COVID-19 has struck the world by surprise since it began to spread as a novel viral infection in ... more COVID-19 has struck the world by surprise since it began to spread as a novel viral infection in China in December 2020. In Malaysia, it only began to spread among the local population since March 2020 and resulting in movement lockdown imposed by the government from mid-March 2020 to June 2020. Although the movement lockdown was lifted in June 2020, academic activities in Malaysian universities are still restricted. Consequently, prevalence of psychological complications surge among the university students. Nevertheless, there is paucity of data on mental health status of university students in response to COVID-19 after the movement lockdown was lifted. This cross-sectional study aimed to fill the research gap by: (1) investigating the severity of depressive, anxiety, and psychological stress symptoms in response to the COVID-19 pandemic after the movement lockdown was lifted among a cohort of Malaysian university students and (2) determining the association between various COVID-...
Additional file 1 Table S1. The mean and standard deviation for age, the WHOQOL-BREF, and the BFI... more Additional file 1 Table S1. The mean and standard deviation for age, the WHOQOL-BREF, and the BFI scores.
Although healthcare workers play a crucial role in helping curb the hazardous health impact of co... more Although healthcare workers play a crucial role in helping curb the hazardous health impact of coronavirus disease 2019 (COVID-19), their lives and major functioning have been greatly affected by the pandemic. This study examined the effects of the COVID-19 pandemic on the quality of life (QoL) of Malaysian healthcare workers and its predictive factors. An online sample of 389 university-based healthcare workers completed questionnaires on demographics, clinical features, COVID-19-related stressors, psychological experiences, and perceived social support after the movement lockdown was lifted. All domains of QoL were within the norms of the general population except for social relationship QoL, which was lower than the norm. Multiple linear regression analysis indicated that COVID-19-related stressors (e.g., stress due to annual leave being frozen, loss of daily routine, and frequent exposure to COVID-19 patients) and psychological sequelae (e.g., greater severity of depression, anx...
Psychotropic polypharmacy among elderly patients is problematic due to their multiple comorbiditi... more Psychotropic polypharmacy among elderly patients is problematic due to their multiple comorbidities. This study investigated psychotropic polypharmacy among elderly patients discharged from a Malaysian university hospital and its associated factors. Discharges of patients aged 65 years or above from the psychiatric wards from 2010 to 2019 were reviewed. Sociodemographic data, length of stay (LOS), psychiatric and other diagnoses, and psychotropic prescription upon discharge were extracted from electronic databases. Multiple logistic regression was conducted with age, gender, race, marital status, main psychiatric diagnosis, LOS, and the number of medical comorbidities as independent variables, and polypharmacy (>2 psychotropics) as the dependent variable. There were 354 discharges in this period. The mean age was 72.4 years (SD=5.9 years); 63.0% were female and 39.8% were Malays. Most were married (84.2%). The commonest category of psychiatric diagnosis was mood disorders (54.5%)...
Neuroleptic malignant syndrome (NMS) is a well-known and potentially fatal complication of antips... more Neuroleptic malignant syndrome (NMS) is a well-known and potentially fatal complication of antipsychotic use. The elderly population, with multiple risk factors, are more vulnerable to this condition. We described a case of an 80-yearold man with bipolar disorder, previously on oral extended-release sodium valproate, aripiprazole and long-acting injectable paliperidone, who developed NMS. He presented with generalised muscle rigidity, fever, fluctuating blood pressure and elevated creatinine kinase during his hospitalisation for a manic episode. Contributing factors included old age, underlying vascular Parkinsonism, electrolyte imbalance, intercurrent lung infection with acute exacerbation of chronic obstructive pulmonary disease, hyperactive delirium, and repeated administration of parenteral typical antipsychotic. Antipsychotics were withheld promptly, and the patient was treated with dantrolene, bromocriptine and amantadine. His symptoms resolved after a week. He subsequently re...
Super-refractory status epilepticus (SRSE) is a neurocritical emergency, associated with signific... more Super-refractory status epilepticus (SRSE) is a neurocritical emergency, associated with significant morbidity and mortality. The precise pathophysiology is still not completely understood. The likelihood of spontaneous seizure termination reduces with time, and it is of paramount importance to abort status in order to prevent permanent long-term neurological sequelae and death. A few neuroprotective strategies, such as general anaesthesia, steroids, ketogenic diet and hypothermia, have been used to treat SRSE, however, the clinical outcome remains inconclusive. We herein present two cases of SRSE, which were successfully treated with electroconvulsive therapy (ECT) after failing all pharmacological measures.
Objective: To determine consultation-liaison psychiatry (CLP) referral rate and patient character... more Objective: To determine consultation-liaison psychiatry (CLP) referral rate and patient characteristics in a regional referral hospital. Methods: Retrospective review of CLP referral records at Hospital Raja Permaisuri Bainun, Ipoh over 12 weeks. Results: The inpatient referral rate was 12.1 per 1,000 patients (Median age: 43 years, male: 58%). The emergency department referred most cases (51.1%), followed by the medical wards (29.6%). Top referral reasons were depression (22.8%), suicide assessment (15.9%), and substance-related problems (13.0%). Depressive disorders (20.6%), substance-related disorders (17.2%), and schizophrenia (14.3%) were the commonest diagnoses. Male, Malay, and orthopaedic patient were factors associated with substance-related referrals. Deliberate self-harm patients were younger, more likely to be female, Indian, and without a psychiatric disorder. Conclusion: Substance-related disorders and DSH contributed much to CLP workload at the regional hospital studi...
Aim/background Even though dialectical behavior therapy (DBT) has received substantial empirical ... more Aim/background Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia. Methods Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention. Results There were significant reductions in dep...
Purpose: Anxiety is prevalent among women with diabetes mellitus. Women also tend to have higher ... more Purpose: Anxiety is prevalent among women with diabetes mellitus. Women also tend to have higher levels of neuroticism and anxiety. These symptoms can have an impact on social functioning and diabetes care. The main aim of the present study was to determine the relationship between neuroticism and anxiety symptoms, and other clinical and psychosocial variables, among women with diabetes mellitus (DM). Patients and methods: This was a cross-sectional study conducted on women with diabetes mellitus. Sociodemographic and clinical variables were acquired, including perceptions on religious practice, social support, and diabetic self-care. Study subjects completed the Generalized Anxiety Disorder 7-item (GAD-7) and the Big-Five Inventory (BFI). The neuroticism subscale of the BFI was used for analysis. Results: The study included 141 subjects (Median age: 64.0 years, IQR: 52.5–71.0 years) with a median duration of diabetes of 12.0 years (IQR: 6.0–20.0 years). Neuroticism scores correlate...
Introduction: Marital issues among gynecologic cancer survivors are common but complex. This stud... more Introduction: Marital issues among gynecologic cancer survivors are common but complex. This study aimed to investigate the relationship between sociodemographic and clinical factors, including sexual dysfunction and marital satisfaction among Malaysian gynecologic cancer survivors.Methods: A cross-sectional survey of married women with gynecologic cancers was conducted at a Malaysian university hospital. Sociodemographic and clinical data were gathered. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI), while marital satisfaction was evaluated with the Malay Version Golombok Rust Inventory for Marital Satisfaction (MVGRIMS).Results: A total of 116 patients participated in this study. The median age was 59.0 years (Interquartile range, IQR: 49.0–67.0 years); the median duration of marriage was 32 years (IQR: 20.0–40.8 years). 80.2% had a secondary and lower level of education. 37.9% of study subjects (n = 44) reported poor-and below-levels...
Background and aims This online cross-sectional study investigated the severity of depressive, an... more Background and aims This online cross-sectional study investigated the severity of depressive, anxiety, and stress symptoms among university students and determined the association between various factors and the levels of depressive and anxiety symptoms in response to the coronavirus disease 2019 (COVID-19) pandemic after the movement control order (MCO) was lifted. Methods A total of 316 participants were administered a self-report questionnaire that collected data on sociodemographic attributes, personal characteristics, COVID-19-related stressors, religious coping, and clinical characteristics. In addition, the Multidimensional Scale of Perceived Social Support (MSPSS) and the 21-item Depression, Anxiety and Stress Scale (DASS-21) were administered. Results Regarding depression, 15.5%, 11.7%, and 9.2% of the participants reported mild, moderate, and severe to extremely severe depression, respectively. For anxiety, 7.0%, 16.5%, and 13.2% of the respondents had mild, moderate, and...
International Journal of Diabetes in Developing Countries
Diabetes mellitus (DM) is an increasingly prevalent condition that is associated with significant... more Diabetes mellitus (DM) is an increasingly prevalent condition that is associated with significant complications, especially when glycemic control is poor. This study explored what biopsychosocial factors are associated with poor vs. very poor glycemic control among Malaysian patients with sub-optimal glycated hemoglobin (HbA1c) levels. This cross-sectional study recruited diabetic patients with poor glycemic control (HbA1c ≥ 7.0%) from the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. The Generalized Anxiety Disorder (GAD)-7, Beck Depression Inventory (BDI) and Big Five Inventory (BFI) questionnaires assessed for anxiety, depression and personality traits, respectively. Multivariate logistic regression analysis was performed to evaluate associations between biopsychosocial factors and the occurrence of poor vs. very poor glycemic control, using the median HbA1c level of the study sample as the cutoff point. The median age of participants (n = 176) was 61.5 years. The median duration of diabetes was 15.0 years, and the median HbA1c level was 8.5%. Very poor control of diabetes (HbA1c > 8.5%) was associated with younger age, single status, retirement, hypertension and dyslipidemia in bivariate analysis. However, in the final multivariate regression model, only agreeableness was associated with very poor glycemic control (p < 0.01). There were no differences in depression and anxiety scores between the poor and very poor glycemic control groups. This study suggests that the agreeableness personality trait may be associated with very poor glycemic control. The effects of personality traits on glycemic control might be influenced by sociocultural factors. Further investigations are needed to provide a better understanding of this area.
International Journal of Environmental Research and Public Health
This study investigated the prevalence and severity of depression, anxiety, and stress and determ... more This study investigated the prevalence and severity of depression, anxiety, and stress and determined the association between various factors, social support, and depression, anxiety, and stress among university healthcare workers in Malaysia after the government lifted the movement control order (MCO) put in place to curb the coronavirus disease 2019 (COVID-19) pandemic. This online, cross-sectional survey recruited 399 participants from two university hospitals, and they were administered a self-reported questionnaire on demographic, personal, and clinical characteristics, as well as COVID-19-related stressors and coping. In addition, they completed the Multidimensional Scale of Perceived Social Support (MSPSS) to measure perceived social support, as well as the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess depression, anxiety, and stress. We found that the prevalence rates of depression, anxiety, and stress were 21.8%, 31.6%, and 29.1%, respectively. Participa...
Burnout and mental health issues are common among healthcare workers. Burnout and mental ill-heal... more Burnout and mental health issues are common among healthcare workers. Burnout and mental ill-health may also adversely affect quality of life (QOL). This study aimed to determine the prevalence of burnout, mental ill-health, and QOL among employees of Hospital Bentong in Pahang state, Malaysia. This was a 2-week, cross-sectional online survey for Hospital Bentong employees. It consisted of (i) sociodemographic data, (ii) respondents’ perceptions, (iii) Malay-version Copenhagen Burnout Inventory (CBI), (iv) 21-item Depression, Anxiety and Stress scale (DASS-21), and (v) WHO Quality of Life-BREF (WHOQOL-BREF) instrument. In total, 52.4% of hospital employees (N = 251) participated in the study. The burnout rates were 17.5% (personal burnout), 13.9% (work burnout), and 6.0% (client burnout). The prevalence rates of depression, anxiety, and stress were 18.7, 38.6, and 12.0%, respectively. In multivariate regression analysis, personal burnout was associated with Malay ethnicity [odds rat...
The Malay-version Generalised Anxiety Disorder-7 (GAD-7) questionnaire previously demonstrated go... more The Malay-version Generalised Anxiety Disorder-7 (GAD-7) questionnaire previously demonstrated good concurrent validity, i.e. sensitivity and specificity as a screening instrument for anxiety. However, its psychometric properties on factorial validity had not been further investigated. This study investigated the factor structure of the Malay-version GAD-7 in among 300 diabetic outpatients (mean age: 60.4 years, SD: 13.4 years; 52.7% male) in a Malaysian university hospital in Kuala Lumpur. Study participants completed questionnaires on sociodemographic information, the GAD-7, the Beck's Depression Inventory (BDI), and the WHOQOL-BREF instrument. The Malay-version GAD-7 displayed good internal consistency (Cronbach's α=0.91) and satisfactory convergent validity with depression (Pearson's R=0.642, p<0.001), overall perceptions of QOL (R=-0.277, p<0.001) and health (R=-0.257, p<0.001). In exploratory factor analysis, there was only one component with an eigenvalue >1 (eigenvalue=4.614), suggesting a unidimensional factor structure. All seven items were loaded on a higher-order factor ('generalized anxiety') in confirmatory factor analysis. This model did not have a good fit with the data. After examining the modification indices, the model was respecified to allow covariance of the error terms of items 1 and 2, and 2 and 3. The respecified model appeared to fit the data better (χ 2 =35.216, df=12, p<0.001, CFI=0.98, TLI=0.97, RMSEA=0.08, and AIC=67.22). The findings suggested that items 1, 2 and 3 of GAD-7 may share distinctive variance out of that explained by the 'generalized anxiety' factor. Overall, the Malay-version GAD-7 appeared to be a valid measurement of the symptoms of anxiety in this study.
Background: Diabetes mellitus is highly prevalent in the elderly population, with a significant i... more Background: Diabetes mellitus is highly prevalent in the elderly population, with a significant impact on quality of life. This study aimed to explore the relationship between personality traits and quality of life in an elderly population with diabetes. Methods: A cross-sectional study was conducted at the Universiti Kebangsaan Malaysia Medical Center. Outpatients above 60 years old with a diagnosis of type 1 or type 2 diabetes mellitus were recruited. Sociodemographic and clinical information were obtained. Quality of life was assessed using the WHO Quality of Life-BREF questionnaire and personality traits were assessed using the Big Five Inventory questionnaire. Depression and anxiety were measured with Beck Depression Inventory and Generalized Anxiety Disorder 7-item scale respectively and controlled for in statistical analyses. Results: There were 170 study participants (median age=69.0 years; IQR: 65.0-73.0; 51.2% male). In stepwise linear regression models, higher conscientio...
Asian Journal of Pharmaceutical and Clinical Research, May 1, 2018
Traditional herbal medicines are generally perceived as natural and safe. Nonetheless, adulterati... more Traditional herbal medicines are generally perceived as natural and safe. Nonetheless, adulteration of such complementary products, including Chinese Proprietary Medicines with undeclared drugs, notably steroids, is a recognized problem. While there are many accounts of Cushing's syndrome due to steroid content in traditional medicines, psychiatric complications caused by the similar insults are not reported throughout the literature. We report a case of acute mania after the short-term use of steroid-adulterated herbal product in a previously healthy young male. It shows that psychiatric complications can occur in such a scenario without the physical and metabolic features of Cushing's syndrome, and pharmacodynamic interaction between the herbal ingredient and adulterant is a possible factor. The case also highlights the need for awareness of culturally influenced health product consumption and its potential effects on clinical conditions, as well as the important role of a robust surveillance system for such products.
Objective. Diabetes mellitus is one of the most common noncommunicable diseases in Malaysia. It i... more Objective. Diabetes mellitus is one of the most common noncommunicable diseases in Malaysia. It is associated with significant complications and a high cost of treatment, especially when glycaemic control is poor. Despite its negative impact on health, data is still lacking on the possible biopsychosocial predictors of poor glycaemic control among the diabetic population. This study is aimed at determining the prevalence of poor glycaemic control as well as its association with biopsychosocial factors such as personality traits, psychiatric factors, and quality of life (QOL) among Malaysian patients with diabetes.Methods. A cross-sectional study was conducted at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using outpatient population diabetic patients. Demographic data on social and clinical characteristics were collected from participants. Several questionnaires were administered, including the Beck Depression Inventory-II (BDI-II) to measure depressive symptoms, the G...
Background: Insight influences treatment adherence among patients with depression. These patients... more Background: Insight influences treatment adherence among patients with depression. These patients also experience considerable social and self-stigma. The relationship between insight and internalized stigma has been extensively studied among patients with schizophrenia but not patients with depression. Aim: This study aimed to determine the relationship between the level of insight in illness and internalized stigma among patients with depression and to identify the clinical factors associated with impaired insight. Materials and Methods: A cross-sectional survey was conducted among adult psychiatric outpatients with depressive disorders at a teaching hospital in Kuala Lumpur for 10 months. Sociodemographic and illness-related data were gathered. Two questionnaires, Mood Disorder Insight Scale (MDIS) and Internalized Stigma of Mental Illness Scale (ISMI), were administered. Results: Ninety-nine respondents participated in the study (female: 63.6%; Malay: 41.4%; mean age: 46.4 years). The median duration of illness was 6.0 years. More respondents were taking combination therapy (59.6%). There was a statistically significant correlation between ISMI and MDIS scores (rs = 0.339, P = 0.001). On bivariate analyses, intact insight was associated with non-Malay race, combination therapy, higher average ISMI scores and subscores for alienation, stereotype endorsement, discrimination experience, and social withdrawal. Combination therapy, higher scores for alienation, and social withdrawal subscales were associated with a greater likelihood for intact insight in logistic regression model. Conclusions: Significant association exists between insight and internalized stigma in patients with depression. Interventions to reduce the impact of internalized stigma while improving patients' insight are required.
COVID-19 has struck the world by surprise since it began to spread as a novel viral infection in ... more COVID-19 has struck the world by surprise since it began to spread as a novel viral infection in China in December 2020. In Malaysia, it only began to spread among the local population since March 2020 and resulting in movement lockdown imposed by the government from mid-March 2020 to June 2020. Although the movement lockdown was lifted in June 2020, academic activities in Malaysian universities are still restricted. Consequently, prevalence of psychological complications surge among the university students. Nevertheless, there is paucity of data on mental health status of university students in response to COVID-19 after the movement lockdown was lifted. This cross-sectional study aimed to fill the research gap by: (1) investigating the severity of depressive, anxiety, and psychological stress symptoms in response to the COVID-19 pandemic after the movement lockdown was lifted among a cohort of Malaysian university students and (2) determining the association between various COVID-...
Additional file 1 Table S1. The mean and standard deviation for age, the WHOQOL-BREF, and the BFI... more Additional file 1 Table S1. The mean and standard deviation for age, the WHOQOL-BREF, and the BFI scores.
Although healthcare workers play a crucial role in helping curb the hazardous health impact of co... more Although healthcare workers play a crucial role in helping curb the hazardous health impact of coronavirus disease 2019 (COVID-19), their lives and major functioning have been greatly affected by the pandemic. This study examined the effects of the COVID-19 pandemic on the quality of life (QoL) of Malaysian healthcare workers and its predictive factors. An online sample of 389 university-based healthcare workers completed questionnaires on demographics, clinical features, COVID-19-related stressors, psychological experiences, and perceived social support after the movement lockdown was lifted. All domains of QoL were within the norms of the general population except for social relationship QoL, which was lower than the norm. Multiple linear regression analysis indicated that COVID-19-related stressors (e.g., stress due to annual leave being frozen, loss of daily routine, and frequent exposure to COVID-19 patients) and psychological sequelae (e.g., greater severity of depression, anx...
Psychotropic polypharmacy among elderly patients is problematic due to their multiple comorbiditi... more Psychotropic polypharmacy among elderly patients is problematic due to their multiple comorbidities. This study investigated psychotropic polypharmacy among elderly patients discharged from a Malaysian university hospital and its associated factors. Discharges of patients aged 65 years or above from the psychiatric wards from 2010 to 2019 were reviewed. Sociodemographic data, length of stay (LOS), psychiatric and other diagnoses, and psychotropic prescription upon discharge were extracted from electronic databases. Multiple logistic regression was conducted with age, gender, race, marital status, main psychiatric diagnosis, LOS, and the number of medical comorbidities as independent variables, and polypharmacy (>2 psychotropics) as the dependent variable. There were 354 discharges in this period. The mean age was 72.4 years (SD=5.9 years); 63.0% were female and 39.8% were Malays. Most were married (84.2%). The commonest category of psychiatric diagnosis was mood disorders (54.5%)...
Neuroleptic malignant syndrome (NMS) is a well-known and potentially fatal complication of antips... more Neuroleptic malignant syndrome (NMS) is a well-known and potentially fatal complication of antipsychotic use. The elderly population, with multiple risk factors, are more vulnerable to this condition. We described a case of an 80-yearold man with bipolar disorder, previously on oral extended-release sodium valproate, aripiprazole and long-acting injectable paliperidone, who developed NMS. He presented with generalised muscle rigidity, fever, fluctuating blood pressure and elevated creatinine kinase during his hospitalisation for a manic episode. Contributing factors included old age, underlying vascular Parkinsonism, electrolyte imbalance, intercurrent lung infection with acute exacerbation of chronic obstructive pulmonary disease, hyperactive delirium, and repeated administration of parenteral typical antipsychotic. Antipsychotics were withheld promptly, and the patient was treated with dantrolene, bromocriptine and amantadine. His symptoms resolved after a week. He subsequently re...
Super-refractory status epilepticus (SRSE) is a neurocritical emergency, associated with signific... more Super-refractory status epilepticus (SRSE) is a neurocritical emergency, associated with significant morbidity and mortality. The precise pathophysiology is still not completely understood. The likelihood of spontaneous seizure termination reduces with time, and it is of paramount importance to abort status in order to prevent permanent long-term neurological sequelae and death. A few neuroprotective strategies, such as general anaesthesia, steroids, ketogenic diet and hypothermia, have been used to treat SRSE, however, the clinical outcome remains inconclusive. We herein present two cases of SRSE, which were successfully treated with electroconvulsive therapy (ECT) after failing all pharmacological measures.
Objective: To determine consultation-liaison psychiatry (CLP) referral rate and patient character... more Objective: To determine consultation-liaison psychiatry (CLP) referral rate and patient characteristics in a regional referral hospital. Methods: Retrospective review of CLP referral records at Hospital Raja Permaisuri Bainun, Ipoh over 12 weeks. Results: The inpatient referral rate was 12.1 per 1,000 patients (Median age: 43 years, male: 58%). The emergency department referred most cases (51.1%), followed by the medical wards (29.6%). Top referral reasons were depression (22.8%), suicide assessment (15.9%), and substance-related problems (13.0%). Depressive disorders (20.6%), substance-related disorders (17.2%), and schizophrenia (14.3%) were the commonest diagnoses. Male, Malay, and orthopaedic patient were factors associated with substance-related referrals. Deliberate self-harm patients were younger, more likely to be female, Indian, and without a psychiatric disorder. Conclusion: Substance-related disorders and DSH contributed much to CLP workload at the regional hospital studi...
Aim/background Even though dialectical behavior therapy (DBT) has received substantial empirical ... more Aim/background Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia. Methods Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention. Results There were significant reductions in dep...
Purpose: Anxiety is prevalent among women with diabetes mellitus. Women also tend to have higher ... more Purpose: Anxiety is prevalent among women with diabetes mellitus. Women also tend to have higher levels of neuroticism and anxiety. These symptoms can have an impact on social functioning and diabetes care. The main aim of the present study was to determine the relationship between neuroticism and anxiety symptoms, and other clinical and psychosocial variables, among women with diabetes mellitus (DM). Patients and methods: This was a cross-sectional study conducted on women with diabetes mellitus. Sociodemographic and clinical variables were acquired, including perceptions on religious practice, social support, and diabetic self-care. Study subjects completed the Generalized Anxiety Disorder 7-item (GAD-7) and the Big-Five Inventory (BFI). The neuroticism subscale of the BFI was used for analysis. Results: The study included 141 subjects (Median age: 64.0 years, IQR: 52.5–71.0 years) with a median duration of diabetes of 12.0 years (IQR: 6.0–20.0 years). Neuroticism scores correlate...
Introduction: Marital issues among gynecologic cancer survivors are common but complex. This stud... more Introduction: Marital issues among gynecologic cancer survivors are common but complex. This study aimed to investigate the relationship between sociodemographic and clinical factors, including sexual dysfunction and marital satisfaction among Malaysian gynecologic cancer survivors.Methods: A cross-sectional survey of married women with gynecologic cancers was conducted at a Malaysian university hospital. Sociodemographic and clinical data were gathered. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI), while marital satisfaction was evaluated with the Malay Version Golombok Rust Inventory for Marital Satisfaction (MVGRIMS).Results: A total of 116 patients participated in this study. The median age was 59.0 years (Interquartile range, IQR: 49.0–67.0 years); the median duration of marriage was 32 years (IQR: 20.0–40.8 years). 80.2% had a secondary and lower level of education. 37.9% of study subjects (n = 44) reported poor-and below-levels...
Background and aims This online cross-sectional study investigated the severity of depressive, an... more Background and aims This online cross-sectional study investigated the severity of depressive, anxiety, and stress symptoms among university students and determined the association between various factors and the levels of depressive and anxiety symptoms in response to the coronavirus disease 2019 (COVID-19) pandemic after the movement control order (MCO) was lifted. Methods A total of 316 participants were administered a self-report questionnaire that collected data on sociodemographic attributes, personal characteristics, COVID-19-related stressors, religious coping, and clinical characteristics. In addition, the Multidimensional Scale of Perceived Social Support (MSPSS) and the 21-item Depression, Anxiety and Stress Scale (DASS-21) were administered. Results Regarding depression, 15.5%, 11.7%, and 9.2% of the participants reported mild, moderate, and severe to extremely severe depression, respectively. For anxiety, 7.0%, 16.5%, and 13.2% of the respondents had mild, moderate, and...
International Journal of Diabetes in Developing Countries
Diabetes mellitus (DM) is an increasingly prevalent condition that is associated with significant... more Diabetes mellitus (DM) is an increasingly prevalent condition that is associated with significant complications, especially when glycemic control is poor. This study explored what biopsychosocial factors are associated with poor vs. very poor glycemic control among Malaysian patients with sub-optimal glycated hemoglobin (HbA1c) levels. This cross-sectional study recruited diabetic patients with poor glycemic control (HbA1c ≥ 7.0%) from the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. The Generalized Anxiety Disorder (GAD)-7, Beck Depression Inventory (BDI) and Big Five Inventory (BFI) questionnaires assessed for anxiety, depression and personality traits, respectively. Multivariate logistic regression analysis was performed to evaluate associations between biopsychosocial factors and the occurrence of poor vs. very poor glycemic control, using the median HbA1c level of the study sample as the cutoff point. The median age of participants (n = 176) was 61.5 years. The median duration of diabetes was 15.0 years, and the median HbA1c level was 8.5%. Very poor control of diabetes (HbA1c > 8.5%) was associated with younger age, single status, retirement, hypertension and dyslipidemia in bivariate analysis. However, in the final multivariate regression model, only agreeableness was associated with very poor glycemic control (p < 0.01). There were no differences in depression and anxiety scores between the poor and very poor glycemic control groups. This study suggests that the agreeableness personality trait may be associated with very poor glycemic control. The effects of personality traits on glycemic control might be influenced by sociocultural factors. Further investigations are needed to provide a better understanding of this area.
International Journal of Environmental Research and Public Health
This study investigated the prevalence and severity of depression, anxiety, and stress and determ... more This study investigated the prevalence and severity of depression, anxiety, and stress and determined the association between various factors, social support, and depression, anxiety, and stress among university healthcare workers in Malaysia after the government lifted the movement control order (MCO) put in place to curb the coronavirus disease 2019 (COVID-19) pandemic. This online, cross-sectional survey recruited 399 participants from two university hospitals, and they were administered a self-reported questionnaire on demographic, personal, and clinical characteristics, as well as COVID-19-related stressors and coping. In addition, they completed the Multidimensional Scale of Perceived Social Support (MSPSS) to measure perceived social support, as well as the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess depression, anxiety, and stress. We found that the prevalence rates of depression, anxiety, and stress were 21.8%, 31.6%, and 29.1%, respectively. Participa...
Burnout and mental health issues are common among healthcare workers. Burnout and mental ill-heal... more Burnout and mental health issues are common among healthcare workers. Burnout and mental ill-health may also adversely affect quality of life (QOL). This study aimed to determine the prevalence of burnout, mental ill-health, and QOL among employees of Hospital Bentong in Pahang state, Malaysia. This was a 2-week, cross-sectional online survey for Hospital Bentong employees. It consisted of (i) sociodemographic data, (ii) respondents’ perceptions, (iii) Malay-version Copenhagen Burnout Inventory (CBI), (iv) 21-item Depression, Anxiety and Stress scale (DASS-21), and (v) WHO Quality of Life-BREF (WHOQOL-BREF) instrument. In total, 52.4% of hospital employees (N = 251) participated in the study. The burnout rates were 17.5% (personal burnout), 13.9% (work burnout), and 6.0% (client burnout). The prevalence rates of depression, anxiety, and stress were 18.7, 38.6, and 12.0%, respectively. In multivariate regression analysis, personal burnout was associated with Malay ethnicity [odds rat...
The Malay-version Generalised Anxiety Disorder-7 (GAD-7) questionnaire previously demonstrated go... more The Malay-version Generalised Anxiety Disorder-7 (GAD-7) questionnaire previously demonstrated good concurrent validity, i.e. sensitivity and specificity as a screening instrument for anxiety. However, its psychometric properties on factorial validity had not been further investigated. This study investigated the factor structure of the Malay-version GAD-7 in among 300 diabetic outpatients (mean age: 60.4 years, SD: 13.4 years; 52.7% male) in a Malaysian university hospital in Kuala Lumpur. Study participants completed questionnaires on sociodemographic information, the GAD-7, the Beck's Depression Inventory (BDI), and the WHOQOL-BREF instrument. The Malay-version GAD-7 displayed good internal consistency (Cronbach's α=0.91) and satisfactory convergent validity with depression (Pearson's R=0.642, p<0.001), overall perceptions of QOL (R=-0.277, p<0.001) and health (R=-0.257, p<0.001). In exploratory factor analysis, there was only one component with an eigenvalue >1 (eigenvalue=4.614), suggesting a unidimensional factor structure. All seven items were loaded on a higher-order factor ('generalized anxiety') in confirmatory factor analysis. This model did not have a good fit with the data. After examining the modification indices, the model was respecified to allow covariance of the error terms of items 1 and 2, and 2 and 3. The respecified model appeared to fit the data better (χ 2 =35.216, df=12, p<0.001, CFI=0.98, TLI=0.97, RMSEA=0.08, and AIC=67.22). The findings suggested that items 1, 2 and 3 of GAD-7 may share distinctive variance out of that explained by the 'generalized anxiety' factor. Overall, the Malay-version GAD-7 appeared to be a valid measurement of the symptoms of anxiety in this study.
Background: Diabetes mellitus is highly prevalent in the elderly population, with a significant i... more Background: Diabetes mellitus is highly prevalent in the elderly population, with a significant impact on quality of life. This study aimed to explore the relationship between personality traits and quality of life in an elderly population with diabetes. Methods: A cross-sectional study was conducted at the Universiti Kebangsaan Malaysia Medical Center. Outpatients above 60 years old with a diagnosis of type 1 or type 2 diabetes mellitus were recruited. Sociodemographic and clinical information were obtained. Quality of life was assessed using the WHO Quality of Life-BREF questionnaire and personality traits were assessed using the Big Five Inventory questionnaire. Depression and anxiety were measured with Beck Depression Inventory and Generalized Anxiety Disorder 7-item scale respectively and controlled for in statistical analyses. Results: There were 170 study participants (median age=69.0 years; IQR: 65.0-73.0; 51.2% male). In stepwise linear regression models, higher conscientio...
Asian Journal of Pharmaceutical and Clinical Research, May 1, 2018
Traditional herbal medicines are generally perceived as natural and safe. Nonetheless, adulterati... more Traditional herbal medicines are generally perceived as natural and safe. Nonetheless, adulteration of such complementary products, including Chinese Proprietary Medicines with undeclared drugs, notably steroids, is a recognized problem. While there are many accounts of Cushing's syndrome due to steroid content in traditional medicines, psychiatric complications caused by the similar insults are not reported throughout the literature. We report a case of acute mania after the short-term use of steroid-adulterated herbal product in a previously healthy young male. It shows that psychiatric complications can occur in such a scenario without the physical and metabolic features of Cushing's syndrome, and pharmacodynamic interaction between the herbal ingredient and adulterant is a possible factor. The case also highlights the need for awareness of culturally influenced health product consumption and its potential effects on clinical conditions, as well as the important role of a robust surveillance system for such products.
Objective. Diabetes mellitus is one of the most common noncommunicable diseases in Malaysia. It i... more Objective. Diabetes mellitus is one of the most common noncommunicable diseases in Malaysia. It is associated with significant complications and a high cost of treatment, especially when glycaemic control is poor. Despite its negative impact on health, data is still lacking on the possible biopsychosocial predictors of poor glycaemic control among the diabetic population. This study is aimed at determining the prevalence of poor glycaemic control as well as its association with biopsychosocial factors such as personality traits, psychiatric factors, and quality of life (QOL) among Malaysian patients with diabetes.Methods. A cross-sectional study was conducted at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using outpatient population diabetic patients. Demographic data on social and clinical characteristics were collected from participants. Several questionnaires were administered, including the Beck Depression Inventory-II (BDI-II) to measure depressive symptoms, the G...
Background: Insight influences treatment adherence among patients with depression. These patients... more Background: Insight influences treatment adherence among patients with depression. These patients also experience considerable social and self-stigma. The relationship between insight and internalized stigma has been extensively studied among patients with schizophrenia but not patients with depression. Aim: This study aimed to determine the relationship between the level of insight in illness and internalized stigma among patients with depression and to identify the clinical factors associated with impaired insight. Materials and Methods: A cross-sectional survey was conducted among adult psychiatric outpatients with depressive disorders at a teaching hospital in Kuala Lumpur for 10 months. Sociodemographic and illness-related data were gathered. Two questionnaires, Mood Disorder Insight Scale (MDIS) and Internalized Stigma of Mental Illness Scale (ISMI), were administered. Results: Ninety-nine respondents participated in the study (female: 63.6%; Malay: 41.4%; mean age: 46.4 years). The median duration of illness was 6.0 years. More respondents were taking combination therapy (59.6%). There was a statistically significant correlation between ISMI and MDIS scores (rs = 0.339, P = 0.001). On bivariate analyses, intact insight was associated with non-Malay race, combination therapy, higher average ISMI scores and subscores for alienation, stereotype endorsement, discrimination experience, and social withdrawal. Combination therapy, higher scores for alienation, and social withdrawal subscales were associated with a greater likelihood for intact insight in logistic regression model. Conclusions: Significant association exists between insight and internalized stigma in patients with depression. Interventions to reduce the impact of internalized stigma while improving patients' insight are required.
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Papers by Luke Woon