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Diet and Mental Health: What Should Be Done for Malaysian Adolescents

Tajik E, Javadi M, Mohammadzadeh M

Iran J Public Health, 2017 Jul;46(7):992-994.
PMID: 28845413
Life Skills Needs Assessment among Iranian Immigrant Students in Malaysia

Mohammadzadeh M, Awang H, Tajik E

Iran J Public Health, 2017 Jan;46(1):143-145.
PMID: 28451544
Fulltext Prevalence of depression and anxiety and their association with body mass index among high school students in Qazvin, Iran, 2013-2014

Javadi M, Jourabchi Z, Shafikhani AA, Tajik E

Electron Physician, 2017 Jun;9(6):4655-4660.
PMID: 28848644 DOI: 10.19082/4655

BACKGROUND: Evidence shows that mental disorders among adolescents are associated with suicide, drug abuse, acute infectious diseases and low educational performances.
OBJECTIVE: To determine the prevalence of depression and anxiety and their associations with body mass index (BMI) among high school students in Qazvin, Iran in 2013-2014.
METHODS: A descriptive and analytical cross-sectional study using cluster-sampling method recruited 1,040 students among high schools in Qazvin, Iran from March 2013 to April 2014. Data were collected using questionnaires including demographic, Beck depression inventory and Beck anxiety inventory, and were analyzed with SPSS-19 by descriptive analyses, t-test, Chi-square and Pearson correlation.
RESULTS: The prevalence of depression and anxiety was 31.8% and 14.9%, respectively and these amounts were significantly higher in girls than in boys (p<0.05). Respondents showed 23.75% and 11.07% mild to moderate symptoms of depression and anxiety, respectively as well as 8.08 and 3.75% severe symptoms of depression and anxiety, respectively. There was a positive and significant association between depression and anxiety (r=0.256, p<0.001) and between depression and body mass index (BMI) (r=0.333, p<0.001), however there was an inverse association between anxiety and BMI (r=0.086, p<0.006).
CONCLUSION: The current study made a significant step forward in assessment of mental disorders and BMI to show the significance of depression and anxiety among adolescents in Qazvin. Therefore, effective interventions are necessary to improve this situation as well as the evaluation of the effectiveness of the interventions.
Emotional health and coping mechanisms among adolescents in Malaysian residential foster care homes: A comparative study with adolescents living with families

Mohammadzadeh M, Tajik E, Awang H, Latiff LA

Asian J Psychiatr, 2018 Feb;32:156-158.
PMID: 29278817 DOI: 10.1016/j.ajp.2017.12.011
Fulltext Contributing factors of obesity among stressed adolescents

Tajik E, Zulkefli NA, Baharom A, Minhat HS, Latiff LA

Electron Physician, 2014;6(1):771-8.
PMID: 25763144 DOI: 10.14661/2014.771-778

BACKGROUND: Many adolescents suffer from common mental disorders such as stress, which affects health through the psychosocial process, eating behavior, food choices and physical activity. During adolescence, dietary patterns are formed and can affect the occurrence of diseases in later life. This is a review of the results in the pertinent literature, from 1989 until November 2013, concerning stress and the contributing factors that lead to obesity among adolescents. The aim of this review is to identify obesity among stressed adolescents as well as the contributing factors.
METHODS: A descriptive design was used for both quantitative and qualitative studies while, in addition, psychological theories were used for the qualitative studies. The articles were screened to ensure their quality and included in this review accordingly. Ten articles were included in the review comprising cross-sectional, cohort, review and meta-analysis. Interviews and questionnaires were used for data collection.
RESULTS: The literature provided obvious information focusing on emotional stress and obesity for both boys and girls. This review revealed that stress results in overweight and obesity among adolescents through changes in lifestyle including decreased physical activity and increased food intake. Gender and economic status are the main components that affect obesity in stressed adolescents.
CONCLUSION: Obesity is a consequence of stress among adolescents and is exacerbated by the wrong eating attitude. Developing proper food choices among adolescents can help prevent obesity and other complications in adulthood.
KEYWORDS: Adolescent; Body Mass Index; Eating; Obesity; Stress
A study on level of physical activity, depression, anxiety and stress symptoms among adolescents

Tajik E, Abd Latiff L, Adznam SN, Awang H, Yit Siew C, Abu Bakar AS

J Sports Med Phys Fitness, 2017 Oct;57(10):1382-1387.
PMID: 28004901 DOI: 10.23736/S0022-4707.16.06658-5

BACKGROUND: Inadequate physical activity has adverse health consequences among adolescents. Mental health problem can be developed by lack of physical activity however it is controversial. The current study aimed to examine the association between level of physical activity with depression, anxiety and stress symptoms among adolescents.
METHODS: A representative sample of 1747 adolescents (13-14 years) was randomly selected from 6 schools in a south part of Malaysia. Respondents were asked to fill consent form, and questionnaires including Depression Anxiety and Stress Scale-21 and Physical Activity Questionnaire for Adolescents.
RESULTS: Majority of respondents (71.9%) was Malay and more than half of the adolescents had low physical activity. About 40% had depression symptoms, followed by anxiety symptoms (65.9%) and stress symptoms (38.5%). Level of physical activity was significantly associated with gender, anxiety and stress (P<0.001). There were no associations with race, religion and depression symptom.
CONCLUSIONS: This study provides some evidence among school-going adolescents related to anxiety and stress symptoms and low physical activities. Further studies are needed to show the protection effects of higher physical activity for depression, anxiety and stress symptoms in adolescents.
Fulltext Designing and validating a questionnaire on healthy lifestyle to reduce depressive symptoms among adolescents

Tajik E, Latiff LA, Yit Siew C, Awang H, Adznam SNA

Iran J Psychiatry, 2020 Jan;15(1):27-40.
PMID: 32377212

Objective: Most adolescents do not meet national recommendations for healthy lifestyle and reducing depressive symptom. A comprehensive educational program with its specified questionnaire is needed to improve healthy lifestyle to assess the lifestyle components. This study aimed to confirm the validity of a healthy lifestyle questionnaire to assess depressive symptoms among adolescents.
Method: A descriptive predictive study using simple random sampling was performed in a secondary school in Kuala Lumpur, Malaysia, among 235 school-going adolescents (13-15 years old) with Malaysian nationality. The instrument consisted of a set of dual language (English and Malay) for both researcher-administered questionnaires (knowledge, attitude, eating behavior, and relaxation activities) and standard-validated questionnaires (Physical Activity questionnaire for Adolescents, Depression, Anxiety, and Stress Scale- 21, and Brief Copping). Data were analyzed using the kappa statistics (k) and the intraclass correlation coefficient test for reliability and Partial Least Squares (PLS) for validity.
Results: The reliability of all variables was over the substantial level (ICC and/or k > 0.61). The model and construct variables were predictive of depressive symptoms by 49.4%. To analyze the validity of the questions, 11 questions were removed from the initial model for factorial loading less than 0.5. In convergent validity of theory of information-motivation-behavioral skills, AVE (average variance construct), the outer loading, was higher than 0.5.
Conclusion: PLS confirmed the existence of sufficient correlations between different items of the construct. Thus, the weights of indicators appeared to be appropriate indicators for the model. The results proved that the information, motivation, and behavioral skills model was efficient for healthy lifestyle and can be a good base for further research.
Fulltext Depression and its associated factors among secondary school students in Malaysia

Abdul Latiff L, Tajik E, Ibrahim N, Abubakar AS, Ali SS

Southeast Asian J Trop Med Public Health, 2016 Jan;47(1):131-41.
PMID: 27086434

Research in the field of factors associated with depression among adolescents is lacking in Malaysia. The aims of the present study were to assess the current prevalence of depression and its related factors among secondary school students in Pasir Gudang, South Malaysia. In this cross sectional study, 2,927 secondary school students (13-17 years old) from urban areas were screened for symptoms of mental disorder as well as demographic and risk behaviors using a validated Depression, Anxiety and Stress Scale (DASS) 12 questionnaire. The majority of the respondents (53.8%) were Malay, of which 53.1% were female. Symptoms of mild depression were found in 33.2% of the respondents, while the prevalence of the symptoms of moderate, severe, and extremely severe depression was 21.5%, 18.1%, and 3.0%, respectively. Logistic regression suggested that participants who were Chinese or had a lower average grade were three times more likely to have depression, while those who came from a single-parent family were twice as likely to have this condition. This study indicated that academic performance and risk behaviors along with the demographic characteristics are important contributors to adolescent depression.
Unhealthy diet practice and symptoms of stress and depression among adolescents in Pasir Gudang, Malaysia

Tajik E, Latiffah AL, Awang H, Siti Nur'Asyura A, Chin YS, Azrin Shah AB, et al.

Obes Res Clin Pract, 2016 Mar-Apr;10(2):114-23.
PMID: 26204813 DOI: 10.1016/j.orcp.2015.06.001

BACKGROUND/OBJECTIVE: Missing main meals and an unhealthy snacking pattern can lead to poor diet quality and consequently to the presence of chronic diseases among which mental disorder is no exception. Since there is little research on diet, skipping meals and psychological status in Asian countries, this study tries to determine eating behaviour and predicting symptoms of stress and depression of adolescents in Pasir Gudang, Malaysia.

SUBJECTS AND METHODS: A cross-sectional study was conducted among Form 1 secondary school-going adolescents (n 1565, response rate: 90%) in southern Malaysia from April to May 2013. A self-administered structured and validated questionnaire (socio-demographic, eating behaviour questionnaire, and depression, anxiety and stress scales (DASS-21)) was used for data collection.

RESULTS: Among respondents, 803 (51.3%) were female, 1125 were Malay (71.9%) with a mean age of 13.7 (SD=0.8) years. Logistic regression analysis indicated that students who were underweight (OR=3.07, 95% CI 1.21, 7.76), obese (OR=2.64, 95% CI 1.01, 6.87), used to eat out of home (OR=1.37, 95% CI 1.28, 2.13), eat dinner (>4 days/week) (OR=1.59, 95% CI 1.04, 2.43) were more likely to have depression or stress symptoms. Moreover, participants with 4-7 days/week eating breakfast (OR=0.88, 95% CI 0.21, 0.89) were less likely to be at mild/moderate stress.

CONCLUSIONS: Findings underscore the effect of unhealthy eating practices among adolescents on mental health. Targeted education should be implemented to improve psychological well-being.
Testing comparison models of DASS-12 and its reliability among adolescents in Malaysia

Osman ZJ, Mukhtar F, Hashim HA, Abdul Latiff L, Mohd Sidik S, Awang H, et al.

Compr Psychiatry, 2014 Oct;55(7):1720-5.
PMID: 24952938 DOI: 10.1016/j.comppsych.2014.04.011

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 Cronbach's 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.