Article

OMEGA—Journal of Death and Dying

2023, Vol. 87(2) 469–484
Depression and ! The Author(s) 2021
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DOI: 10.1177/00302228211021746
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Understanding of
and Willingness
to Help Suicide
Attempt Patients

Ching Sin Siau1 ,

Caryn Mei Hsien Chan1,
Lei Hum Wee1, Suzaily Wahab2,
Uma Visvalingam3, Won Sun Chen4,
Seen Heng Yeoh5, Jing Ni Tee6,
Lena Lay Ling Yeap7, and
Norhayati Ibrahim1

Abstract
We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation,
self-efficacy in preventing suicide and demographic factors predicted the understand-
ing of and willingness to help suicidal patients among hospital healthcare workers.
A total of 368 healthcare workers from the major surgical and medical departments

1
Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
2
Department of Psychiatry, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
3
Hospital Putrajaya, Kementerian Kesihatan Malaysia, Putrajaya, Malaysia
4
Faculty of Health, Arts, and Design, Swinburne University, Hawthorn, Australia
5
Faculty of Medicine, Universiti Tunku Abdul Rahman, Kajang, Malaysia
6
Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
7
Stats Consulting, Kuala Lumpur, Malaysia
Corresponding Author:
Lei Hum Wee, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz,
50300 Kuala Lumpur, Malaysia.
Email: weeleihum@ukm.edu.my
470 OMEGA—Journal of Death and Dying 87(2)

in a general hospital setting were recruited. Participants responded to the

Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and
Understanding Suicide Attempt Patient Scale. Those from the psychiatric depart-
ment, with higher suicide prevention self-efficacy, and lower personal accomplish-
ment indicated more understanding and helpful attitudes; doctors, depressed and
anxious healthcare workers reported less understanding and helpful attitudes.
Suicide prevention efforts must be conducted in tandem with equipping and support-
ing the healthcare workers who manage suicidal patients.

Keywords
healthcare worker, general hospital, suicide, psychological distress, burnout,
self-efficacy

Suicide is a preventable public health problem (World Health Organization,

2014). Experts estimate that 89.4% of those who died by suicide received health-
care treatment three months before death (De Leo et al., 2013). A majority of
Australian and Canadian Pharmacists (85%) had interaction with a suicidal
individual (Murphy et al., 2020). In Malaysia, 21.4% of individuals who were
admitted to the hospital following a suicide attempt died in the hospital accident
and emergency department and other wards (Ali et al., 2014). These data indi-
cate that the healthcare system has the opportunity to intervene with and pre-
vent suicide. They also highlight the important gate-keeping role that hospital
health workers play.
A systematic review on health-care workers’ attitudes toward suicidal
patients indicate that their attitudes remain complex and could be influenced
by multiple factors (Boukouvalas et al., 2019). Some former suicidal patients
reported not being taken seriously and that their suffering was not acknowl-
edged by mental healthcare workers (Hagen et al., 2018). Negative or dismissing
attitudes could deter suicidal individuals from seeking help, as they may fear
condemning reactions from others (Dadasev et al., 2016; Reynders et al., 2016;
Vandewalle et al., 2020).
A number of characteristics influence healthcare professionals’ attitudes
toward suicidal patients. Women professionals reported less stigmatizing atti-
tudes toward suicidal patients (Batterham et al., 2013). Older healthcare workers
(McCarthy & Gijbels, 2010) and those who have treated more suicidal patients
likewise reported more negative attitudes (Murphy et al., 2020). In terms of
profession, nurses reported more positive attitudes than doctors (Saunders et
al., 2012). Psychiatric workers also indicated more positive attitudes toward
suicidal patients compared to those from other medical disciplines (Grimholt
et al., 2014; Siau et al., 2017). Notably, training and increased self-efficacy in
Siau et al. 471

suicide management were integral in improving attitudes toward suicidal

patients (Boukouvalas et al., 2019; Osteen et al., 2017; Siau et al., 2018).
Even though psychological health and personal suicide history may be impor-
tant factors influencing healthcare workers’ attitudes toward suicidal patients,
there had been limited studies on this topic. This gap exists in spite of the fact
that healthcare workers’ rates of burnout, psychological morbidity and suici-
dality were reportedly higher than those found in the general population (e.g.,
Kuhn & Flanagan, 2017). Literature also indicated that compromised psycho-
logical health among healthcare workers could lead to an impaired ability to
attend to their patients. For example, Spanish and French healthcare workers
who reported experiencing higher burnout levels showed diminished empathy
toward patients in general (e.g., Yuguero et al., 2017).
With regard to suicide attempt patients, negative attitudes toward them were
reported by New Zealand hospital staff who reported high emotional exhaustion
and low personal accomplishment (Gibb et al., 2010). Suokas et al. (2008)
research on emergency personnel in two Scandinavian hospitals indicated no
association between psychological distress and attitudes toward suicide attemp-
ters. However, healthcare workers who had experienced depression or suicidal-
ity reported higher empathy towards suicidal patients (Boukavalas et al., 2019).
A study among students in the helping professions indicated that those with
positive mental health reported a higher pro-preventive attitude toward suicide
(Stecz et al.,2020 ). Wilson and Langan-Martin’s (2020) recent study among
junior medical doctors indicated no relationship between burnout and attitudes
toward self-harm patients.
There is scant literature on the association between healthcare workers’
attitudes toward suicidal patients and psychological distress aspects such as
burnout, depression, anxiety, stress and personal and family suicide history.
Thus, further investigation in this area is warranted. Hence, we examined
whether burnout, depression, anxiety, stress, suicidality, self-efficacy in
preventing suicide and relevant demographic factors were significant predictors
of understanding suicide attempt patients among Malaysian hospital healthcare
workers.

Method
Study Site
This study took place in a large general hospital (1054 beds) in the Klang Valley,
Malaysia. We sampled the major medical and surgical departments offering
inpatient and outpatient services, including the general medical, general surgical,
accident and emergency, obstetrics and gynecology, pediatrics, psychiatry, and
orthopedics departments.
472 OMEGA—Journal of Death and Dying 87(2)

Participants
A total of 368 participants (Mean age ¼ 32.33; SD ¼ 5.43) responded to the
questionnaire. Most of the participants were women (68.8%). The preponder-
ance were nurses (41.0%), worked at the accident and emergency department
(19.1%), and had not managed any suicidal patients (39.0%). The reported
lifetime suicidal ideation and family suicide history prevalence were 16.0%
and 6.0% respectively (Table 1).

Instruments
Suicidal ideation and family suicide history were measured through two ques-
tions from the Attitudes Toward Suicide (ATTS) questionnaire (Renberg &
Jacobsson, 2003). Lifetime suicidal ideation was indicated by the question
“Have you ever thought of taking your own life, even if you would not really
do it?” (1 ¼ Never, 2 ¼ Seldom, 3 ¼ Sometimes and 4 ¼ Frequently). We recoded
the participants’ responses to 1 ¼ No and 2, 3, 4 ¼ Yes during the analysis stage.
Family suicide history was indicated if the participant answered “Yes” to the
question “Has any of the following persons made a suicide attempt: father/
mother/brother/sister/child/partner?” (1 ¼ No, 2 ¼ Yes).
Maslach Burnout Inventory – Human Services Survey; The MBI-HSS
(Maslach et al., 1996) consists of 22 sentences describing aspects of burnout
among human services providers. It has three factors: Emotional Exhaustion
(EE), Depersonalization (DP) and Personal Accomplishment (PA). Participants
answer on a 7-point Likert scale (0 ¼ Never to 6 ¼ Every Day). Based on con-
vention, healthcare workers with high levels of EE (>26) and/or DP (>12) were
considered burned out (Maslach et al., 1996). The translated Malay MBI-HSS
was validated among nurses in public hospitals and exhibited acceptable valid-
ity, internal reliability of a ¼ .80, and intraclass correlation of .85 (EE), .77 (DP),
and .73 (PA) Cronbach’s a respectively (Chen et al., 2014). In this study, the
internal consistency reliability was Cronbach’s a ¼ .89 (EE), .82 (DP) and .86
(PA).
Depression Anxiety and Stress Scale; The DASS-21 (Lovibond & Lovibond,
1995) consists of 21 sentences, scored on a 4-point Likert scale (0 ¼ Never to
3 ¼ Almost always). It measures symptoms of depression, anxiety, or stress in the
past week. We totalled scores and multiplied by two to compare with the DASS-
42. The cut off score of 10 was used to identify the presence of symptoms for
depression, 8 for anxiety, and 15 for stress (Cheung & Yip, 2015; Lovibond
& Lovibond, 1995). The DASS-21 was translated and validated for the
Malaysian population among patients in three government clinics in Kuala
Lumpur, demonstrating reliable Cronbach’s a values of .84, .74 and .79 for
depression, anxiety and stress respectively (Musa et al., 2007). The Hospital
Anxiety and Depression scales correlated moderately with the Malay DASS-
Siau et al. 473

Table 1. Healthcare Workers’ Demographic Characteristics, Burnout, Depression, Anxiety,

Stress, Suicidality, Self-Efficacy in Suicide Prevention and Understanding of Suicide Attempt
Patients (N ¼ 368).

Variable n (%) M (SD)

Age 32.33 (5.43)

Gender
Male 111 (30.2)
Female 253 (68.8)
Occupation
Hospital attendant 88 (23.9)
Nurse 151 (41.0)
Assistant medical officer 25 (6.8)
Doctor 100 (27.2)
Department
General Medical 57 (15.7)
Psychiatry 52 (14.2)
Accident and Emergency 70 (19.1)
Pediatric 43 (11.7)
General Surgery 41 (11.2)
Obstetrics and Gynecology 47 (12.8)
Orthopedics 54 (14.8)
No. of suicidal patients managed
None 142 (39.0)
1–10 138 (37.9)
11–20 43 (11.8)
21–30 12 (3.3)
31–40 8 (2.2)
>40 21 (5.8)
Lifetime suicidal ideation history
Yes 59 (16.0)
No 286 (77.7)
Family suicide history
Yes 22 (6.0)
No 318 (86.4)
Burnout
Emotional exhaustion 20.23 (11.60)
Present 99 (26.9)
Absent 264 (71.7)
Depersonalization 6.38 (6.41)
Present 60 (16.3)
Absent 303 (82.3)
Low personal accomplishment 35.67 (9.96)
Present 174 (47.3)
Absent 189 (51.4)
(continued)
474 OMEGA—Journal of Death and Dying 87(2)

Table 1. Continued.
Variable n (%) M (SD)

Depression Anxiety and Stress Scale – 21

Depression symptoms 8.46 (8.28)
Present 136 (37.0)
Absent 225 (61.1)
Anxiety symptoms 9.92 (8.05)
Present 199 (54.1)
Absent 162 (44.0)
Stress symptoms 11.83 (8.55)
Present 113 (30.7)
Absent 248 (67.4)
Self-efficacy in suicide prevention 9.85 (2.32)
Understanding of suicide attempt patients (USP) 21.44 (3.40)
Note. Number (n) and percentage (%) is based on available information. M ¼ Mean score, SD ¼ Standard
Deviation.

21 anxiety (.61) and depression (.49) domains (Musa et al., 2011). In this study,
the internal consistency reliability was Cronbach’s a ¼ .93 (Depression), .89
(Anxiety) and .90 (Stress).
Self-efficacy in Suicide Prevention (Quinnett, 1995) consists of six sentences to
measure a participant’s level of confidence in suicide prevention. Participants
responded on a 5-point Likert scale (1 ¼ Disagree completely to 5 ¼ Agree
completely) with higher agreement indicating higher self-efficacy. Due to the
low Cronbach’s a value demonstrated by the translated Malay questionnaire
(a ¼ 0.57), we selected three questions (“If someone I knew was showing signs of
suicide, I would directly raise the question of suicide with them”, “If a person’s
words and/or behavior suggest the possibility of suicide, I would ask the person
directly if he/she is thinking about suicide” and “If someone told me they were
thinking of suicide, I would intervene”) to yield a higher internal consistency of
Cronbach’s a ¼ .66.
Understanding Suicide Attempt Patient Scale; USP (Samuelsson et al., 1997)
consists of 11 sentences to measure healthcare worker understanding of and
willingness to treat suicide attempt patients. Scores are on a 4-point scale
(1 ¼ Agree completely to 4 ¼ Disagree completely), with lower scores indicating
more empathy and prosocial attitudes toward suicidal patients. Questions 2, 6
and 9 were reverse scored. The original USP developed by Samuelsson et al.
(1997) demonstrated an internal reliability of Cronbach’s a ¼ 0.74. The Malay
translation of the USP in this study yielded a Cronbach’s a of 0.62. After
removing item 6, “I often find it difficult to understand a person who has
tried to commit suicide,” the Cronbach’s a improved to .71. Therefore, subse-
quent analyses utilized the 10-item USP questionnaire.
Siau et al. 475

Procedures
A mental health and a linguistic expert forward translated (English-Malay) the
suicidality, self-efficacy in suicide prevention and USP questions. Another
mental health and linguistic expert backward translated the questions before
the backward and forward translated versions were harmonized in a meeting
among the researchers. The USP and suicidality questions were pilot tested on
51 healthcare workers. Meanwhile, the self-efficacy questions were pilot tested
on 30 healthcare workers.
In the main study, we included physicians, nurses, assistant medical officers,
and hospital attendants, and excluded trainees. We employed systematic
random sampling by selecting participants randomly from a sampling frame
provided by the hospital. For doctors, initial attempts to recruit through sys-
tematic random sampling were unsuccessful due to difficulty in accessing them
during normal clinical hours. As a result, only 46 (32.86%) doctors responded.
After three months of effort, we recruited doctors before/after Continuing
Education (CE) workshop sessions.
We approached the participants at their respective stations or before/after CE
sessions to take part in the study. Participation was voluntary and strict confi-
dentiality was maintained where no identifier was used in the questionnaire.
After giving informed consent, participants filled out the questionnaire and
returned it, sealed in an envelope, to the researchers within a week. This research
obtained ethical approval from the University Kebangsaan Malaysia Research
Ethics Committee (NN-035-2015).

Results
A three-stage hierarchical multiple regression analysis was used to determine the
significant predictors of understanding suicide attempt patients. Age, gender,
occupation, department and the number of suicidal patients managed were
entered at Stage One of the regression to control for the influence of demo-
graphic variables. Self-efficacy in suicide prevention was entered at Stage Two.
Finally, burnout, depression, anxiety, stress, lifetime suicidal ideation and
family suicide history were entered at Stage Three.
The results of the regression indicated that the demographic predictors
accounted for a significant 19.5% of the variance in the USP (R2 ¼ .195, adjust-
ed R2 ¼ .151, F (16, 308) ¼ 4.42, p < .001) at Stage One. Adding self-efficacy in
suicide prevention explained an additional 7.6% of the variance in understand-
ing suicide attempt patients, R2 ¼ .271, adjusted R2 ¼ .228, F (17, 308) ¼ 6.35,
p < .001. Finally, when burnout, depression, anxiety, stress, lifetime suicidal
ideation and family suicide history were added into the regression model, an
additional 12.2% was added to the variance (R2 ¼ .392, adjusted R2 ¼ .339,
F (25, 308) ¼ 7.31, p < .001). Together, all the independent variables accounted
476 OMEGA—Journal of Death and Dying 87(2)

for 39.2% of the variance in understanding of suicidal patients. In the final

regression model, healthcare workers with high self-efficacy in suicide preven-
tion (p < .001; sr2 ¼ .040), lower personal accomplishment (p < .001; sr2 ¼ .030),
from the psychiatric department (p ¼ .007; sr2 ¼ .016), who were doctors
(p ¼ .012; sr2 ¼ .013), higher depression (p ¼ .045; sr2 ¼ .010) and higher anxiety
(p ¼ .041; sr2 ¼ .009) had a significantly higher understanding of suicide attempt
patients (Table 2).

Discussion
Even though literature has shown high rates of burnout, depression, anxiety,
stress, and suicidality among healthcare workers, to our best knowledge there is
as yet no study to examine these factors in combination as predictors of atti-
tudes toward suicidal patients. Adding to current evidence, this study revealed
that healthcare workers faced high rates of anxiety and depression, factors
which independently predicted decreased understanding of and willingness to
help suicidal patients.
A pioneering study on psychological distress and attitudes toward suicidal
patients found no significant relationship (Suokas et al., 2008). However, this
study showed that depression and anxiety among healthcare workers independently
predicted lower understanding of and willingness to help suicidal patients. Our
study expanded on previous studies where an inverse relationship was found
between psychological distress and a lack of empathy toward general medical
patients (Neumann et al., 2011; Shanafelt et al., 2005). This was perhaps due to
healthcare workers down-regulating their empathetic response to protect themselves
from further emotional distress when managing suicidal patients. Moreover, symp-
toms of depression and anxiety could lead to psychosocial impairment (Cha et al.,
2017), which hinders relationship building with suicidal patients.
It is interesting to note that lower personal accomplishment contributed to a
better understanding of suicidal patients. The results are not consistent with
Gibb et al. (2010) findings. Perhaps the healthcare worker’s higher empathy
toward their patients led to higher rates of burnout evidenced by a low personal
accomplishment, a relationship which was demonstrated in a study on Iranian
oncology nurses (Taleghani et al., 2017).
Self-efficacy in suicide prevention was the most influential predictor of a
positive attitude toward suicidal patients in this study. The results imply that
healthcare workers who were confident about their suicide prevention skills may
have a higher likelihood to intervene with suicidal patients. Inversely, the lack of
self-efficacy may lead to a sense of powerlessness against suicide, amplifying a
healthcare worker’s reluctance to help suicidal patients. The positive findings
on self-efficacy may explain why training in suicide management, which
increases one’s suicide prevention self-efficacy, could increase positive attitudes
(Osteen et al., 2017).
Table 2. Hierarchical Multiple Regression Analysis for Variables Predicting Understanding of and Willingness to Help Suicide Attempt
Patients (N¼368).
a b c
Stage 1 Stage 2 Stage 3
Siau et al.

Variable B t p-value B t p-value B t p-value

Constant 22.859 16.195 26.501 17.661 26.869 16.684

Age .031 .826 .410 .022 .613 .540 .036 1.041 .299
Gender
Male†
Female .089 .196 .845 .254 .587 .558 .080 .190 .850
Occupation
Hospital attendant†
Nurse .399 .768 .443 .362 .730 .466 .259 .553 .581
Assistant medical officer .763 .877 .381 .591 .712 .477 .696 .894 .372
Doctor 2.085 3.510 .001** 2.161 3.815 <.001*** 1.455 2.522 .012*
Department
Medical†
Psychiatry 2.373 2.951 .003** 1.940 2.516 .012* 1.985 2.706 .007**
Accident and emergency 1.015 1.424 .156 .941 1.384 .168 .588 .905 .366
Pediatric .232 .323 .747 .283 .412 .681 .070 .107 .915
Surgery .491 .682 .496 .510 .744 .458 .653 1.006 .315
Obstetrics and gynecology 1.138 1.563 .119 1.016 1.464 .144 .299 .460 .646
Orthopedics 1.442 2.069 .039* 1.465 2.205 .028* 1.139 1.837 .067
No. of suicidal patients managed
None†
1–10 .260 .548 .584 .373 .823 .411 .268 .627 .531
11–20 .994 1.418 .157 .613 .913 .362 .567 .899 .369
21–30 1.568 1.408 .160 .844 .789 .431 .444 .444 .657
(continued)
477
Table 2. Continued.
478

a b c
Stage 1 Stage 2 Stage 3

Variable B t p-value B t p-value B t p-value

31–40 2.034 1.320 .188 2.057 1.400 .163 1.338 .971 .333
>40 .401 .412 .681 .394 .424 .672 .005 .006 .995
Self-efficacy in suicide prevention .432 5.490 <.001*** .327 4.285 <.001***
Maslach Burnout Inventory-Human Services
Emotional exhaustion .019 .945 .346
Depersonalization .010 .297 .767
Low personal accomplishment .065 3.714 <.001***
Depression, Anxiety and Stress Scale
Anxiety .097 2.015 .045*
Depression .092 2.051 .041*
Stress .053 1.091 .276
Lifetime suicidal ideation
No†
Yes .761 1.600 .111
Family suicide history
No†
Yes .571 .806 .421
Stage 1a Stage 2b Stage 3c
2
R .195 .271 .392
Adjusted R2 .151 .228 .339
D R2 – .076*** .122***

Note. *p<.05. **p < .01. ***p < .001.

†
Reference group.
a
F (16, 308) ¼ 4.42, p < .001.
b
F (17, 308) ¼ 6.35, p < .001.
c
OMEGA—Journal of Death and Dying 87(2)

F (25, 308) ¼ 7.31, p < .001.

Siau et al. 479

Medical and surgical workers from non-psychiatric departments demonstrat-

ed relatively more negative attitudes compared to psychiatric workers, and this
is consistent with other studies (Saunders et al., 2012; Siau et al., 2017). Doctors
reported less understanding of and willingness to help suicidal patients com-
pared to hospital attendants. Perhaps psychiatric workers and hospital attend-
ants have more opportunities to interact with the patients, and therefore are
able to form more positive attitudes toward them (Norheim et al., 2016;
Saunders et al., 2012).
As suicide prevention shifts from a medical approach to a wider public health
approach (World Health Organization, 2014), the responsibility of preventing
suicide becomes the role of all healthcare workers. They therefore need to dem-
onstrate less stigmatizing attitudes and acquire skills for early detection, man-
agement and referral of suicidal individuals. This could be achieved through
hospital-wide guidelines and gatekeeper training (Siau et al., 2018). The six-item
Columbia-Suicide Severity Rating Scale (C-SSRS) is an example of a screening
tool which could be taught to healthcare workers and employed in a hospital-
wide suicide risk screening program (Roaten et al., 2018). In addition, in order
to reduce the stigma surrounding a patient’s disclosure of suicidality, healthcare
workers who have likewise experienced depression or anxiety may employ
appropriate, non-burdening self-disclosure of their own experiences when treat-
ing suicidal patients. Research has indicated that self-disclosures which human-
ized the healthcare worker and emphasized his/her similarity with the patient
predicted better outcomes for the patient (Levitt et al., 2016).
Healthcare workers are burdened with expanded scope and new challenges,
whereas resources for mental healthcare continue to be scarce in this region. As
this study indicates, there is an urgent need to ameliorate healthcare workers’
burnout and psychological distress through individual and organizational
approaches, such as implementing duty hour requirements and mindfulness-
based training (West et al., 2016). This may improve healthcare workers’ work-
life quality which in turn would facilitate better attitudes toward suicidal patients.

Strengths and Limitations

This study attempted to include burnout, psychological distress, suicidal idea-
tion and self-efficacy in suicide prevention as predicting factors while adjusting
for demographic variables. We emphasized the importance of including these
personal and work-related correlates as past studies have documented the high
prevalence of burnout and psychological morbidity among healthcare workers,
confirmed in this study.
We employed systematic random sampling of all healthcare workers, except
for doctors, who were recruited through a mix of random and universal sam-
pling. This may cause selection bias. In terms of instrumentation, the self-
efficacy in suicide prevention scale recorded a low internal reliability. As this
480 OMEGA—Journal of Death and Dying 87(2)

is a cross-sectional study, we could not establish the trends of healthcare work-

ers’ attitudes across time and the causative effect of the predictors on the under-
standing of suicidal patients. Future studies should include a nationally
representative sample to establish more generalizable prevalence rates of health-
care worker well-being and attitudes. In addition, the specific mechanisms which
determined the influence of lifetime suicidal ideation, depression, anxiety, per-
sonal achievement and self-efficacy in suicide prevention on understanding of
suicidal patients could be further explored through a qualitative approach. A
step further in Asian suicide attitude studies could involve matching suicidal
patient outcomes such as care satisfaction and post-discharge suicidality with
healthcare worker characteristics.

Conclusion
There were high rates of burnout, depression, anxiety, stress and suicidal idea-
tion among the hospital healthcare workers in this study. Depression and anx-
iety predicted lower understanding of and willingness to help suicidal patients.
Meanwhile, low personal accomplishment and high self-efficacy in suicide pre-
vention predicted positive attitudes.
There is a need to discern physical, psychological and training needs of
healthcare workers in hospitals, and to realistically identify the limits posed
by professional and systemic factors in suicide prevention (Smith et al., 2015).
The quality of care for suicidal patients presenting with a potentially life-
threatening situation must be improved, but only in tandem with equipping
and supporting the healthcare workers attending to them.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This work was supported by Geran
Universiti Penyelidikan, Universiti Kebangsaan Malaysia (GUP-2014-065).

ORCID iDs
Ching Sin Siau https://orcid.org/0000-0001-7612-6839
Norhayati Ibrahim https://orcid.org/0000-0002-1395-2794

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Author Biographies
Ching Sin Siau is a Senior Lecturer in the Center for Community Health Studies,
Faculty of Health Sciences, Universiti Kebangsaan Malaysia.

Caryn Mei Hsien Chan is a Senior Lecturer in the Center for Community Health
Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia.

Lei Hum Wee is a professor in the Center for Community Health Studies,
Faculty of Health Sciences, Universiti Kebangsaan Malaysia.

Suzaily Wahab is a psychiatrist in the Department of Psychiatry, UKM Medical

Centre.

Uma Visvalingam is a psychiatrist in the Department of Psychiatry and Mental

Health, Hospital Putrajaya.

Won Sun Chen is a Senior Lecturer and statistician in the Faculty of Health,
Arts, and Design, Swinburne University, Hawthorn, Australia.

Seen Heng Yeoh is a psychiatrist with a private practice at Klinik Dr. Yeoh dan
Dr. Hazli, Kuala Lumpur.

Jing Ni Tee is a graduate in Master of Child Psychology, UCSI University,

Kuala Lumpur.

Lena Lay Ling Yeap is a statistician with Stats Consulting Pte. Ltd.

Norhayati Ibrahim is a counsellor and associate professor in the Center for

Community Health Studies, Faculty of Health Sciences, Universiti
Kebangsaan Malaysia.
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