 95% CI 0.21, 0.89) were less likely to be at mild/moderate stress. Conclusions Findings underscore the effect of unhealthy eating practices among adolescents on mental health. Targeted education should be implemented to improve psychological well-being. [ABSTRACT FROM AUTHOR]

Cancer is one of the diseases which have severe psychological and physiological implications in the affected patients, and it gets an even uglier form in case of childhood cancer that engulfs the entire household. The devastating nature of the childhood cancer causes a wave like effect which goes from adolescent to the parents/caregivers/family, making it a family disease. Along with the distressing effects and side effects of cancer the adolescents are constantly grappled with the developmental issues, whereas, family/caregivers struggle with a unique adaptation and evolution, due to the challenges posed by the disease. The current paper is a literature review of resilience among adolescent cancer patients (ACPs) and their caregivers, in Malaysian backdrop. It offers an insight into the gap in the current knowledge and highlights the need of an analysis of the concept of resilience among the targeted population in accordance with specific cultural considerations. The review primarily based upon studies targeting adolescents with the disease and their caregivers, their stressors; and processes of adjustment and coping while highlighting the cultural and religious aspect. It established the fact that in Malaysia, ACPs have hardly been studied unlike their caregivers. It's essential to consider the optimistic concepts such as resilience as a foundation stone for those who are struggling with health challenges, directly or indirectly, especially in Asian societies, while focusing on their cultures, religion and spirituality. It's the responsibility of the clinicians, researchers and health care providers to undertake the research and recommend new ways of living for the patients and those related. [ABSTRACT FROM AUTHOR]

Background This study examined the mediating role of negative automatic thoughts in the relationship between depression and suicidal behaviour in a sample of at-risk Malaysian adolescents. Method A total of 1441 adolescents were initially recruited via multistage cluster sampling. Subsequently, 294 at-risk adolescents were selected for further analyses through a specified cut-off score. Results The results showed significant positive relationships among the study variables. Specifically, negative automatic thoughts emerged as a significant mediator in the relation between depression and suicidal behaviour (z = 7.15, p < .001). Conclusions The findings suggest that depressed adolescents are at high risk for a host of negative thought processes which in turn lead to suicidal behaviour. The study limitations and recommendations for further research are discussed. [ABSTRACT FROM AUTHOR]

Introduction: There is a strong body of evidence advocating parent training programmes in the management of behavioral problems in children. In these programmes, attrition is a major challenge. We aimed to examine the sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children's behavioural problems as rated by mothers who completed (PC) and mothers who dropped out (PD) of a parent training programme. We also aimed to determine whether there was any change in their children's behaviour scores before and after intervention. We hypothesized that parent and child sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children's behavioural problems would be different between PC and PD, and that children of PC would experience significant improvements in their behaviour. Methods: Data from a randomised controlled trial (RCT) involving 35 mothers and children aged 6-12 years old with behavioural problems who were enrolled in a parent training programme were examined. Child behaviour was measured using the Strength and Difficulties Questionnaire. Results: No significant differences were found between PC and PD in terms of the sociodemographic and clinical profiles, parental motivation, and pre-or post-intervention child behaviour. After programme completion, PC (n=27) reported improvements in all the behaviour subscales; total difficulties (p<0.001), emotional problem (p=0.004), conduct problem (p=0.001), hyperactivity symptoms (p<0.001), peer problems (p=0.036), and prosocial behaviour (p=0.001). Conclusion: The parent training programme produces significant child behaviour improvements in mothers who complete the programme. Nonetheless, the study has some limitations which restrict the generalizability of these findings. [ABSTRACT FROM AUTHOR]

• A parenting program established in a developed country could be transferred to a developing country with minimal adaptation, despite minimum resources and engagement barriers. • With some modifications, it is still feasible to deliver a group-based parenting program during a pandemic period. • A modified version of School Age BASIC Incredible Years parenting program was effective in improving both children and parental outcomes among children with clinical levels of behavioral problems. Although parenting programs have been supported as an effective family-based intervention for children's behavioral problems, they are underutilized in developing countries. This randomized controlled study aims to determine the effectiveness of the Incredible Years parenting program (IYPP) in improving behavioral problems in children, parenting stress, and parental mental health. Seventy mother–child dyads from three tertiary hospitals in Malaysia were divided into the IYPP and waitlist control groups. Weekly parent training sessions were adjusted during the pandemic period. Child's total difficulty scores of the Strength and Difficulty Questionnaire (SDQ-TDS), Parental Stress Scale (PSS) scores, and parental DASS-21 scores were measured at pre- and post-intervention, and follow-up, and analyzed using generalized estimating equation (GEE). Compared to the control group at baseline, the intervention group showed a 4.2- and a 3.5-point significantly lower SDQ-TDS at 2 weeks post-intervention and 3 months follow-up, respectively (B = -4.20, 95 % CI: −6.68, −1.72, p = 0.001; B = -3.51, 95 % CI:-6.37, −0.66, p = 0.016), a 5.0-point significantly lower PSS at 3 months follow-up (B = -5.03, 95 % CI: −9.16, −0.90, p = 0.017), and a 4.1-point significantly lower general stress scores at 2 weeks post-intervention (B = -4.06, 95 % CI: −7.20, −0.92, p = 0.011). Effect sizes were small (d s = 0.28–0.40). There was no significant intervention effect on maternal anxiety and depression scores. The modified parenting program was effective in improving children's behavior, parenting stress, and general stress among mothers of children aged 6–12 years presented with borderline and abnormal levels of behavioral problems, with sustained effects demonstrated for child behavior. However, the interpretation of these findings requires careful consideration of potential pandemic-instigated challenges and implications. [ABSTRACT FROM AUTHOR]

Introduction: Secure attachment to parents prevents adolescents from externalizing behaviours especially in developing countries. The aim of this study was to identify the contributors to parental attachment in a developing society. Methodology: This cross sectional study was performed on urban secondary students (aged between 13 and 17 years) based on multistage sampling in Pasir Gudang District, Johor, Malaysia. The depression, anxiety and stress (DASS-21) and Inventory of parent and peer attachment (IPPA) questionnaires were used along with a questionnaire for demographic information. Analysis of covariance (ANCOVA) was used to identify the main effect of study parameters on IPPA scores for father and mother. Results: A total of 2980 students (46.9% male and 53.1% female) participated in this study. Mean and SD for age was 14.39±1.28. Depression score and school form had a significant main effect on both paternal and maternal attachment (p<0.05). Age (p=0.003), ethnicity (p=0.01), history of intimate relationship (p=0.03), paternal education level (p=0.006) and maternal education level (p=0.04) had a main effect on paternal attachment, while gender (p=0.02) and stress (p=0.001) were shown to have significant main effect on maternal attachment. Discussion: The findings of this study revealed different contributors for adolescent attachment with father and mother. Local, cultural and economic structure of the community should be taken into account in order to plan for an intervention strategy to secure adolescent's relationship with parents. [ABSTRACT FROM AUTHOR]

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 < 0.001) and perceived child weight (B = 3.338, 95 % CI = 1.350, 5.327, p = 0.001) predicted autism severity.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. [ABSTRACT FROM AUTHOR]

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

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, P<0.001, η2 = 0.11), anxiety (F = 6.28, P = 0.01, η2 = 0.02), stress (F = 32.05, P<0.001, η2 = 0.11) and self-esteem (F = 54.68, P<0.001, η2 = 0.17) were significantly decreased compared to the pre-test values. However, there was no significant difference between two groups in the depression mean scores (F = 2.33, P = 0.13). Regarding to the interaction between group and test a significant change was seen in the mean score of all 4 variables including depression (F = 31.04, P<0.001, η2 = 0.10), anxiety (F = 14.21, P<0.001, η2 = 0.05), stress (F = 15.67, P<0.001, η2 = 0.06) and self-esteem (F = 13.29, P<0.001, η2 = 0.05). Furthermore, except depression (Δmean = -1.37, P<0.001), no significant difference was seen between study variables' mean scores between post- and follow-up test (p>0.001). These results provide preliminary approve for LSE to enhance emotional health and self-esteem in orphanages., Competing Interests: The authors have declared that no competing interests exist.

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 (χ(2)=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., (Copyright © 2014 Elsevier Inc. All rights reserved.)