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Insecure attachment style as a vulnerability factor for depression: recent findings in a community-based study of Malay single and married mothers

Abdul Kadir NB, Bifulco A

Psychiatry Res, 2013 Dec 30;210(3):919-24.
PMID: 24075307 DOI: 10.1016/j.psychres.2013.08.034

The role of marital breakdown in women's mental health is of key concern in Malaysia and internationally. A cross-sectional questionnaire study of married and separated/divorced and widowed women examined insecure attachment style as an associated risk factor for depression among 1002 mothers in an urban community in Malaysia. A previous report replicated a UK-based vulnerability-provoking agent model of depression involving negative evaluation of self (NES) and negative elements in close relationships (NECRs) interacting with severe life events to model depression. This article reports on the additional contribution of insecure attachment style to the model using the Vulnerable Attachment Style Questionnaire (VASQ). The results showed that VASQ scores were highly correlated with NES, NECR and depression. A multiple regression analysis of depression with backward elimination found that VASQ scores had a significant additional effect. Group comparisons showed different risk patterns for single and married mothers. NES was the strongest risk factor for both groups, with the 'anxious style' subset of the VASQ being the best additional predictor for married mothers and the total VASQ score (general attachment insecurity) for single mothers. The findings indicate that attachment insecurity adds to a psychosocial vulnerability model of depression among mothers cross-culturally and is important in understanding and identifying risk.
Vulnerability, life events and depression amongst Moslem Malaysian women: comparing those married and those divorced or separated

Abdul Kadir NB, Bifulco A

Soc Psychiatry Psychiatr Epidemiol, 2011 Sep;46(9):853-62.
PMID: 20556355 DOI: 10.1007/s00127-010-0249-4

INTRODUCTION: The experiences of married and single mothers were compared in an investigation of psychosocial vulnerability, stress and depression in a community-based study of Moslem mothers in Malaysia. For the first time, a model of vulnerability-provoking agent originally developed by Brown et al. in the UK was tested in a Malaysian context.
METHODS: A cross-sectional study was carried out in the district of Johor Bahru, Malaysia. Of the 1,200 women approached from membership of community associations, 1,002 (84%) completed the questionnaires. Severe life events Recent Life Events Questionnaire (Brugha and Cragg in Acta Psychiatr Scand 82:77-81, 1990) and psychosocial vulnerability (VDQ) (Moran et al. in Br J Clin Psychol 40:411-427, 2001) were used to measure vulnerability factors. Depression was measured by the General Health Questionnaire (GHQ-30) (Havenaar et al. in Soc Psychiatry Psychiatr Epidemiol 43:209-215, 2008).
RESULTS: Single mothers had significantly higher rates of depression than those married (60.5 vs. 39.5%), as well as higher rates of severe life events and Negative Elements in Close Relationships (lack of support and conflict with children). However, married mothers had greater Negative Evaluation of Self. The two vulnerability factors were correlated to each other and to severe life events and social adversity. Logistic regression showed an interaction between severe life events in the material and relationship domains and joint vulnerability for depression outcome. The results are discussed in relation to the low recognition of psychosocial risks for depression in single mothers in Malaysia, as well as lack of appropriate services.
Malaysian Moslem mothers' experience of depression and service use

Abdul Kadir NB, Bifulco A

Cult Med Psychiatry, 2010 Sep;34(3):443-67.
PMID: 20549550 DOI: 10.1007/s11013-010-9183-x

Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.

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