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The literature suggests that some children at increased risk of parentification, which includes children of chronically ill or substance-misusing parents and children of divorced or migrant parents. Despite the necessity for some children to assume adult roles, parentification is potentially harmful. This paper aims to: (i) investigate the parentification concept and outcomes and (ii) summarize the components that render parentification adaptive in children. Articles were retrieved from Scopus, PubMed, Dimensions AI, Google Scholar, and reference list tracking using the keywords “parentification” and “parentification AND children”. A critical review was performed with a narrative approach to synthesize the 61 included studies to determine the existing knowledge and identify research priorities within the field of parentification. The findings were reported based on the Literature Review Synthesis Process and the Scale for the Assessment of Narrative Review Articles (SANRA). The experience of parentification could be adaptive and empowering for children. The potential components of adaptive parentification included emotional support, supportive and positive relationships with siblings and grandparents, parents openly delegating the roles to each child, having age-appropriate roles, parental support and validation, and children’s positive appraisal and perception of the role-taking.

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.

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 (ATQMalay), 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 BYI2 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.

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.

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.

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.

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 analyzing 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 analyze 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 health care 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.

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 > 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.

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.

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: 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.

Introduction: The current study as a part of our investigation on improving emotional and behavioural health in Malaysian orphanages was aimed to establish Content Validity Index (CVI) as well as Face Validity of a new life skill-based module for improving emotional health and coping mechanisms in Malaysian Institutionalised Adolescents including 2 different parts. Methods: In order to assess the content validity and using a 16-item questionnaire, the initial version of the module was reviewed by 9 experts in the area. In the second part, the face validity of the module was assessed among 30 adolescents aged 14-17 from 2 orphanages. Using Depression, Anxiety, Stress Scale (DASS21) and Brief COPE scale as the study instruments, the emotional heath and coping mechanisms among the participants was investigated before and after a life skills workshop (pre- and post-test). The activities in the workshop were randomly selected from the module activities. Results: Results of the first part of study showed the minimum Value of the Item-level Content Validity Index and the computed the sum of items (S-CVI) for the study module were 0.78 and 0.93 respectively. The results of the second part of study showed the selected activities from module were significantly change the coping mechanisms expect substance use, behavior disengagement, venting, humor and religion (p>0.05). Furthermore, the mean score of anxiety (t=5.39, P<0.001) and stress (t=3.90, P<0.001) significantly decreased among the participants in post-test but there was no significant change on the mean score of depression (t=0.50, P=0.59). Conclusion: both contend and face validity of the developed module were approved.

BACKGROUND: Inadequate physical activity has adverse health consequences among adolescents. Mental health problem can be developed by lack of physical activity however it is controversial. The current study aimed to examine the association between level of physical activity with depression, anxiety and stress symptoms among adolescents. METHODS:A representative sample of 1747 adolescents (13-14 years) was randomly selected from 6 schools in a south part of Malaysia. Respondents were asked to fill consent form, and questionnaires including Depression Anxiety and Stress Scale-21 and Physical Activity Questionnaire for Adolescents. RESULTS:Majority of respondents (71.9%) was Malay and more than half of the adolescents had low physical activity. About 40% had depression symptoms, followed by anxiety symptoms (65.9%) and stress symptoms (38.5%). Level of physical activity was significantly associated with gender, anxiety and stress (P<0.001). There were no associations with race, religion and depression symptom. CONCLUSIONS:This study provides some evidence among school-going adolescents related to anxiety and stress symptoms and low physical activities. Further studies are needed to show the protection effects of higher physical activity for depression, anxiety and stress symptoms in adolescents.

Introduction: Internet is important to university students, especially for medical students who use it to search for literature and relevant information. However, some of the users are experiencing a gradual loss of the ability to reduce the duration and frequency of their internet activities, despite the negative consequences. The literature on internet usage among Malaysian medical students is limited. This study aims to determine the prevalence and factors associated with internet usage among medical students in a public university in Malaysia. Methods: This cross-sectional study was performed among all the medical students (Year 1-5). Students were assessed on their internet activities using the internet addiction questionnaires (IAT). A Multiple Logistic Regression was used for data analysis. Results: The study was conducted among 426 students. The study population consisted of 156 males (36.6%) and 270 females (63.4%). The mean age was 21.6 ±1.5 years. Ethnicity distribution among the students was: Malays (55.6%), Chinese (34.7%), Indians (7.3%) and others (2.3%). According to the IAT, 36.9% of the study sample was addicted to the internet. Using the multivariate logistic regression analysis, we have found that the use of internet access for entertainment purposes (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.05-12.00), male students (OR 1.8, 95% CI 1.01-3.21) and increasing frequency of internet usage were associated with internet addiction (OR 1.4, 95% CI 1.09-1.67). Conclusion: Internet addiction is a relatively frequent phenomenon among medical students. The predictors of internet addiction were male students using it for surfing and entertainment purposes.

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.

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.