The Mental Health of Malaysians: The Effect of Movement Control Order

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This paper explores the effect of the movement control order implemented during the spread of COVID-19 on the mental health of the population in Malaysia. The report described in the paper is based on the testing procedure of a group of respondents consisting of 4 adults of different age groups. Test methodology rests on using three types of questionnaires DASS-21, GF-12, and IES-R with the latter offered to be filled in by the participants twice over one week. This work also reviews the validity and reliability of the test forms mentioned above in the context of the location (Malaysia) and respondent group size. Results of the test-retest procedure are calculated using the respective statistical tests and are compared between the three age groups of the respondents.

2020 was marked with the beginning of what some people consider a worldwide crisis. In two months the novel Coronavirus appeared and spread from the capital of Chinas Hubei province Wuhan to a full-scale pandemic. On the one hand, populations were presented with new social, health, and environmental challenges. On the other hand, governments worldwide instituted new laws and orders hoping to slow down the spread of COVID-19, but instead suspended the economies, leaving thousands of citizens unemployed, mentally stressed and exhausted. This papers objective is to discuss a report on the effect of the movement control order (MCO) implemented on March 18 by the Malaysian government. The report is based on conducting a test-retest procedure, using specific questionnaire validation forms, and on interpreting the results associated with the impact of the MCO on psychosocial and family relations.

COVID-19 in Malaysia

The coronavirus outbreak, caused by a novel severe acute respiratory syndrome, began in China in late December 2019. Still, already on January 30, the World Health Organization declared a public health emergency of global concern. Coronaviruses are a large family of viruses that can cause diseases ranging from common colds to more severe conditions. COVID-19 is a strain of Coronavirus that has never been detected in humans before. Harapan et al. (2020) state that given the pandemic scale of the infection, careful surveillance is immensely important to monitor viral evolution, transmissibility, and pathogenicity (p. 10). Due to the rapid transmission of the virus, countries around the globe introduce control systems, focusing on disease surveillance measures, and establishing rapid response teams.

To help the public health system to prepare for the influx of COVID patients, on March 18, 2020, the Malaysian government introduced the MCO, referred to by media and public as a lockdown order. The purpose of the MCO is to impose harsh control measures that allow the limited civil freedom of circulation, for over three months. However, the MCO adversely impacted the labour market in Malaysia, and according to Hassan (2020), resulted in the unemployment rate hit a 10-year high in March (para. 4). Stress, associated with unemployment or the prospect of losing a job, results in an inability to stay mentally healthy for a large group of the middle-age population.

The MCO also had a significant impact on the students stratum in Malaysia due to the closure of colleges and universities and a shift to online studying. Abu Karim (2020) argues that such restriction on the freedom of movement can have negative psychological outcomes, including acute stress reaction and long term post-traumatic stress disorder (para. 7). A large number of students was forced to remain at university campuses, forced to avoid their regular routines, and face enormous worries about their families back home, health, and career prospects.

Adults of 55 years of age and older represent a different age group of the population affected by the MCO in a specific way. Older people spend an increased amount of time at home, thus putting a long hold on physical activities that promote healthy ageing. Since the retirement age in Malaysia is 60 years old for both men and women, this population stratum is at a higher risk of losing employment during the pandemic. Many Malaysian businesses that are not well-equipped to deal with the outbreak and have no financial capabilities to survive the crisis are more likely to cut down their staff numbers, starting with those approaching the retirement age. The following practical report will cover procedures, methodology, and results of the test experiment involving the three age brackets described above.

Test Methodology

Site of Experiment, Timeframe and Participant Population

For the Test-Retest experiment on the impact of the MCO on the population, participants were selected using convenience sampling on Malaysias territory. The period between administering the test forms to the participants is one week. Since age is one of the critical factors when considering the impact of an event on family and psychosocial functioning, participants were sampled on an age basis. The participant population comprised of one (1) working adult aged 40 years old, two (2) students aged 18-25 years old, and one (1) older adult aged 55 years old.

Description of measures

The first tool used by the respondents to rate their degree of distress and anxiety in the context of the MCO effect is the IES-R. IES-R has 22 questions and is considered an effective instrument to measure the participants responses to certain life-threatening events. The individual stress results are assessed on a 5-point scale, ranging from 0 not at all to 5 extremely. It applies to the experiment described since the IES-R target population may vary from healthy young adults to older respondents. In respect to the IES-R tools validity and reliability, it can be assumed that it is an appropriate measure to assess the subjective response to stressful or traumatic events using a particular period of seven (7) days. According to McCabe (2019), the intrusion and avoidance subscales show good internal consistency in the clinical response to traumatic events of varying severity (para.4), which is particularly applicable to the experiment. However, it should be noted that the IES-R serves more as a screening tool, rather than diagnostic. IES-R is the only form administered in the course of the experiment twice.

The second measure used in the experiment, DASS-21, was developed by Lovibond and Lovibond in 1995. It is a self-assessment form, presented in a set of three scales with seven items each, intended to measure the mental states of anxiety, depression, and stress. Scores for each scale are calculated by adding the scores for the individual items. There are various international studies on the reliability of the DASS-12, proving it to be a useful instrument to measure emotional symptoms of stress, depression, and anxiety in both non-clinical and clinical groups of adults. According to the research, described in the 12^th volume of the African Research Review, DASS-12 showed excellent Cronbachs alpha values of 0.81, 0.89 and 0.78 for the subscales of depression, anxiety and stress, respectively (Coker, Coker, & Sanni, 2018, p. 135). Other studies show that DASS-12 is especially suitable in assessing mental issues such as depression and anxiety; however, its effectiveness in measuring stress may be somewhat limited.

In the test experiment, the GF-12 subscale was administered to identify respondents with various levels of family functioning (healthy and unhealthy). The GF-12 scale is easy to administer as it has only 12 items, with scores ranging from 1 as healthy to 4 as unhealthy, known as 4-point Lukert scale. In their research paper, Wo et al. (2018) state that the GF-12 subscale proved to be a factorially valid and reliable instrument for assessing general family functioning in Malaysia (p. 26). It can also be determined from their study that the GF-12 subscale shows sufficient psychometric properties (test-retest and internal consistency). Similarly to the study mentioned above, our experiment results might be limited since the sample size of our study (4 participants) is small compared to other studies using GF-12 as the assessment tool.

Results

The findings of the test-retest experiment were computed using the appropriate statistical test on spss. The score results are presented in Table 1 as follows: 24 or more PTSS is a clinical concern, 33 and above probable PTSS, 37, and more high enough to suppress immune system functioning.

Table 1

	Scores
	24 or less	24 or more	33 or more	37 or more
Test No. 1 (first week)	Three respondents	One respondent
Test No. 2 (second week)	One respondent	Two respondents	One respondent

Respondent No. 4 (older adult, aged 55 and over) scored the highest on the second test, proving to be most susceptible to the effect of the MCO. According to the second administered test, 50 % of the respondents were identified as probable PTSS cases (one male and one female). Cronbachs alpha score for the whole sample was 0.95 proving an adequate level of internal reliability of the IES-R.

The objective of administering the DASS-21 form was to validate the efficiency of the test among the sample group, comprising four adults of different age groups. The present experiment showed that the DASS-21 proved to have an acceptable psychometric structure and its internal consistency reliability, with Cronbachs alpha values above 0.837 that measure depression, anxiety, and stress of the participants.

The GF-12 test results were limited since the sample size of the respondent group was small (4). However, such factors as gender or age were not found to affect the overall subscale score.

Discussion

The study performed using the IES-R, DASS-21, and GF-12 test forms and subsequent re-testing of the form IES-R showed that the MCO affected respondents of three different age groups in a distinctive manner. Younger participants tended to report fewer signs of mental health issues, such as depression, given the effect of MCO. However, as for family functioning, younger adults results were more towards the unhealthy level rather than middle-aged and older age groups. Again, it is important to stress that the test results are limited due to the sample size group of only four respondents; therefore cannot be viewed as indicative in respect of larger groups of the population.

References

Abu Karim, M. (2020). Handling students mental health during MCO. The Straits Times.

Coker, A.O., Coker, O.O., & Sanni, D. (2018). Psychometric properties of the 21-item Depression anxiety stress scale (DASS-12). African Research Review 12(2), 135-142.

Harapan, H., Itoh, N., Yufika, A., Winardi, W., Keam, S., Te, H., & Mudasir, M. (2020). Coronavirus disease 2019 (COVID-19): A literature review. Journal of Infection and Public Health, 13(5), 667-673.

Hassan, H. (2020). Most Malaysian companies struggling under movement control curbs, unemployment at a 10-year high. The Straits Times.

McCabe, D. (2019). The Impact of Event Scale-Revised (IES-R). Try This: General Assessment Series 19.

Wo, S., Lai, L., Ong, L., Low, W., Wu, D., Nathan, A., Wong, C. (2018). Factorial validation of the Chinese general functioning subscale (GF-12) of the family assessment device in Malaysia. JUMMEC, 21(2), p. 23-30.

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