INTRODUCTION: Aimed at providing integrated multi-level crisis intervention to women experiencing violence such as rape, One Stop Crisis Centre (OSCC) in Malaysia is often located in the emergency department. Hence, it is imperative that emergency department healthcare providers possess adequate knowledge and acceptable attitudes and practices to ensure the smooth running of an efficient OSCC work process.
METHOD: To study the knowledge, attitude and practice of rape management in OSCC among four groups of healthcare providers in the emergency department [i.e., the emergency medicine doctors (EDs), the staff nurses (SNs), the medical assistants (MAs) and the hospital attendants (HAs)], a selfadministered questionnaire in the form of Likert scale was conducted from January to October 2013. Correct or favourable responses were scored appropriately.
RESULTS: Out of the 159 participants invited, 110 responded (69.2% response rate). As all data sets in the Knowledge, Attitude and Practice sections are non-parametric, Kruskal- Wallis test was performed. Homogeneity of variance was verified using non-parametric Levene test. In all three sections, there are statistically significant differences in scores obtained among the four groups of healthcare providers with H(3) = 16.0, p<0.001 for Knowledge, H(3) = 27.1, p<0.001 for Attitude and H(3) = 15.8, p<0.001 for Practice sections. Generally, the SNs obtained the highest mean rank score in the knowledge and practice sections but the EDs obtained the highest mean rank score in the attitude section. Some of the responses implied that our healthcare providers have the victim-blaming tendency that can negatively impact the victims.
CONCLUSION: Healthcare providers must not only have adequate knowledge but also the non-judgemental attitude towards victims in OSCC.
Globally women's mental health issues have been emphasized since many decades ago. World Health Organization (WHO) has highlighted the importance of justice and equality in term of social context related to gender in order to achieve good mental well-being. Gender differences in the prevalence of psychiatric disorders have been recognized long ago where women commonly exceeds the men for a number of psychiatric illnesses (1). Women are more likely to suffer from depression, anxiety, somatic problems and being victims of sexual or physical violence. At least 1 in 5 women suffer rape in their lifetime but the rate differ from various country (2). Much work has been done to look into the general well-being and psychological distress in women as well as to understand the reason for women become more vulnerable to stress as compared to men. Multiple factors such as biological determinants and psychosocial issues have been found to be correlated to depression. Women with chronic major depression tend to have a younger age at the onset of her illness, a more extensive family history of mood disorder, poorer social adjustment, and poorer quality of life compared to chronically depressed men (3). Women are also known to be more likely to seek help for their mental health problem from primary care physician. Furthermore, across socio-economic levels many women nowdays are doing multiple roles in the society. They are not only wives and mothers in their family, but women also go out to earn for living. Some women are holding a higher position at workplace or in any organization. These multitasking roles may cause stress to women especially if she has to handle family-work or work-family conflicts. Biological differences related to gender have been increasingly explored. Differences exist in brain anatomy and that male and female reproductive hormones i.e. estrogen and progesterone produce psychoactive effects (4). Estrogen's antidopaminergic (5) and serotonin-enhancing (6) effects may play a role in psychiatric disorders in women. These are the areas that need more research investigations.
The global statistics reveal that at least one in every five women experiences rape or attempted rape during her lifetime. Rape myths encompass a set of (false) beliefs. Adolescents have high rates of rape victimization than other age groups. Rape myths among health care providers may have a negative influence on proper care of the victims. A total of 422 medical undergraduates of both sexes, studying at two Malaysian Institutes took part in the study. A validated questionnaire used in an earlier study was used for the present study, with a slight modification of scoring system. The age range of medical students was 17 to 34 years: mean +/- SD of men and women, were 20.6 +/- 2.1 and 20.3 +/- 2 respectively. Only about 19% of women and 11% of men had a very good positive attitude. Nearly 1/3 of women and 1/2 of men had a more negative attitude. On the whole the average total score of women was significantly higher (p=0.0004) than men. Nearly 50% of candidates with a village background carried more negative attitude. Violence against women is a significant public health problem. The major revelation of the present study is that only less than 20% of the medical undergraduates had a more positive attitude towards rape. Introduction of courses on 'sexual violence' in medical curriculum is likely to increase a) awareness, b) skills in management, c) in providing support and care for the victims and d) in implementing preventive actions.
Sexual abuse of children is increasing at an alarming rate. This study aims to describe the risk factors and the effects of sexual abuse on children. This unobtrusive qualitative study was conducted on children aged 10 to 18 years old who experienced sexual abuse and followed-up at a psychiatric clinic between the years 2019 and 2021. The information from case records was transcribed. Thematic analysis was performed. Thirty case records were reviewed. The mean age of the victims was 14.6 years; 94% of the victims had experienced vaginal penetration, and 23% of the cases involved incest. The results indicated that socio-psychological predisposing factors involving family structure and dynamic dysfunction, low intrapersonal strength, social influence, and low family socioeconomic status could lead to sexual victimization. This sexual victimization can then lead to emotional turmoil, negative effects on cognitive, academic and social function, negative parental reactions toward the incident, the creation of baby-mother relationships and love-hate relationships, and a lack of goals and hope for the future. Children who experienced sexual abuse may show rape or pregnancy symptoms but may also show entirely non-specific ones. A thorough examination of their history, including biopsychosocial aspects, is necessary to appropriately care for them.
Objective: This case report aims to discuss the diagnosis of mental retardation as insanity defence in a crime offender. Methods: We report a gentleman who committed murder and rape 9 years ago, and currently being treated at a mental institution. Results: Patient was certified to have mental retardation, and was pleaded on the defence of unsoundness of mind because he had defect of reason at the time of alleged offence. Conclusion: Mental retardation does fulfil the McNaughton’s rule. Unsoundness of mind becomes the insanity defence even for murder under section 84 of the Penal Code. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 97-100.
This article provides violent crime data in Malaysia from 2006 to 2017. The violent crimes include murder, rape, gang robbery, robbery and voluntarily causing hurt cases. A total of 330,395 violent crime cases were reported in this 12 year period and the data were tabulated state by state for all thirteen states of Malaysia, including two states in Borneo (Sabah and Sarawak) and one federal territory (Kuala Lumpur). In general, violent crimes show a decreasing trend from 2006 to 2017 in Malaysia. However, armed gang robbery and armed robbery show a fluctuating pattern from 2008 to 2011. A similar pattern was also recorded for unarmed gang robbery from 2008 to 2010. The violent crime data deposited here are available for further analysis, e.g., for identifying risk factors such as demography, lifestyle, socio-economic status, government policies etc. which may be associated with violent crime incidence and pattern across the country.
Southeast Asia is one of the most dynamic regions in the world. It is experiencing rapid socioeconomic change that may influence the level of sexual aggression, but data on the scale of sexual aggression in the region remain sparse. The aim of the present article was to systematically review the findings of studies available in English on the prevalence of self-reported sexual aggression and victimization among women and men above the age of 12 years in the 11 countries of Southeast Asia (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam). Based on four scientific databases, the search engine Google, Opengrey database, and reference checking, 49 studies were found on sexual victimization. Of those, 32 included only women. Self-reported perpetration was assessed by only three studies and included all-male samples. Prevalence rates varied widely across studies but showed that sexual victimization was widespread among different social groups, irrespective of sex and sexual orientation. Methodological heterogeneity, lack of representativeness of samples, imbalance of information available by country, missing information within studies, and cultural differences hampered the comparability between and within countries. There is a need for operationalizations that specifically address sexual aggression occurring after the age of consent, based on detailed behavioral descriptions of unwanted sexual experiences and allied to a qualitative approach with cultural sensitivity. Data on sexual aggression in conflict settings and in human trafficking are also limited. Recommendations for future research are presented in the discussion.
This case report highlights on the dilemma in making a decision for termination of pregnancy (TOP) for a muslim rape victim in Malaysian setting. We report a case of 17 year-old student at 7 weeks of pregnancy after being gang-raped, who, together with her parents, had requested for a TOP. Psychiatric assessment showed that the patient suffered from a major depressive disorder and post-traumatic stress disorder which justified termination of pregnancy on a psychological and clinical basis. However the available Malaysian Islamic fatwa had caused some uncertainties on the final decision making. This case demonstrated on the needs to understand the relevant issues beyond clinical judgment in relation to TOP in our setting which encompasses the legal provision, ethical obligation as well as the needs for a clear religious understanding and stand to support the medical decision.
This paper investigates the pattern of sexual offence cases attended at the One Stop Crisis Center (OSCC) of the Accident and Emergency Department, Hospital Universiti Sains Malaysia (HUSM), Kelantan. A total of 439 reported sexual offence cases were examined over a period of 4 years from 2000 to 2003. Sexual offence constituted by male partner or boyfriend in 18.9%, by relatives in 27.3% and by "others" in 53.8% of cases. Only 0.7% of victims did not attempt to lodge a police report. There is a significant relationship between occupation and the risk of experiencing sexual violence. Students were mostly targeted by the perpetrator throughout the study period. Among the offences, rape cases were the highest in number, among those who attended at the OSCC, HUSM with a total of 72.7%; followed by 27.3% of incest; 26.4% of child sexual abuse; 4.8% of sodomy and lastly 1.6% of gerontophilia cases. Only 70% of the specimens obtained from sexual offences victims were sent for laboratory analysis. The result remained negative in 82.4% specimens and thus the laboratory analysis result is merely functioning as a supportive evidence for sexual offence cases attended at OSCC. The studies showed that most of the sexual assault perpetrators were known to the victims. The place of crime was also known to the perpetrators. Health sectors of various levels should be working in conjunction to promote a societal changes to improve more of the women's right and thus to reduce the violence crime.
"Comfort women" refers to young women and girls who were forced into sexual slavery by the Imperial Japanese military during World War II. They were abducted from their homes in countries under Imperial Japanese rule, mostly from Korea, and the rest from China, Philippines, Malaysia, Taiwan, Indonesia, the Netherlands, etc. "Comfort women" endured extreme trauma involving rape, sexual torture, physical abuse, starvation, threats of death, and witnessed many others being tortured and killed. This article reviews all the studies that have investigated the psychiatric or psychosocial sequelae of the survivors of the Japanese military sexual slavery. Most importantly, a recent study which conducted a psychiatric evaluation on the former "comfort women" currently alive in South Korea is introduced. The participants' unmarried rate was relatively high and their total fertility rate was relatively low. Majority of the participants reported having no education and being the low economic status. They showed high current and lifetime prevalence of posttraumatic disorder, major depressive disorder, somatic symptom disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Participants showed high suicidality and majority of the participants still reported being ashamed of being former "comfort women" after all these years. This article high-lights the fact that the trauma has affected the mental health and social functioning of former "comfort women" throughout their lives, and even to the present day.