Firdaus Mukhtar

Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures

The DASS-21 is a well-established instrument for measuring depression, anxiety, and stress with good reliability and validity reported from Hispanic American, British, and Australian adults. However, the lack of appropriate validation among Asian populations continues to pose concerns over the use of DASS-21 in Asian samples. Cultural variation may influence the individuals experience and emotional expression. Thus, when researchers and practitioners employ Western-based assessments with Asian populations by directly translating them without an appropriate validation, the process can be challenging. We conducted a series of rigorous statistical tests and minimized any potential confounds from the demographic information. Following factor analyses, we performed multigroup analysis across six nations to demonstrate consistency of our findings. The advantages of this revised DASS-18 stress scale are twofold. First, it possesses fewer items, which results in a cleaner factorial structure. Second, it has a smaller interfactor correlation. With these justifications, the revised DASS-18 stress scale is potentially more suitable for Asian populations. Nonetheless, given limitations, findings should be considered preliminary.

Prevalence, associated factors and predictors of depression among adults in the community of Selangor, Malaysia

Introduction Depression is one of the most common mental health disorders and is an emerging public health problem. The objectives of this paper were to determine the prevalence of depression, its associated factors and the predictors of depression among adults in the community of Selangor. Methods A cross sectional study was conducted in three districts in Selangor, from 11th June to 30th December 2012. The sampling frame was obtained from the Department of Statistics Malaysia (DOS) in May 2012, using the National Population and Housing Census 2010. Adults aged 18 years and above, living in the selected living quarters were approached to participate in the study and requested to complete a set of questionnaires. Results A total of 1,556 out of 2,152 participants participated in this study, giving an overall study response rate of 61.90%. Patient Health Questionnaire 9 (PHQ-9) was used to determine the presence of depression. The prevalence of depression was 10.3%, based on the PHQ-9 cut off point of 10 and above. Based on multiple logistic regression analysis, the predictors of depression were presence of anxiety, serious problems at work, unhappy relationship with children, high perceived stress, domestic violence, unhappy relationship with spouse, low self-esteem, unhappy relationship with family, serious financial constraint and presence of chronic diseases. When reanalyzed after removing anxiety, high perceived stress and low self-esteem, additional predictors of depression were found to be serious marital problems and religiosity. Conclusion The prevalence of depression in this study is similar to that found in other studies. Findings from this study are being used as baseline data to develop an effective program to assist in the management of common mental health disorders in the community, in particular depression. The identification of predictors of depression in the community is important to identify the target population for the program.

Exploratory and confirmatory factor validation of the Dysfunctional Attitude Scale for Malays (DAS-Malay) in Malaysia

The aim of this study was to investigate the factor structure of the Malay version of the Dysfunctional Attitude Scale (DAS-Malay) in clinical and nonclinical populations. The DAS is a self-report inventory derived from Becks cognitive theory of depression to measure beliefs constituting a predisposition to depression. The 40-item DAS-Malay was completed by 315 university students, 495 members of the general community, 167 medical patients, and 113 patients diagnosed with major depressive disorder. Through principal axis factoring, with varimax rotation, two factors were extracted; performance evaluation and self-control. Correlation with depression and other variables indicated that the DAS-Malay held good concurrent validity. In addition, sensitivity and specificity of the total scores of the DAS were evident in this study. The results showed that the DAS-Malay possesses satisfactory psychometric properties suggesting that this instrument is appropriate for use as a cognitive measure in a Malay cultural context although several issues require consideration.

A review on assessment and treatment for depression in Malaysia.

This paper aimed to review the literature on depression that focused on its assessment and treatment in Malaysia. PsycINFO, Medline, local journals were searched, and 18 published articles were included in this paper. Results indicate that research on depression in Malaysia, particularly validation studies and psychotherapy research, was weak and fragmented, with minimal empirical evidence available. Pharmacotherapy still dominated the treatment for depression, and, in terms of psychotherapy, Cognitive Behavioural Therapy (CBT) was recently practiced, but only a few studies have reported on the treatment efficacy of CBT. Major limitations of studies were noted, and, consequently, the problems that are associated with the implementation and future direction of clinical and research on depression in Malaysia were discussed. In short, the contribution of empirical research on the assessment and treatment for depression remained inconsistent and fragmented and urgently in need of further empirical investigation.

Effectiveness of a Group Support Lifestyle Modification (GSLiM) Programme among Obese Adults in Workplace: A Randomised Controlled Trial.

Background There was an increasing trend in the prevalence of obesity and its comorbidities over the past decades in Malaysia. Effective intervention for obesity remains limited. This study aimed to compare the effectiveness of a group based lifestyle modification programme amongst obese individuals with an existing dietary counseling programme. Methods We recruited one hundred and ninety four overweight and obese (BMI>27.5 kg/m2) employees from a local university. They were randomly allocated to either Group Support Lifestyle Modification (GSLiM) (intervention)(n = 97) or dietary counseling (comparison)(n = 97). The GSLIM activities included self monitoring, cognitive-behaviour sessions, exercise as well as dietary change advocacy, which were conducted through seminars and group sessions over 24 weeks. The comparison group was given dietary counselling once in 12 weeks. Both groups were followed up for additional 12 weeks to check for intervention effect sustenance. Anthropometric and biochemical parameters were measured at baseline, 12, 24 and 36 weeks; while dietary intake, physical activities, psychological measures and quality of life measured at baseline, 24 and 36 weeks. Data analysis was conducted using ANOVA repeated measures with intention to treat principle. Results The participants were predominantly women with mean (standard deviation) age of 40.5 (9.3) years. A total of 19.6% of the participants in GSLiM achieved 6% weight loss compared to 4.1% in the comparison group (Risk Ratio 4.75; 95% CI: 1.68, 13.45). At 24 weeks, the retention rate was 83.5% for GSLiM and 82.5% for comparison group. GSLiM participants also achieved significant improvement in total weight self-efficacy score, negative emotions and physical discomfort subscales, MDPSS friend subscale and all domains in quality of life. Participants in the comparison group experienced reduction in negative self-thoughts. Conclusion The GSLiM programme proved to be more effective in achieving targeted weight loss, improving weight self-efficacy, friend social support, and quality of life compared to dietary counseling. Trial Registration Iranian Registry of Clinical Trials IRCT201104056127N1

Testing comparison models of DASS-12 and its reliability among adolescents in Malaysia

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 Cronbachs 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.

Predictors of Group Cognitive Behaviour Therapy outcomes for the treatment of depression in Malaysia.

The aim of this study was to identify predictors of response to treatment for depression in Malaysia, using demographic and cognitive predictors. 113 patients, that were diagnosed with depression, were randomly assigned to the Treatment-As-Usual (TAU) (n=55), or TAU plus eight sessions of Group Cognitive Behaviour Therapy (TAU+GCBT; n=58). Pre-treatment using the Beck Hopelessness Scale (BHS), the Automatic Thoughts Questionnaire-Malay (ATQ-Malay), the Dysfunctional Attitude Scale-Malay (DAS-Malay), a quality of life scale, and demographic characteristics, were used in a series of multiple regression models, as potential predictors of the Beck Depression Inventory-Malay (BDI-Malay) post-assessment scores. Regression results revealed that age, the quality of life scale, and all three cognitive measures were significant predictors of outcomes in the Group Cognitive Behaviour Therapy (GCBT) group, showing that Becks cognitive model for depression could be applied in Malaysia.

Mindful Attention Awareness Scale (MAAS): factorial validity and psychometric properties in a sample of medical students in Malaysia

Purpose The principles of mindfulness have been increasingly applied in medical education for stress reduction. One of the most often used measures for mindfulness research is the Mindful Attention Awareness Scale (MAAS). The purpose of this paper is to determine the factor structure, and investigate its reliability and validity in a sample of multi-ethnic medical students in Malaysia. Design/methodology/approach In total, 590 medical students were involved in the study. After minor modification of the MAAS, a test battery including sociodemographic information, the MAAS, Subjective Happiness Scale (SHS), Satisfaction with Life Scale (SWLS), Five-facet Mindfulness Questionnaire (FFMQ), Depression, Anxiety and Stress Scale (DASS), and Perceived Stress Scale (PSS) was administered to the participants. Findings Exploratory and confirmatory factor analyses supported a one-dimensional factor structure of the MAAS. Cronbach’s α coefficient of the scale was 0.92 and in a sub-sample (n=118), it showed satisfactory temporal stability in two weeks period. There were significant positive correlations with SHS, SWLS, and four subscales of FFMQ scores (convergent validity); and negative correlations (discriminant validity) with the DASS and PSS scores (p<0.05). In another sub-sample (n=52) who participated in a four-week mindfulness-based intervention, the scale showed significant change in scores (p=0.002). Originality/value The study provided preliminary results supporting the use of the MAAS as a valid, reliable and stable factor structure of mindfulness measure among medical students in Malaysia.

Association between perceived parental style and depressive symptoms among adolescents in Hulu Langat District, Malaysia

Abstract Depression among adolescents is increasing and worrying because of its morbidity and mortality from suicide. It has been found to be associated with negative parental styles. The objective of this study was to determine the relationship between perceived negative parental styles and depressive symptoms among adolescents in Hulu Langat District, Selangor, Malaysia. A cross-sectional study was carried out on 1769 secondary school students by using a multistage cluster sampling method. Data were collected by using a set of validated, pre-tested and standardized questionnaires which included the Measures of Parental styles (MOPS) and modified Depression, Anxiety and Stress Scale 12 (DASS-12) for adolescents. Data were analyzed by using the chi-square test, Pearson’s correlation coefficient and independent t-tests. Out of 1800, 1769 completed the questionnaire giving a response rate of 98.3%. The prevalence of severe depressive symptoms was about 14% while 18.0% and 36.1% of respondents have moderate and mild depressive symptoms, respectively. There were significantly moderate and positive correlations between perceived indifferent parents (Father: r = 0.367; Mother: r = 0.340, p < 0.05), perceived abusive parents (Father: r = 0.338; Mother: r = 0.331, p < 0.05) and depressive symptoms among the respondents. While perceived over control parents shows a significantly positive but weak correlation (Father: r = 0.206; Mother: r = 0.244, p < 0.05) with depressive symptoms among respondents. All types of parental styles in this study were significantly different among respondents with different categories of depressive symptoms (p < 0.008). Perceived negative parental styles have significant influence on adolescents’ depressive symptoms. Intervention on modifying parental style is needed to reduce depressive symptoms.

Classifications of clinical depression detection using acoustic measures in Malay speakers

Objective screening mechanism using paralinguistic cues to enhance current diagnostic on detecting depression is desirable, which resulted in the rise of research on this area. However, to date, there has been no research done using dataset of Malay speakers. This paper presented an acoustic depression detection classification using Linear and Quadratic Discriminant analysis with transition parameters and power spectral density as the acoustic features. Among the two features, power spectral density performed better, especially with the combination of band 1, 2 and 3 for both male and female data. As for the Transition parameters, we found that unvoiced feature performed best overall for both male and female.