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Fulltext The outcomes that an interview-based medical school admission process has on academic performance, psychological health, personality traits, and emotional intelligence

Yusoff MSB

J Taibah Univ Med Sci, 2018 Dec;13(6):503-511.
PMID: 31435370 DOI: 10.1016/j.jtumed.2018.09.003

Objectives: This study investigated the outcomes that an interview-based medical school admission process has on academic performance, psychological health, personality traits, and emotional intelligence.
Methods: A comparative cross-sectional study was conducted on the interviewed and non-interviewed cohorts. Their examination marks were obtained from the academic office, psychological health was measured by DASS-21, personality traits were measured by USMaP-15, and emotional intelligence was measured by USMEQ-17.
Results: The interviewed cohort performed significantly better in the clinical examination than the non-interviewed cohort. Conversely, the non-interviewed cohort performed significantly better in the theoretical examination. Depression, anxiety, and stress level between the two cohorts showed no difference. The interviewed cohort demonstrated more desirable personality traits, higher emotional intelligence, and social competence than the non-interviewed cohort.
Discussion: This study provides evidence to support the claim that the interview-based admission process has favourable outcomes on clinical performance, emotional intelligence, and personality traits. Several insights gained as a result of this study are discussed.

Matched MeSH terms: Depressive Disorder
Fulltext The theoretical model of school refusal: the self-efficacy concept

Maruzairi Husain, Ng, Vi Vien

Malaysian Journal of Paediatrics and Child Health, 2019;25(2):7-13.
MyJurnal

Introduction: School refusal is a common cause of chronically poor school attendance. The basis of school refusal behaviour can be grouped into the symptomatic and functional models, the operant conditioning model and the cognitive model. Objective: This paper is aimed to discuss the various systems and models which explain the school refusal behaviour. Method: An initial search of published literature in English Language was performed on the online databases including Google Scholar, Science Direct, EBSCOhost, and Proquest with the main keywords were School Refusal and Self–efficacy. Further sources were identified after consulting the original author for recommendations, and references within the literature retrieved in the initial search. Results: Out of 57 articles found, 41 were used in this review. Development and maintenance of school refusal involve heterogeneous risk factors and processes. The existing theoretical basis of school refusal behaviour can be grouped into symptomatic models, the operant conditioning model and the cognitive model. Conclusion: School refusal depicts a symptom, heralding the need for early intervention before development of a more pervasive mental health disorder. Where the problem had persisted for months to years, the child or adolescent would commonly present with coexisting anxiety or depressive disorders.

Matched MeSH terms: Depressive Disorder
Exploratory and confirmatory factor validation and psychometric properties of the Beck Depression Inventory for Malays (BDI-Malay) in Malaysia

Mukhtar F, Oei TPS

Malaysian Journal of Psychiatry, 2008;17:51-64.

The Beck Depression Inventory (BDI) has been shown to have good psychometric properties in Western and non-Western populations for the past 40 years. The present study reported on the factor structures and provided evidence of the psychometric properties of the BDI for the Malays in Malaysia. A total of 1090 Malays in four samples (students, general community, general medical patients, and patients with major depressive disorders) were recruited in this study. They completed a battery of questionnaires that included symptoms, cognition and quality of life measures. Two factors of the BDI-Malay namely Cognitive/Affective and Somatic/Vegetative were extracted from Exploratory Factor Analysis (EFA) and were confirmed through Confirmatory Factor Analysis (CFA). Internal consistency (Cronbach's ) ranging from = .71 to .91 and validity of the BDI-Malay were satisfactory. The BDI-Malay can be used with confidence as an instrument to measure levels of depression for Malays in Malaysia. Keywords: Beck Depression Inventory, Malaysia, psychometric, confirmatory factor analysis

Matched MeSH terms: Depressive Disorder
Fulltext Dopamine transporter 1 (DAT1) rs40184 single nucleotide polymorphism is not associated with the Malaysian major depressive disorder subjects

Aldoghachi, Asraa Faris, Cheah, Pike-See, Normala Ibrahim, Lye, Munn Sann, Ling, King-Hwa

Neuroscience Research Notes, 2019;2(4):5-13.
MyJurnal

Major depressive disorder (MDD) is a serious mental illness with a multifactorial aetiology that was shown to influence behaviour and affect cognition. Previous research has favoured the involvement of dopamine in the aetiology of the disorder, and since one of the critical regulators of the dopamine levels and activity in the brain is DAT1, the present study investigated the association of a single nucleotide polymorphism in the DAT1gene (rs40184) and MDD in the Malaysian population. A total of 300cases and 300 matched controls were recruited from four Klang valley hospitals and were screened for DAT1rs40184 using high resolution melting assays. The allele and genotype frequencies were analysed by using Chi-square. Hardy Weinberg equilibrium for the distribution of alleles and genotypes was tested by using Chi-square. Determination of the association between rs40184 and MDD was achieved by conditional logistic regression using SPSS. In the present study, no significant association was obtained between DAT1and MDD in the Malaysianpopulation.

Matched MeSH terms: Depressive Disorder, Major
Fulltext Network analysis of the depressive symptom profiles in Asian patients with depressive disorders: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD)

Park SC, Jang EY, Xiang YT, Kanba S, Kato TA, Chong MY, et al.

Psychiatry Clin Neurosci, 2020 Jun;74(6):344-353.
PMID: 32048773 DOI: 10.1111/pcn.12989

AIM: We aimed to estimate the network structures of depressive symptoms using network analysis and evaluated the geographic regional differences in theses network structures among Asian patients with depressive disorders.
METHODS: Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD), the network of the ICD-10 diagnostic criteria for depressive episode was estimated from 1174 Asian patients with depressive disorders. The node strength centrality of all ICD-10 diagnostic criteria for a depressive episode was estimated using a community-detection algorithm. In addition, networks of depressive symptoms were estimated separately among East Asian patients and South or Southeast Asian patients. Moreover, networks were estimated separately among Asian patients from high-income countries and those from middle-income countries.
RESULTS: Persistent sadness, fatigue, and loss of interest were the most centrally situated within the network of depressive symptoms in Asian patients with depressive disorders overall. A community-detection algorithm estimated that when excluding psychomotor disturbance as an outlier, the other nine symptoms formed the largest clinically meaningful cluster. Geographic and economic variations in networks of depressive symptoms were evaluated.
CONCLUSION: Our findings demonstrated that the typical symptoms of the ICD-10 diagnostic criteria for depressive episode are the most centrally situated within the network of depressive symptoms. Furthermore, our findings suggested that cultural influences related to geographic and economic distributions of participants could influence the estimated depressive symptom network in Asian patients with depressive disorders.

Matched MeSH terms: Depressive Disorder/diagnosis*; Depressive Disorder/drug therapy; Depressive Disorder/physiopathology*
Fulltext Prevalence of depression in cancer patients: a review on the comparison between different regions

Ng, C.G., Zainal N.Z.

Malaysian Journal of Psychiatry, 2014;23(2):90-113.
MyJurnal

Introduction: Depression is the most common psychological sequelae in cancer patients. It is challenging to diagnose depression in cancer patients. Furthermore, the presentation is influenced by the patients’ cultural background. Objectives: This literature review aims to determine the prevalence of depression in cancer patients across regions of different cultural background. Methods: A literature search was undertaken by using Pubmed electronic database. Studies were included in this review if they (a) examined the prevalence of depression in cancer patients and (b) published in English peer-review journal between 2000 and 2009. Results: A total of 59 studies from 21 countries were reviewed and summarised. The prevalence of depression in cancer patients ranged from 3% to 72%. Studies from Asia reported the lowest prevalence (3-39%) and Europe reported the highest prevalence (7-72%). Conclusion: Cultural influence may play a role in the prevalent difference of depression in cancer patients. Somatization and stigmatization are suggested as the possible reasons of lower prevalence of depression in Asia region. The biopsychiatric model of mental illness and western psychologization explain the higher prevalence in Western region. Future research on the cross-cultural variability in the presentation of depression in cancer patients is recommended.

Matched MeSH terms: Depressive Disorder
Fulltext Effectiveness of group cognitive behaviour therapy augmentation in reducing negative cognitions in the treatment of depression in Malaysia

Firdaus Mukhtar, Tian, PS Oei, Mohd Jamil Mohd Yaacob

ASEAN Journal of Psychiatry, 2011;12(1):0-0.
MyJurnal

Objective: Cognitive Behaviour Therapy (CBT) for depression is popular in Western countries. In the context of Malaysia, CBT has been applied as an individual session in a clinical setting. However, there is limited research in the area of group CBT for depression among Malays. The aim of this study is to investigate the effectiveness of Group Cognitive Behavioural Therapy (GCBT) in reducing the negative cognitions that are related to depression in a group of Malay patients. Methods: One hundred and thirteen patients, diagnosed with depression, were randomly allocated to either a Treatment As Usual (TAU)
group (n = 55), or a TAU plus GCBT group (n = 58). All participants completed two questionnaires that measured maladaptive cognitions at pretreatment, midway through treatment, post-treatment (week 4), and at followups after three (week 16) and six months (week 28). Results: The TAU+GCBT patients improved significantly more, and at a faster rate, than the TAU group; which showed minimal improvement. The effect size (Cohen’s d) of the treatment group was 0.93 and 96.55% of the treatment group achieved a clinically significant change. Conclusions: The findings suggest that GCBT, when used in addition to the TAU, is effective in reducing negative thoughts and maladaptive attitudes of Malaysian patients suffering from depression.

Matched MeSH terms: Depressive Disorder
Fulltext Anxiety and depressive symptoms and health-related quality of life status among patients with cancer in Terengganu, Malaysia

Lua, Pei Lin, Wong, Sok Yee, Neni Widiasmoro Selamat

ASEAN Journal of Psychiatry, 2011;12(1):0-0.
MyJurnal

Objective: This study was aimed to determine the prevalence of anxiety and depressive symptoms , to examine their association with health-related quality of life (HRQoL) profiles and to determine the predictors on overall HRQoL. Methods: This was a cross-sectional study conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. The Malay Hospital Anxiety and Depression Scale (HADS) and McGill Quality of Life Questionnaire (MMQoL) were administered to a sample of 150 cancer patients (mean age = 50.4 years).
Chi-square test, correlation and multiple regression were utilised for data analysis. Results: The prevalence for mild anxiety and depressive symptoms was 30.7% and 23.3% espectively. The HADS-A correlated strongest with Total MMQoL Score (r = - 0.578) and Psychological Well-Being (r = -0.526). Only HADS-A (beta = - 0.486), and HADS-D (beta = -0.173) were significant in predicting overall health-related quality of life. Conclusion: Findings in our study indicated that the prevalence of anxiety and depressive symptoms in
Terengganu cancer patients are moderate. If anxiety and depression are identified and treated, health-related quality of life among oncology patients appropriately could significantly be improved.

Matched MeSH terms: Depressive Disorder
Electrical Stimulation Normalizes c-Fos Expression in the Deep Cerebellar Nuclei of Depressive-like Rats: Implication of Antidepressant Activity

Huguet G, Kadar E, Temel Y, Lim LW

Cerebellum, 2017 04;16(2):398-410.
PMID: 27435250 DOI: 10.1007/s12311-016-0812-y

The electrical stimulation of specific brain targets has been shown to induce striking antidepressant effects. Despite that recent data have indicated that cerebellum is involved in emotional regulation, the mechanisms by which stimulation improved mood-related behaviors in the cerebellum remained largely obscure. Here, we investigated the stimulation effects of the ventromedial prefrontal cortex (vmPFC), nucleus accumbens (NAc), and lateral habenular nucleus on the c-Fos neuronal activity in various deep cerebellar and vestibular nuclei using the unpredictable chronic mild stress (CMS) animal model of depression. Our results showed that stressed animals had increased number of c-Fos cells in the cerebellar dentate and fastigial nuclei, as well as in the spinal vestibular nucleus. To examine the stimulation effects, we found that vmPFC stimulation significantly decreased the c-Fos activity within the cerebellar fastigial nucleus as compared to the CMS sham. Similarly, there was also a reduction of c-Fos expression in the magnocellular part of the medial vestibular nucleus in vmPFC- and NAc core-stimulated animals when compared to the CMS sham. Correlational analyses showed that the anxiety measure of home-cage emergence escape latency was positively correlated with the c-Fos neuronal activity of the cerebellar fastigial and magnocellular and parvicellular parts of the interposed nuclei in CMS vmPFC-stimulated animals. Interestingly, there was a strong correlation among activation in these cerebellar nuclei, indicating that the antidepressant-like behaviors were possibly mediated by the vmPFC stimulation-induced remodeling within the forebrain-cerebellar neurocircuitry.

Matched MeSH terms: Depressive Disorder/metabolism*; Depressive Disorder/pathology; Depressive Disorder/therapy*
Fulltext Gender identity disorder is not simply two in one

Syed Masroor, A., Abdul Ghani, K.

International Medical Journal Malaysia, 2013;12(2):83-85.
MyJurnal

A Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This
contribution will highlight the cultural and religious perspective of this Disorder.

Matched MeSH terms: Depressive Disorder
Fulltext Psychological Distress Among Infertile Women: Exploring Biopsychosocial Response To Infertility

Zuraida, A.S.

Malaysian Journal of Psychiatry, 2010;19(2):1-11.
MyJurnal

Previous studies have shown that the experience of infertility is linked with psychological responses such as depression, anxiety, guilt, social isolation, and decreased self-esteem in both men and women. The prevalence of depression among infertile women ranges from 8% to 54%. Treating gynecologists and healthcare professionals seldom recognized the psychosocial distress in women undergoing fertility treatment. Therefore this paper reviewed the bio-psychosocial response towards infertility among women with infertility.

Matched MeSH terms: Depressive Disorder
Gender and risk of depression in Saudi Arabia, a systematic review and meta-analysis

Alibrahim OA, Al-Sadat N, Elawad NA

J Public Health Afr, 2010 Sep 01;1(1):e7.
PMID: 28299041 DOI: 10.4081/jphia.2010.e7

Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks.

Matched MeSH terms: Depressive Disorder
Fulltext A Comparison of Insight in Schizophrenia, Bipolar Affective Disorder with Psychosis and Major Depressive Disorder with Psychosis

Sharmilla, K., Ahmad, H.S.

Malaysian Journal of Psychiatry, 2006;14(1):35-40.
MyJurnal

Objective: The objective of the study is to compare insight in Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis. Also to ascertain if impaired insight is associated with poorer psychosocial function. Method: 90 consecutively'admitted patients who were diagnosed with Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis were administered the scale to assess unawareness to mental illness to measure insight, the global assessment of function to measure psychosocial function and the brief psychiatric rating scale to measure psychosis.

Results: Schizophrenia was found to be associated wit h the poorest insight compared to the affective disorders. Major depression with psychosis was found to be associated with better insight than bipolar affective disorder. Results being significant in both cases. Also it was noted that there was a negative correlation between insight and psychosocial function.

Conclusion: We can conclude that Schizophrenics have the poorest insight followed by bipolar affective disorder with psychosis and then major depressive disorder with psychosis. We also infer that Schizophrenics have the poorest psychosocial function followed by bipolar affective disorder with psychosis and then major depressive disorder patients with psychosis. Also impaired insight is associated with impaired function.

Matched MeSH terms: Depressive Disorder, Major
Detection of polymorphonuclear leukocyte dysfunctioin via chemilumi-nescence assay in children with recurrent bacterial infections

Noah, R.M., Yusuff, Z., Jais, M.R., Noh, L.M.

Malaysian Journal of Child Health, 1997;9(2):170-173.
MyJurnal

Chemiluminescence assay was used to assess the respiratory burst activities of polymorpho-nuclear leukocytes from paediatric patients reported to manifest with several episodes of recurrent bacterial infections. From this group of patients evaluated, only 10 cases of severe recurrent bacterial abscess exhibited more than 80% depression in the phagocytic chemilumi-nescence responses. The assay, being a sensitive method, was able to provide further useful laboratory investigation in diagnosing 4 patients with chronic granulomatous disease.

Matched MeSH terms: Depressive Disorder
Fulltext Suicidal ideation amongst epilepsy patients in a tertiary centre

Rafiz Abdul Rani, Rosdinom Razali

Neurology Asia, 2014;19(2):129-136.
MyJurnal

Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk of suicidal ideation and suicide. Although depression is a significant risk factor for suicidal ideation in epilepsy patients, epilepsy itself is independently associated with suicidal ideation. There are various other factors related to epilepsy that further increase this risk. Methods: We conducted a study of suicidal-ideation amongst epilepsy patients in our centre. Demographic data and clinical history were obtained while suicidal ideation was determined using the Columbia Suicide Severity Rating Scale (C-SSRS). Beck’s Depression Inventory–II (BDI-II) was used to identify presence of depression. Results: We recruited 80 patients with epilepsy and an equal number of controls. Epilepsy patients were more likely to be depressed with a mean BDI-II score of 9.09 ±6.48 compared to controls who has a mean score of 5.56 ±4.56. The proportion of epilepsy patients with suicidal ideation was 33.75% vs. 5.00% in the control group (p 3 anti-epileptic drugs or prior head surgery. Our findings suggest that assessment of suicidal ideation is pertinent in high-risk epilepsy patients and should be routinely carried out in the clinical setting.

Matched MeSH terms: Depressive Disorder
Fulltext Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS)

Ramli Musa, Mohd Ariff Fadzil, Zaini Zain

ASEAN Journal of Psychiatry, 2007;8(2):82-89.
MyJurnal

Background: Up to date, there are handful questionnaires that have been validated in Bahasa Malaysia (BM). This study aimed to translate the Depression Anxiety Stress Scales 21-item (DASS-21) and measure its psychometric properties. Objectives: To determine the construct validity and acceptability of the DASS, BM. Methods: Two forward and backward translations were done in BM in accordance to guideline, and its validation was determined by using confirmatory factor analysis. A total of 263 subjects were selected by systematic random sampling to represent Malaysian population for reliability and validity purposes. Results: The BM DASS-21 had very good Cronbach’s alpha values of .84, .74 and .79, respectively, for depression, anxiety and stress. In addition, it had good factor loading values for most items (.39 to .73). Correlations among scales were between .54 and .68. Conclusions: BM DASS-21 is correctly and adequately translated to Bahasa Malaysia with high psychometric properties. Further studies are required to support these findings.

Matched MeSH terms: Depressive Disorder
Fulltext Depression and coping strategies among sexually abused children in a Malay community in Malaysia

Rosliwati Md Yusof, Mohd Jamil Yaacob, Zaharah Sulaiman, Rohayah Husain

ASEAN Journal of Psychiatry, 2009;10(2):169-180.
MyJurnal

Objective: The fact that childhood sexual abuse is associated with depression is well-known. To date, there is no proper study done on screening for depression and coping strategies among sexually abused children in Malaysia. This study aimed to determine the prevalence of depression and examine the association of depression with the socio-demographics and
coping strategies used by sexually abused children. Methods: Sixty-five sexually abused children who attended the One Stop Crisis Centre (OSCC) services at Hospital Universiti Sains Malaysia and fulfilled the study criteria were screened for depression using a validated Malay version of Children Depression Inventory (CDI).Depression was determined by a positive score of the Malay-CDI with depression being indicated in scores of more than 18.
Results: In the study sample, 16 (24.6 %) participants had been depressed and 49 (75.4 %) participants had not been depressed. Having a confidante was a protective factor against depression. Short duration of time between the abuse incident and the clinical interview was significantly associated with depression. With respect to coping strategies, 59 (90.8 %) used emotionfocused strategies and 6 (9.2 %) used problem or task-focused strategies. Among emotion-focused coping strategies, participants did the following: deciding that nothing could be done to change things, were in denial, and suppressed their feelings. Conclusion: Twenty five percent of the sample suffered from depression. The screening of depression in the vulnerable group such as sexually abused children is important, particularly for early
detection and treatment. By recognizing the coping strategies used in sexually abused children, the clinician could understand them better and plan for their psychological management.

Matched MeSH terms: Depressive Disorder
Fulltext Prevalence and contributing factors of job strain among crane operators in a Port Container Terminal in Malaysia

Nor Wahida Yakub, Sherina Mohd Sidik

Malaysian Journal of Medicine and Health Sciences, 2014;10(2):39-46.
MyJurnal

The information on job strain among crane operators in Malaysia is lacking. The aim of this study was to determine the prevalence and contributing factors of job strain among crane operators working in port container terminals. A cross sectional study was carried out at a port container terminal in Malaysia. Data was collected using validated self-administered questionnaires, which consisted of the Job Content Questionnaire (JCQ), and the Depression, Anxiety, and Stress Scale (DASS-21). All crane operators in the selected terminal participated in the study. Data was analyzed using SSPS version 19. Two-hundred- and-forty crane operators participated in the study.. The prevalence of job strain determined from the JCQ was 43.8%. Job strain was significantly associated with psychological job demand, decision latitude, anxiety, physical isometric loads and muscle ache. The prevalence of job strain in this study was high. There is an urgent need to recognize the existence of this problem among crane operators by their respective management. Implementation of comprehensive stress management programs are recommended to reduce job strain among these workers.

Matched MeSH terms: Depressive Disorder
Fulltext Neurotic personality traits and depression among first year medical and dental students in Universiti Sains Malaysia

L. Kelvin, Y.S., Othman, Z., Othman, A., Yasin, M.A.M.

Malaysian Journal of Psychiatry, 2013;22(1):1-10.
MyJurnal

Objective: This study aims to evaluate the association of neurotic personality traits and coping styles with depression amongst first year medical and dental students. Methods: A total of 167 students consisting of 133 medical and 34 dental students in their first year were recruited. All the subjects were assessed using BDI, NEO PI-R (N) and Brief COPE for depression, neurotic personality traits and coping styles respectively. Result: First year dental students were 3 times more likely to have depression than first year medical students. Students who scored high and very high on the total Neuroticism factor and the Depression facet of NEO PI-R (N) were 3.6 times and 7 times more likely to have depression than students who scored very low, low or average for the above scales. All coping styles and other socio-demographic factors showed no association with depression. Conclusion: Neurotic personality traits are significantly associated with depression. NEO PI-R (N) proved to be a useful tool to evaluate the neurotic traits among medical and dental students allowing early interventional measures to those who need it.

Matched MeSH terms: Depressive Disorder
Fulltext Modified assertive community treatment (ACT) in the management of comorbid mental and physical illnesses: a case report

Lai, M.H., Marhani, M.

Malaysian Journal of Psychiatry, 2013;22(1):1-4.
MyJurnal

The holistic approach of assertive community treatment (ACT) may provide better care and lead to better outcomes in populations with difficult-to-treat comorbid mental and physical illnesses. This paper describes the complex issues in managing a person with multiple chronic medical illnesses who also
had comorbid treatment-resistant depression and poor social support. The patient achieved improvement after the implementation of the therapeutic ingredients of ACT.

Matched MeSH terms: Depressive Disorder, Treatment-Resistant

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