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Background and aimsThe mental well-being among low-income urban populations is arguably challenged more than any other population amid the COVID-19 pandemic. This study investigates factors associated with depression and anxiety symptoms, and quality of life among Malaysias multi-ethnic urban lower-income communities. MethodsThis is a community-based house-to-house survey conducted from September to November 2020 at the Petaling district in Selangor, Malaysia. Five hundred and four households were identified using random sampling, and heads of eligible households were recruited. Inclusion criteria were age [≥] 18 years with monthly household income [≤]RM6960 (estimated USD 1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life. Multivariable logistic regression was performed for the final analysis. ResultsA total of 432 (85.7%) respondents with a mean age of 43.1 years completed the survey. Mild to severe depression was detected in 29.6%, mild to severe anxiety in 14.7%, and problematic quality of life in 27.8% of respondents. Factors associated with mild to severe depression were younger age, chronic health conditions, past stressful events, lack of communication gadgets and lack of assets or commercial property. While respiratory diseases, marital status, workplace issues, financial constraints, absence of investments, substance use and lack of rental income were associated with mild to severe anxiety. Not attributing poverty to structural issues, help-seeking from professionals, and self-stigma were barriers, while resiliency facilitated good psychological health. Problematic quality of life was associated with depression, older age, unemployment, cash shortage, hypertension, diabetes, stressful life events and low health literacy. ConclusionsA higher proportion had reported mild to severe anxiety and depression symptoms in the sampled urban poor population than previous pre-pandemic reports. The psychosocial determinants should inform policy and direct future research within this underserved population.
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<p><b>INTRODUCTION</b>The aim of this study was to assess the reliability and validity of a modified Malaysian version of the Medication Adherence Reasons Scale (MAR-Scale).</p><p><b>METHODS</b>In this cross-sectional study, the 15-item MAR-Scale was administered to 665 patients with hypertension who attended one of the four government primary healthcare clinics in the Hulu Langat and Klang districts of Selangor, Malaysia, between early December 2012 and end-March 2013. The construct validity was examined in two phases. Phase I consisted of translation of the MAR-Scale from English to Malay, a content validity check by an expert panel, a face validity check via a small preliminary test among patients with hypertension, and exploratory factor analysis (EFA). Phase II involved internal consistency reliability calculations and confirmatory factor analysis (CFA).</p><p><b>RESULTS</b>EFA verified five existing factors that were previously identified (i.e. issues with medication management, multiple medications, belief in medication, medication availability, and the patient's forgetfulness and convenience), while CFA extracted four factors (medication availability issues were not extracted). The final modified MAR-Scale model, which had 11 items and a four-factor structure, provided good evidence of convergent and discriminant validities. Cronbach's alpha coefficient was > 0.7, indicating good internal consistency of the items in the construct. The results suggest that the modified MAR-Scale has good internal consistencies and construct validity.</p><p><b>CONCLUSION</b>The validated modified MAR-Scale (Malaysian version) was found to be suitable for use among patients with hypertension receiving treatment in primary healthcare settings. However, the comprehensive measurement of other factors that can also lead to non-adherence requires further exploration.</p>
