Surprisingly, our study did not find that the emergence of the COVID-19 pandemic increased the odds of anxiety. Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Affiliation: The total sum score for the DASS-21 ranges from 0 to 126. In addition, family members and providers should be encouraged to support individuals to promote help-seeking behaviour. All authors contributed to the study conception and design. Wang, Y. N., Di, Y., Ye, J. J., & Wei, W. B. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Self-administered Hospital Anxiety and Depression scale (HADS) and World Health Organisation QOL questionnaire (WHOQOL-BREF) were used to assess their psychological symptoms and QOL. We recruited 326 participants, who were administered a sociodemographic characteristics questionnaire; the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess the presence or absence of depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms; and the World Health Organization Quality of Life-BREF (WHOQoL-BREF) to assess their QoL. The association between various demographic characteristics, QoL, and anxiety symptoms among the participants are illustrated in Table 3. Musa, R., Fadzil, M. A., & Zain, A. Subject recruitment and data collection were temporarily halted from mid-March to early June 2020 due to a movement control order (MCO) imposed by the Malaysian government to curb the increasing spread of COVID-19 in the country. Our study reported that the presence of comorbid stress was the only factor significantly associated with increased odds of anxiety symptoms, while social relationship QoL and physical health QoL reduced the odds of anxiety among the participants. As shown in the first and second columns in Table 2, the majority of the study participants had a diploma or were university graduates. PLoS ONE 16(3): The association between various demographic characteristics, QoL, and depression symptoms among the participants are presented in Table 2. Of these, 65% had stress, 85.1% had anxiety and 51.4% had depression. (2020a). Many individuals continue to suffer mentally as economic consequences continue, in addition to restrictions on social activities and prolonged confinement to their homes. Hence, it is not surprising that higher perceived psychological QoL reduced the odds of depression symptoms, as reported by this study. Lastly, we testified to the presence of depression, anxiety, and stress among university students through descriptive statistics and provided empirical evidence in this regard. Nevertheless, the results of these screening tests are diagnosis and require referral to a professional for further evaluation. Significant predictors at p < 0.05 in a bivariate analysis were exported to the multivariable logistic regression model. The increase in the rate of depression was most rapid, and the rate of depression was dramatically high as the COVID-19 pandemic moved into its seventh month in Malaysia. The changes in the mood states of individuals due to the pandemic underpins the rationale of the present study. The highest percentage of respondents reported anxiety (32.3%), followed by depressive (20.6%) and stress (11.5%) symptoms in the first time period (12 May7 June 2020). (2020b). B., Sang, H. B., Liu, S. Y., & Akbaruddin, A. Medical Journal of Malaysia, 58(1), 7988. Biofeedback training is available online, while MBSR can be conducted online and has been found to be effective in reducing depression, anxiety, and stress symptoms (Khoury, Sharma, Rush, & Fournier, 2015; Muller et al., 2020; Sidi, 2020). Haridah Alias, Prevalence of different levels of anxiety during third wave of COVID-19 in Malaysia. The discrepancy in the prevalence of anxiety, depression, and comorbid depression and anxiety between our study and other studies in the Malaysian community may be attributed to the different screening tools used. The increase in mental disorders over time can perhaps be seen as part of the continuous economic and societal consequences as the pandemic has progressed. This research was approved by the University of Malaya Research Ethics Committee (UM.TNC2/UMREC 884). The psychological impact of the COVID-19 epidemic on college students in China. First, since comorbid stress and fear of being infected with COVID-19 elevate the odds of acquiring depression symptoms and depression with comorbid anxiety symptoms, whereas better psychological QoL is protective against depression and depression with comorbid anxiety in the urban population, at a time when COVID-19 is still prevalent globally, there is a need for public health authorities and mental health providers to offer online psychotherapy. Depression, Anxiety & Stress Scale (DASS) is 21-item questionnaires designed to measure the current mental health and emotional states, identifying Depression, Anxiety or Stress. Firdaus, G., & Ahmad, A. Shumye, S., Belayneh, Z., & Mengistu, N. (2019). Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Affiliation: This finding implies that the Malaysian public became increasingly vulnerable to depressive disorder as the pandemic continued. Several population-based surveys have also revealed that students report a higher prevalence of depressive, anxiety and stress symptoms [27, 28]. Effectiveness of telemedicine: A systematic review of reviews. PubMed 01 / 07. e0248916. Specifically, depression was found to be the main risk factors associated with suicidal behaviours [23, 24]. This is because what triggers a stress response in one individual may not be the same that triggers a stress response in another individual, and it can greatly vary from forgetting to send an email to a death of a loved one. Again, persistence of stress may induce an increase in amygdala reactivity, which may be associated with anxiety. Future studies on DASS-21 should include validation across different group comparisons and testing of invariance of all versions. The psychological sequelae during mental health and COVID-19 pandemic: Learning from the past for todays coping styles. This may explain the association between the presence of comorbid stress and higher odds of anxiety symptoms in our study. The cut-offs for depression (moderate 710, severe 1113 and extremely severe 14), anxiety (moderate 67, severe 89 and extremely severe 10) and stress (moderate 1012, severe 1316 and extremely severe 17) were calculated [12]. Over the last 2 weeks, how often have you been feeling nervous, anxious or on edge? In this study, univariable analyses revealed that higher income and perceived financial status were well associated with better mental health outcomes. Most cases of stress (74.6%) and depression (66.2%) were of normal-to-mild level, while 74.6% of them showed moderate-to-extremely severe anxiety. Cities and mental health. A study of 301 Malaysian respondents from an urban poor community indicated that the prevalence of depression was 12.3%, and the demographic factors associated with depression included young age (<25years old), male gender, and living in the community for<4years (Tan & Yadav, 2012). The inclusion criteria were that the respondents were from the general Malaysian public and 18 years old. Written informed consent to participate in the study was signed from each participant before they were enrolled in the study. PubMedGoogle Scholar. Azmawaty Mohamad Nor, The height and weight of the participants were also measured to compute the body mass index (BMI). Nonetheless, it is possible that people experiencing psychological distress or mental health consequences were more likely to respond to the survey. Hasanah, C. I., Naing, L., & Rahman, A. R. A. PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US. The mean QoL domain scores were as follows: physical health QoL, 69.44 (SD=12.82); psychological QoL, 71.06 (SD=12.78); social relationship QoL, 72.40 (SD=12.82); and environmental QoL, 68.44 (SD=12.52). The time of assessment in relation to the declaration of coronavirus disease 2019 as a pandemic was coded into two groups, that is, before COVID-19 was declared as a global pandemic, coded as 0, and after COVID-19 was declared as a global pandemic, coded as 1. There was a statistically signicant association between stress score and the year of study. Videoconferencing and web-conferencing applications are of utmost importance to sustain social communication and social relationships among the people in urban communities when COVID-19 infection is still prevalent and social distancing has become the current norm in daily living. These findings further indicate the seriousness of overall mental health problems as the COVID-19 pandemic has progressed. Kyaimon Myint, The psychological impact continues to rise across the CMCO and RMCO phase. Psychometric properties of the 21-item Depression, Anxiety, and Stress PDF Anxiety, depression and quality of life of medical students in Malaysia Simple logistic regression analyses revealed that there were several variables significantly associated with depression with comorbid anxiety symptoms (p<0.1). Difficulty sleeping, early-morning awakening, or oversleeping. However, the prevalence of stress and anxiety were very worrying as our study was based on working adults in a medical university. Other benefits of telemedicine include increased access to healthcare, reduced travel time of patients, improved medication adherence, reduced waiting time and readmissions, and serving as a good modality for education (Kruse et al., 2017). A systematic review of 19 studies on the psychological consequences of COVID-19 for the general population found that the rates of depressive symptoms (14.6%48.3%), anxiety symptoms (6.33%50.9%), and stress symptoms (8.1%81.9%) were alarming in the general population (Xiong et al., 2020). Fig 3 shows the percentage of participants with depressive, anxiety and stress symptoms according to the DASS-21 scores for each time period. The only variable that was protective against depression with comorbid anxiety among the participants was a higher psychological QoL score (adjusted OR=0.82, 95% CI=0.680.98, p=0.041). Che Zarrina Saari, Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. Feeling restless or having trouble sitting still. Kader Maideen, S. F., Mohd Sidik, S., Rampal, L., & Mukhtar, F. (2015). PDF Mental Health Disorder among Malaysian Universities Students - ed PLoS One, 15(4), e0231924. This research work was funded by the CIMB Foundation (311.CIPPT.4117614). In addition, living in an urban area is reported to be protective against anxiety during the COVID-19 pandemic (Cao et al., 2020). Participants were asked to score each item on a Likert scale from a range of 1 to 5. A recent study evaluated the psychometric properties of the Bahasa Malaysia DASS-21 among non-Malays in Malaysia and revealed good reliability and validity, implying the scales can be used in a multiethnic population in Malaysia [15]. (2019). zdin, S., & zdin, S. B. The cut-off scores for case findings in DASS-21 are as follows: 9 for the depression subscale, 7 for the anxiety subscale, and 14 for the stress subscale (Lovibond & Lovibond, 1995). Hence, our study findings may not be generalized to the entire urban population of the country. People with pre-existing comorbidities would need extra support to cultivate resilience, coping, mindfulness and healthy adjustment with the change to an inactive, sedentary lifestyle to enhance their mental wellbeing during the pandemic. Fourth, we did not record the respondents education level and monthly income, which could be confounding factors that potentially influenced our findings. Department of Akidah and Islamic Thought, Academy of Islamic Studies, University of Malaya, Kuala Lumpur, Malaysia, Affiliation: The demographic factors associated with depression were ethnicity and marital status, whilethe only demographic factor associated with anxiety was marital status (Kader Maideen, Mohd. Simple logistic regression analyses demonstrated that those within the age group of 3160years (crude OR=0.48, 95% CI=0.211.08, p=0.075); those who were single, divorced, or widowed (crude OR=2.69, 95% CI=1.345.23, p=0.003); those who were experiencing stress symptoms (crude OR=23.81, 95% CI=12.4445.55, p<0.001); higher physical health QoL score (crude OR=0.79, 95% CI=0.730.85, p<0.001); higher psychological QoL score (crude OR=0.82, 95% CI=0.750.89, p<0.001); higher social relationship QoL score (crude OR=0.65, 95% CI=0.560.75, p<0.001); and higher environmental QoL score (crude OR=0.86, 95% CI=0.800.91, p<0.001) were significantly likely to have anxiety symptoms (p<0.1). A systematic review of reviews on the efficacy of telemedicine found 21 systematic reviews reporting that telemedicine produces significant therapeutic effectiveness for a wide range of psychiatric and medical illnesses, enhances that efficacy of health services, and exhibits good technical effectiveness and reliability. Depression and anxiety in the Malaysian urban population and - Springer In Malaysian population, a few studies have explored the psychometric properties of DASS-21 using Classic Test Theory (CTT) (Musa, et al., 2007; Ramli et al., 2009), but the DASS-21 scale and its depression, anxiety, and stress sub-scales are least explored through the use of modern test theory, specifically item response theory (IRT). Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, SAINS@BERTAM, 13200, Kepala Batas, Pulau Pinang, Malaysia, Mohammad Farris Iman Leong Bin Abdullah,Hazwani Ahmad Yusof,Noorsuzana Mohd Shariff&Rohayu Hami, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia, You can also search for this author in Beck Depression Inventory (BDI) The Beck Depression Inventory (BDI) is widely used to screen for depression and to measure behavioral manifestations and severity of depression. These findings provide an urgent call for increased attention to detect and provide intervention strategies to combat the increasing rate of mental health problems in the ongoing COVID-19 pandemic. These findings are in line with a recent study reporting that individuals with more medical comorbidities were more likely to report elevated depressive symptoms during the COVID-19 pandemic [41]. Not being able to stop or control worrying. Questions were presented in both English and Bahasa Malaysia in the survey link. Maps and Enumeration Blocks of the six selected cities were obtained. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Conversely, a meta-analysis of 14 cohorts of 13 prospective studies reported that high self-reported physical activity reduced the odds of developing anxiety by 1.35-fold, and high self-reported physical activity was protective against development of agoraphobia and posttraumatic stress disorder; these results were evident in Asian and European populations, as well as across different age groups, from children/adolescents to adults (Schuch et al., 2019). PDF Depression, Anxiety and Stress among Postgraduate Students in - UPM Results noticed that more than half of the surveyed respondents (56.4%) did not report anxiety. The links between stress and depression: Psychoneuroendocrinological, genetic, and environmental interactions. Although psychological well-being of the public is expected to improve when restrictions were lifted, nonetheless, the negative mental impact of the people in this study did not decline despite the shift from CMCO to RMCO. Perceived health status was the strongest significant predictor for depressive and anxiety symptoms. The present study investigated the prevalence of depression symptoms, anxiety symptoms, and depression with comorbid anxiety symptoms and their associated factors in a random sample drawn from several urban communities in Malaysia. To date, the Malaysian government has continuously stressed to the general public the use of face masks in public spaces, frequent hand washing and social distancing in the current ongoing pandemic. International Journal of Mental Health Promotion, 16(5), 279288. Sum scores are computed for each subscale by adding the score of each item per subscale and multiplying the sum score with a factor of 2. Depression among the urban poor in peninsular Malaysia: A community based cross-sectional study. Second, the demographic distributions of the participants in this study did not reflect the demographic distributions of the Malaysian urban population. Psychometric properties of the 21-item Depression, Anxiety, and Stress Of note, depression is a leading cause of disability around the world and contributes greatly to the global burden of disease [21]. [ view less ], * E-mail: wonglp@ummc.edu.my (LPW); ivychung@ummc.edu.my (IC), Affiliation: Based on the occupation categories, nearly half were in professional and managerial occupations (50.6%), while general workers and students comprised 7.2% and 29.2%, respectively, of the participants. Causes The cause of stress is different for each individual and there is no one specific cause. Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their efficacy, safety, and cost-effectiveness. Not at all. These variables included those who wereofMalay ethnicity(crude OR=0.37, 95% CI=0.150.94, p=0.089); being single, divorced, or widowed (crude OR=2.61, 95% CI=1.365.01, p=0.037); assessment after COVID-19 was declared as a global pandemic (crude OR=2.06, 95% CI=1.123.77, p=0.020); and stress symptoms (crude OR=39.77, 95% CI=17.0492.81, p<0.001). Depression Anxiety Stress Scale 21 | Online Depression & Anxiety Test Anxiety and panic attacks - NHS Study finds Malaysians' stress levels went up during MCO Depression and anxiety in Malaysian population during third wave of the The mental health status of school-going adolescents should be identified and appropriate timely . The sex difference is in line with evidence suggesting that women are generally more vulnerable to stress and anxiety disorders in response to traumatic events, while men show better resilience [37, 38]. Appetite and/or weight changes. Screengrab from the official Parlimen Malaysia YouTube channel. (2020). A more recent systematic review of 44 studies also pinpointed the benefits of telemedicine in terms of ease of use, tendency to improve outcomes, cost effectiveness, and communication between therapist and patients. All data were analyzed using the Statistical Package for Social Sciences version 26 (SPSS 26; SPSS Inc., Chicago, Illinois, USA). Psychology, Health & Medicine. (PDF) Prevalence of Anxiety, Stress, Depression among Malaysian Adults Mental health problems and social media exposure during COVID-19 outbreak. The first draft of the manuscript was written by [Mohammad Farris Iman Leong Bin Abdullah] and all authors commented on previous versions of the manuscript. CBI is able to identify 3 types of burnout, which are ; World Health Organization Disability Assessment Schedule (WHODAS) is a tool that assesses disability in adults age 18 years and above. The 2018 revision. The prevalence values of psychological complications were as follows: depression symptoms, 23.9% (n=78); anxiety symptoms, 41.7% (n=136); depression with comorbid anxiety symptoms, 19.9% (n=65); and stress symptoms, 31.6% (n=103). The Cox and Snell R2 of the multiple logistic regression model was 0.332 (p<0.001), and the HosmerLemeshow goodness-of-fit test (2=12.43, p=0.133) indicated acceptable fit of the model. (2020). When we compared the prevalence of depression and anxiety in our study to that of a study of depression and anxiety in 576 Malaysian urban dwellers who attended primary healthcare clinics, which also used the DASS-21 as a screening instrument (anxiety: 44.5%; depression: 20.5%; Abd Rahman, Idris, & Ibrahim, 2020), similar prevalence values were noted. Validation of "Depression, Anxiety, and Stress Scales" and "Changes in Students had higher odds of anxiety symptoms than the professional and managerial occupational groups (OR = 1.84, 95% CI 1.192.85). The WHOQoL-BREF has acceptable psychometric properties and can be substituted for the WHOQoL-100 to measure QoL without significant loss of information. In addition, unavoidable stressors may also lead to dysregulation of the noradrenaline system in the locus coeruleus, which may result in features of depression, such as altered attention and memory. As with the association between social relationships and anxiety, cross-sectional data from the assessment of spouse or partner relationships of 4988 Irish adults identified that positive partner interaction was significantly associated with a reduced likelihood of anxiety (Santini, Koyanagi, Tyrovolas, & Haro, 2015). From the survey conducted, it was found . The association of COVID-19 with the development of depression symptoms in our study is consistent with the findings of several studies of the effect of COVID-19 on the general populations in China, Italy, and Turkey, indicating that the odds of depression increased after the emergence of the COVID-19 pandemic (Ahmed et al., 2020; Gao et al., 2020; Mazza et al., 2020; zdin & zdin, 2020; Wang et al., 2020a; Wang et al., 2020b). Prevalence, associated factors and predictors of anxiety: A community survey in Selangor, Malaysia. International Journal of Environmental Research and Public Health, 17, 1729. (2021) Escalating progression of mental health disorders during the COVID-19 pandemic: Evidence from a nationwide survey. This study was initially intended to investigate the prevalence of psychological complications and their associated factors in the urban population. Hence, future studies using diagnostic tools, such as the Structural and Clinical Interview for the DSM or Mini International Neuropsychiatric Interview, are recommended to confirm our findings. Zaliha: Depression And Anxiety Rates Highest In Federal - CodeBlue Suria Zainuddin, To our best knowledge, the measurement of invariance across the English and Bahasa Malaysia version of DASS-21 has never been examined before. Univariable analyses followed by multivariable logistic regression analyses, using a simultaneous forced-entry method, was used to determine the factors influencing depression, anxiety and stress. Centre for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia, Affiliation: (2020). The HosmerLemeshow goodness-of-fit test was referred to as the indicator of the goodness-of-fit of the regression models (test finding with p>0.05 denoted good model fit). Intan Sofia Omar, These findings warrant urgent monitoring of the Malaysian populations mental health and prompt provision of counselling to mitigate the detrimental impact on society. We thank the assistance provided by all members in the Caring Together team. Chiew Hwa Poon, Social distancing, self-isolation and travel restrictions have led to a reduced workforce across all economic sectors and employment loss. The multiple logistic regression analysis pinpointed that there were only two variables that significantly predicted higher odds of depression with comorbid anxiety symptoms, which were assessment after COVID-19 was declared as a global pandemic (adjusted OR=3.19, 95% CI=1.377.45, p=0.005) and stress symptoms (adjusted OR=40.44, 95% CI=15.90102.87, p<0.001). Data collection period and the trend of confirmed cases of COVID-19 in Malaysia. For diagnosis, we recommend you to consult the professional for further assessment. Those who perceived a poor financial status (OR = 1.93, 95% CI 1.033.61) had nearly 2 times higher odds of stress symptoms than those who perceived a good financial status. Fig 1 shows the trend of confirmed COVID-19 cases in Malaysia and the recruitment period. Sidik, Rampal, & Mukhtar, 2014; Kader Maideen, Mohd Sidik, Rampal, & Mukhtar, 2015). Depression and Anxiety: Signs, Symptoms, and Treatment - Verywell Health This number represents an alarming increase from the prevalence of 10.7% estimated by the NHMS in 1996. Maw Pin Tan, Worrying too much about different things. Woon, L. S.-C., Sidi, H., Ravindran, A., Gosse, P. J., Mainland, R. L., Kaunismaa, E. S., et al. Nevertheless, data on the comparison of the prevalence of these psychological symptoms among the urban population before and after the emergence of COVID-19 as a global pandemic are not available.
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