Mental Health Status of Women attending a government primary care clinic in the state of Selangor, Malaysia

Abstract

This thesis was conducted because a need was identified for comprehensive studies on mental health status among women in Malaysia. Objectives: There were two main objectives. The first was to determine the prevalence of depression and anxiety among women attending a government primary care clinic, and investigate the association with socio demographic factors, medical, obstetrics and gynaecology history, stressful life events, and domestic violence. The second was to validate questionnaires on depression and anxiety among Malay speaking participants. Methodology This thesis was conducted in two parts (Part 1 and 2) based on its two main objectives. Setting: The Seri Kembangan Health Clinic (KKSK) from the urban district of Petaling, in the state of Selangor, Malaysia was selected. Study design: This was a cross sectional study. Sampling method: Simple random sampling was used to select the clinic (KKSK). Participant selection: For Part 1, consecutive adult female patients attending KKSK during the data collection period and fulfilling the selection criteria were invited to participate. For Part 2, systematic weighted random sampling was used to select participants who had completed the questionnaires in Part 1 of the thesis. Selection was based on scores from the 9-item Patient Health Questionnaire [PHQ-9] and the 7-item Generalized Anxiety Disorder questionnaire [GAD-7]. Study instruments: For Part 1, participants completed self-administered questionnaires (including the 12-item General Health Questionnaire [GHQ-12], PHQ-9 and GAD-7). The GHQ-12 was used to determine poor mental health status, while the PHQ-9 and GAD-7 were used to determine depression and anxiety, respectively. Part 2 involved diagnostic interviews by the principal investigator using the Composite International Diagnostic Interview (CIDI) as the reference standard to validate the PHQ-9 and GAD-7. Data collection: Data was collected from 10th December 2008 to 30th January 2009. Results Response rate: Eight-hundred-and-ninety-five patients participated in Part 1 (895/1023, response rate 87.5%); while 151 were further interviewed for Part 2 (151/156, response rate 96.8%). Data analysis: Data analysis was based on complete questionnaires; 845 for Part 1 and 146 for Part 2. Results: Findings from Part 1 showed that the prevalence of poor mental health status, depression, anxiety, and co-morbidity (co-existing depression and anxiety) was 17.5% (GHQ-12), 12.1% (PHQ-9), 7.8% (GAD-7) and 5.8% (PHQ-9 and GAD-7), respectively. Multiple logistic regression analysis found that certain stressful life events were significantly associated with depression, anxiety and co-morbidity (p<0.05). The emotional aspect of domestic violence was found to be a main predicting factor for anxiety and co-morbidity (p<0.05). Findings from Part 2 showed that the PHQ-9 had a sensitivity of 87.1% (95% confidence interval 71.1% to 94.9%) and a specificity of 81.7% (73.7% to 87.7%). The GAD-7 had a sensitivity of 76.3% (60.8% to 87.0%) and a specificity of 94.4% (88.4% to 97.4%). Discussion and Conclusion The prevalence of depression and anxiety found in this thesis is similar to other countries. The results on domestic violence are important findings in this thesis, as this is an area which has not been investigated in Malaysia. The Malay versions of the PHQ-9 and GAD- 7 were found to be valid and reliable case-finding instruments for depression and anxiety. The next step will be to explore issues on domestic violence and to disseminate the validated case-finding instruments into regular practice in Malaysian primary care clinics.