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Purpose: This study aimed to estimate the prevalence of mental health problems and identify potential risk and protective exposures for adolescents in Indonesia., Methods: An innovative sampling approach was applied to simultaneously recruit school- and community-based adolescents aged 16-18 years old from Jakarta (urban megacity) and South Sulawesi (remote province). We used multistage cluster sampling for in-school (N = 1,337) and respondent driven sampling for out-of-school (N = 824) adolescents. Mental health was measured using two validated scales: Kessler-10 and Center for Epidemiologic Studies Depression Scale-Revised. Psychiatric interviews were conducted in a subsample (N = 196) of students from Jakarta to validate the self-report scales., Results: The estimated population prevalence of psychological distress and depression were 24.3% (95% CI = 21.5-27.2) and 12.6% (10.5-14.4) for in-school and 23.7% (20.7-26.7) and 23.5% (20.4-26.5) for out-of-school adolescents, respectively. In participants who completed a psychiatric interview, common psychiatric morbidities were social anxiety, depression, and suicidality. Compared to in-school females, male in-school adolescents reported a lower prevalence of psychological distress (16.9% (13.1-20.7) vs. 30.4% (26.4-34.4)) and depression (10.1% (7.2-13.1) vs. 14.6 (11.4-17.8)). By contrast, for out-of-school adolescents, males reported a higher prevalence of psychological distress (25.2% (21.6-28.9) vs. 20.2% (15.1-25.3)) and depression (26.3% (22.5-30.1) vs. 16.9% (11.8-21.9)). In-school adolescents who did not seek healthcare despite a perceived need were more likely to report psychological distress and depression., Discussion: Adolescent mental health problems are highly prevalent in Indonesia, with substantial variation by gender, geography, and school enrolment. This study and its approach to sampling and measurement may serve as a model to improving mental health surveillance across other settings., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Executive function influences children's learning abilities and organizes their cognitive processes, behaviors, and emotions. This cross-sectional study examined whether an Indonesian Computer-Based Game (ICbG) prototype could be used as a Computer-Based Game Inventory for Executive Function (CGIEF) in children and adolescents. The study was conducted with 200 children, adolescents, and their parents. The parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire, and the children and adolescents completed the CGIEF. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were performed using LISREL Version 8.80. The construct of CGIEF was valid/fit with normal theory-weighted least squares = 15.75 ( p > .05). SEM analysis showed that the theoretical construct of the CGIEF was a valid predictor of executive function. The critical t value of the pathway was 2.45, and normal theory-weighted least squares was 5.74 ( p > .05). The construct reliability (CR) for CGIEF was 0.91. Concurrent validity was assessed using the Bland-Altman plot, and the coefficient of repeatability (bias/mean) was nearly zero between the t scores of total executive functions of the CGIEF and BRIEF. This preliminary study showed that the CGIEF can be useful as a screening tool for executive dysfunction, metacognitive deficits, and behavioral regulation problems among children and adolescents in clinical samples., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To translate and validate CLEFT-Q © , patient-reported outcome measure for patients with cleft lip and/or palate (CL and/or P), into Indonesian. CLEFT-Q © covers the domains of appearance, facial function, health-related quality of life and consists of scales describing outcomes after cleft surgery., Design: The CLEFT-Q © instrument was translated according to the International Society of Pharmacoeconomics and Outcomes Research guidelines, including translation, cognitive debriefing, and field-testing., Setting: Dr. Cipto Mangunkusumo Hospital, Indonesia; independent CL and/or P support groups., Patients: Patients ages 8-29 with a history of repaired CL and/or P were grouped based on age. Those unable to complete the questionnaire independently were excluded., Interventions: The primary objective was reliable translation of the CLEFT-Q® instrument. Each scale was assessed for its internal consistency (Cronbach's alpha) and validity (inter-item correlation), and sub-group analyses were performed based on age group., Results: Forward and back translation revealed 25(13.3%) and 12(6.3%) of items were difficult to translate. Cognitive debriefing revealed 10(5.3%) items were difficult to understand, with the lowest reliability on the facial appearance scale (α=0.27). Other scales demonstrated acceptable to excellent reliability (α=0.53-0.68). Field testing revealed acceptable reliability and validity of the translation (α = 0.74-0.92; 69% ideal range of inter-item correlation). Sub-group analyses revealed patients in the <11y.o. and >18y.o. groups had the lowest scores on the "cleft lip scar" scale while those 11-18y.o. had the lowest scores on the "nostrils" scale., Conclusion: Iterative translation and cultural adaptation of CLEFT-Q © into Indonesian demonstrated reliability and validity of the tool, supported by acceptable to excellent internal consistency and ideal inter-item correlation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The coronavirus disease 2019 (COVID-19) pandemic has brought drastic changes globally in the past three years, one of which is an increase in the use of digital media or electronic devices. Previous studies have shown that long screen time may stimulate the neurobiological system, resulting in various behavioural and emotional problems; however, there is insufficient population-based evidence. This study aimed to investigate the influence of screen time on behavioural and emotional problems in Indonesian adolescents at three time points: the pre-, peak, and post-peak periods of COVID-19. Data were collected using an online community mental health survey. This survey incorporated the Youth Screen Time Survey to gauge screen time and the adolescent version of the Strengths and Difficulties Questionnaire to assess emotional, conduct, and prosocial behaviour problems. The participants were adolescents in secondary and senior high schools, with 337, 423, and 1,096 participants from the pre-, peak-, and post-pandemic periods, respectively, included in the analysis. Daily average screen time was compared, followed by the calculation of odds ratios for screen time and mental health problems during the different periods. The results demonstrated significant differences in adolescents' total daily average screen time between the different pandemic periods. Decreased screen time was associated with reduced emotional, conduct, and prosocial behaviour problems, especially during the peak period. Thus, psychoeducation on screen time in adolescents should be considered as a point of interest for mental well-being interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

Introduction: Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience., Methods: A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group ( n  = 52) and control group ( n  = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week., Results: Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P  = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P  < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P  = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P  < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P  = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P  < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference ( P  < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups., Conclusion: The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Kaligis, Ismail, Wiguna, Prasetyo, Gunardi, Indriatmi, Pasaribu, Pandia, Minayati, Magdalena, Nurraga, Pramatirta, Calvin and Sourander.)

Schizophrenia has the main symptom of psychosis which is characterized by speech incoherence due to thought process disturbance. Before schizophrenia, there is a prodromal phase of psychosis in adolescence. Early recognition of this phase is important to prevent the development of symptoms into a severe mental disorder. Machine learning technology can be used to predict thought process disturbance through syntactic and semantic analysis of speech. This study aims to describe the differences in syntactic and semantic analysis in prodromal psychosis and normal adolescents. The research subjects consisted of 70 adolescents aged 14-19 years which were divided into 2 groups. Based on the results of the Prodromal Questionnaire-Brief (PQ-B) Indonesian version, the subjects were split into two groups: prodromal and normal. All participants were voice-recorded during interviews using an open-ended qualitative questionnaire. Syntactic and semantic analysis was carried out on all data which amounted to 1017 phrase segments and classified by machine learning. This is the first study in Indonesia to compare the analysis of syntactic and semantic aspects in prodromal psychosis and normal adolescent populations. There were significant differences in syntactic and semantic analysis between groups of adolescents with prodromal psychosis and normal adolescents at the minimum value of coherence and frequency of use of nouns, personal pronouns, subordinate conjunctions, adjectives, prepositions, and proper nouns., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs., Methods: A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care., Findings: A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay)., Interpretation: Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare., Funding: Australia-Indonesia Centre., Competing Interests: This study was supported by funding from the Health Cluster of the Australia-Indonesia Centre. Peter S. Azzopardi holds a 10.13039/501100000925National Health and Medical Research Council Emerging Leadership Investigator Grant. Jane Fisher is funded by a Professorial Fellowship from the Finkel Family Foundation. Authors declare no other conflict of interests., (© 2023 The Author(s).)

The traditional diagnosis of Attention Deficits/Hyperactivity Disorder (ADHD) is through parent-child interviews and observations; therefore, innovative ADHD diagnostic tools that represent this digital era are needed. Virtual reality (VR) is a significant technology that can present a virtual immersive environment; it can provide an illusion of participation in an artificial milieu for children with ADHD. This study aimed to develop an ADHD-VR diagnostic tool construct (Research Domain Construct/RDC) based on the DSM5 ADHD diagnostic criteria, and using the RDC to develop a diagnostic tool with a machine learning (ML) application that can produce an intelligent model to receive some complex and multifaceted clinical data (ADHD clinical symptoms). We aimed to expand a model algorithm from the data, and finally make predictions by providing new data (output data) that have more accurate diagnostic value. This was an exploratory qualitative study and consisted of two stages. The first stage of the study applied the Delphi technique, and the goal was to translate ADHD symptoms based on DSM 5 diagnostic criteria into concrete behavior that can be observed among children in a classroom setting. This stage aimed to gather information, perceptions, consensus, and confirmation from experts. In this study, three rounds of Delphi were conducted. The second stage was to finalize the RDC of the ADHD-VR diagnostic tool with ML, based on the first-stage results. The results were transformed into concrete activities that could be applied in the programming of the ADHD-VR diagnostic tool, followed by starting to input data that were required to build the diagnostic tool. The second stage consisted of more than ten focus-group discussions (FGDs) before it could be transformed into the ADHD-VR diagnostic tool with the ML prototype. First-stage data analysis was performed using Microsoft Excel for Mac. Qualitative data were analyzed using conceptual content analysis with a manifest/latent analysis approach. From the first stage of the study, there were 13 examples of student behaviors that received more than 75% totally agreed or agreed from the experts. The RDC of the ADHD-VR diagnostic tool with machine learning application consisted of three domains and was divided into six sub-domains: reward-related processing, emotional lability, inhibitory, sustained attention, specific timing of playing in order, and arousal. In conclusion, the results of this study can be used as a reference for future studies in a similar context and content, that is, the ADHD-VR diagnostic tool with machine learning based on the constructed RDC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wiguna, Bahana, Dirgantoro, Minayati, Teh, Ismail, Kaligis and Wigantara.)

Nearly two-thirds of psychiatric patients are reluctant to seek help from healthcare professionals due to stigma, discrimination, and negligence that evolve around the community, including healthcare providers. Future health professionals should have a positive attitude toward psychiatry and patients with mental health problems. Thus, it is vital to identify medical students' attitudes toward psychiatry as future healthcare providers. The authors conducted a cross-sectional study by using online questionnaires of "Perceptions of Psychiatry" in Faculty of Medicine Universitas Indonesia, with first- and fourth-year students (before psychiatric rotation), as well as fifth-year students and alumni (after psychiatric rotation). Out of 250 questionnaires distributed, 224 subjects responded, with a response rate 89.6%. Chi-square or fisher analysis was conducted to know the correlation between gender and attitudes towards psychiatry. The frequency distribution method was applied to identify the degree of stigmatization from respondents. A mix of positive and negative perceptions towards psychiatry was identified. The overall response was favorable to both before and after psychiatric rotation groups. Differences in perceptions between male and female psychiatry students as a discipline and career were statistically significant. Correcting misapprehension and removing the stigma on psychiatry during medical education might decrease the stigma in the psychiatric field and patients., Competing Interests: The authors have declared that no competing interests exist.

Background and Aim: Mental health is an integral part of adolescent wellbeing. However, only few adolescents understand the importance of mental health and are aware of the right time to seek help. Lack of knowledge and stigma may impede help-seeking behavior. To assess these aspects, three questionnaires have been developed in the English language. This study aims to assess the validity and reliability of an Indonesian version of the Mental Health Literacy and Help-Seeking Behavior set of questionnaires among adolescents in Indonesia. Methods: This is a cross-sectional study that used The Mental Health Literacy and Help-Seeking Behavior set of questionnaires developed by Kutcher and Wei. The set consists of three questionnaires: the Mental Health Knowledge, Attitude Toward Mental Health, and Help-Seeking Behavior questionnaire. The study was conducted between October 2020 and January 2021 with 68 first-year medical students at the University of Indonesia, who represented adolescents in a transitional phase. The questionnaires were translated into the Indonesian language by a bilingual psychiatrist and reviewed by 10 expert psychiatrists to determine content validity [Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI)]. Cronbach's alpha values were used to assess internal consistency (reliability). Results: The content validity test produced positive results with an I-CVI scores of 0.7-1.0 and S-CVI scores of 0.87, 0.90, and 0.99 for the knowledge, attitude, and help-seeking behavior questionnaires, respectively. For the reliability test, Cronbach's alpha values were 0.780 for the attitude questionnaire and 0.852 for the help-seeking behavior questionnaire, while the value for the knowledge questionnaire was 0.521. Conclusion: The ability to properly measure mental health through the availability of accessible, valid, and understandable tools plays an important role in addressing mental health issues among adolescents. In the current study, the Indonesian translations of all three questionnaires examining knowledge, attitude, and help-seeking behavior were considered to be valid and reliable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kaligis, Ismail, Wiguna, Prasetyo, Indriatmi, Gunardi, Pandia, Minayati, Magdalena, Nurraga, Anggia, Pamungkas, Tran, Kurki, Gilbert and Sourander.)

Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a "crowdsourcing" sample collection method to recruit 464 adolescents aged 11-17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t -value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t -value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI ( R 2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wiguna, Minayati, Kaligis, Ismail, Wijaya, Murtani and Pradana.)

This study compares the Empathy Quotient (EQ) and Systemizing Quotient (SQ) scores of elementary school children with and without ADHD. The study also examined their brain types and, because sex plays a big role in empathy and systemizing ability, compared the results of the boys and girls. This cross-sectional study involved 122 participants, including 61 parents of children with ADHD and 61 parents of children without ADHD. The EQ, SQ and brain types were obtained using the Empathy and Systemizing Quotient in children (EQ-/SQ-C), validated in the Indonesian language. Data was analyzed using the SPSS program version 20 for Windows, with a p -value < 0.05 for statistical significance. There was a significant difference in EQ between children with and without ADHD, the score being lower in children with ADHD. There was also a significant difference in SQ among girls with and without ADHD, but not in boys. The brain types in both groups were not significantly different. The results indicate that children with ADHD have a lower ability to empathize compared to children without ADHD. Systemizing abilities were significantly lower in girls with ADHD than in girls without. Therefore, an intervention program focusing on improving empathy and systemizing ability needs to be developed in the community., Competing Interests: The authors declare no conflict of interest during the preparation, data collection, interpretation of the results, or article writing.

The aim of this study was to develop an Indonesian computer-based game prototype, including feasibility testing, targeted on attention deficit/hypersensitivity disorder (ADHD) clinical symptoms and executive function. The study comprised five steps. The first to third steps used an exploratory qualitative research design. The Delphi technique with FGD was applied to collect qualitative data. During the study, seven experts participated in ten FGDs. Feasibility testing was conducted as a one group pre- and post-test design that included ten children with drug-naïve ADHD without other mental or physical disorders. Feasibility data were collected before and after 20 training sessions with the Indonesian computer-based game prototype. The framework analysis was performed for qualitative data. Quantitative data were analyzed using the paired t-test, Pearson's correlation and Spearman's rank-order correlation. Outputs of the exploratory qualitative study were the Indonesian computer-based game prototype constructs and general agreements of the prototype,. The Indonesian computer-based game prototype construct comprised six components: reward-related processing, control inhibition, improved sustained attention, specific timing, increased arousal, and improved emotional regulation. After 20 sessions of training, several indicators decreased significantly, such as CATPRS-teacher rating (18.5 [5.31] vs. 12.9 [5.51], p = 0.047), BRIEF-GEC (64.80 [10.21] vs. 57.50 [7.51], p = 0.02), BRIEF-MI (66.1 [7.61] vs. 58.4 [7.56], p = 0.014), BRIEF-Initiate (66.6 [10.15] vs. 54.1 [6.49], p = 0.008), BRIEF-Working Memory (68.0 [6.89] vs. 60.9 [10.05], p = 0.02), and BRIEF-Organization of Material (60.7 [12.88] vs. 49.3 [11.79], p = 0.04). There was a low to moderate correlation between CATPRS-teacher and -parent rating and several BRIEF domains. Feasibility testing output also included the training procedure guideline. The present study indicated that the Indonesian computer-based game prototype could be used as a framework to develop a fixed computer-based game intervention for children with ADHD. However, further randomized controlled studies need to be conducted to show its effectiveness., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

"Transitional-age youth" describes those whose ages range from 16-24 years old. In this phase, the youth face new challenges and new experiences which may increase the risk for having mental health problems, yet not very many seek help from mental health professionals. In Indonesia, no data are available about mental health problems and the needs of transitional-age youth. This study explores common mental health problems experienced during this stage and assesses how they cope with problems and their expectations from health services. This was a cross-sectional study involving 393 Indonesians aged 16-24 years in May 2020. More than 90% of students had financial and academic difficulties and felt lonely. The most prevalent mental health problem among students was anxiety (95.4%). Most of the students, ranging from 90% to 96.4%, had positive coping strategies. However, around 50% of respondents reported self-harming and having suicidal thoughts. The results of subcategories analysis between ages and faculties were similar. Their most important expectations from mental health services included confidentiality (99.2%) and being welcoming and friendly (99.2%). In conclusion, this study highlighted the most common problems transitional-age youth experience in Indonesia. While some of them already knew how to deal with their problems, not all the participants had good coping mechanisms. Their healthcare expectations were also explored, thereby providing a useful background to revise and amend the current conditions.

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus which has not been identified previously in humans. The disease leads to respiratory problems, systemic disorders, and death. To stop the virus transmission, physical distancing was strongly implemented, including working and school from home (WFH & SFH). The limitation altered daily routines and needs advanced to adapt. Many have felt uncomfortable and this could have triggered anxiety symptoms. This study aimed to evaluate the proportion of significant anxiety symptoms and its association with COVID-19-related situations in an Indonesian context during the initial months of the pandemic. Methods: An online community survey was distributed through social media and communication platforms, mainly WhatsApp, targeting people >18 years old in Indonesia. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (Indonesian Version). Demographical data and information on social situation related to the COVID-19 pandemic were collected. The proportion of clinically significant anxiety symptoms was calculated and the association with demographic and social factors was assessed using chi square test (χ 2 ) and logistic regression for multivariate analysis. Results: Out of 1215 subjects that completed the survey, 20.2% ( n = 245) exhibited significant anxiety symptoms. Several factors, such as age (AOR = 0.933 CI 95% = 0.907-0.96), sex (AOR = 1.612 CI 95% = 1.097-2.369), medical workers (AOR = 0.209 CI 95% = 0.061-0.721), suspected case of COVID-19 (AOR = 1.786 CI 95% = 1.001-3.186), satisfaction level of family support (AOR = 3.052 CI 95% = 1.883-4.946), and satisfaction level of co-workers (AOR = 2.523 CI 95% = 1.395-4.562), were associated with anxiety. Conclusion: One out of five Indonesian people could have suffered from anxiety during the COVID-19 pandemic. The riskiest group being young females, people who had suspected cases of COVID-19, and those with less satisfying social support. Nevertheless, health workers were found to have a lesser risk of developing anxiety. Accessible information and healthcare, social connection, supportive environment, and mental health surveillance are important to prevent bigger psychiatric problems post-pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Anindyajati, Wiguna, Murtani, Christian, Wigantara, Putra, Hanafi, Minayati, Ismail, Kaligis, Savitri, Uiterwaal and Diatri.)

The COVID-19 pandemic does not affected only physical but also mental health and socioeconomic part. The social distancing, social quarantine, school from home, and work from becomes a new normal these days. Being adolescence, the above conditions may be challenging due to their developmental milestones. Therefore, this brief report aimed to preliminary identify proportion of adolescents' emotional and behavior problems and several factors related to it during COVID-19 pandemic in Indonesia. The findings might raise some understanding of youth mental well-being and programs that can be applied in schools and community in general to overcome the issues. The study was designed as cross sectional and used online survey that started on April 2020. During April 15-May 10, 2020, there were 113 adolescents participated on this survey. Strength and Difficulties Questionnaire (SDQ) 11-17 years old was used to assess adolescent emotional and behavior problems; and specific life experience questionnaire was designed to collect other independents variables (Cronbach's α = 0.75). All participants fulfilled the online informed consent before they started to complete the questionnaire. All data was analyzed by using SPSS version 20 for Mac. The average age of research subjects were 14.07 (2.18) years old; 98.2% was school from home. There was 14.2% of the total research subject at risk on total difficulties problems; 38.1% of adolescent was at risk on peer-relationship problems, 28.3% at risk on pro-social behavior problems, 15% at risk on conduct behavior and 10.6% at risk on emotional problems. The number of adolescent that perceived worse to significantly worse self-mental well-being prior COVID-19 increased during COVID-19 pandemic in Indonesia ( p < 0.05). There was significantly association between having mental health information and conduct behavior (OR = 10.34, 95%CI = 1.27-78.86); Subjective anxiety due to COVID-19 pandemic and pro-social behavior problems (OR = 2.37, 95% CI = 1.00-5.63), parental support and total difficulties (OR = 0.09, 95% CI = 0.14-0.60) and pro-social behavior problems (OR = 0.09, 95% CI = 0.01-0.82); friends support during COVID-19 pandemic and conduct behavior (OR = 0.20, 95% CI = 0.04-1.00) and pro-social behavior problems (OR = 0.14, 95% CI = 0.02-0.75). To be concluded, during phase 1 and 2 COVID-19 pandemic and school closures in Indonesia, adolescents were at risk for having emotional and behavior problems. Therefore, maintain clear mental health information, keep them on connection with school by designing an optimal tele-education, tele-consultation, and virtual activity programs to accommodate adolescents' biopsychosocial needs in the near future., (Copyright © 2020 Wiguna, Anindyajati, Kaligis, Ismail, Minayati, Hanafi, Murtani, Wigantara, Putra and Pradana.)

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children resulting in disturbances in their daily functioning. Virtual reality (VR) and machine learning technologies, such as deep learning (DL) application, are promising diagnostic tools for ADHD in the near future because VR provides stimuli to replace real stimuli and recreate experiences with high realism. It also creates a playful virtual environment and reduces stress in children. The DL model is a subset of machine learning that can transform input and output data into diagnostic values using convolutional neural network systems. By using a sensitive and specific ADHD-VR diagnostic tool prototype for children with DL model, ADHD can be diagnosed more easily and accurately, especially in places with few mental health resources or where tele-consultation is possible. To date, several virtual reality-continuous performance test (VR-CPT) diagnostic tools have been developed for ADHD; however, they do not include a machine learning or deep learning application. A diagnostic tool development study needs a trustworthy and applicable study design and conduct to ensure the completeness and transparency of the report of the accuracy of the diagnostic tool. The proposed four-step method is a mixed-method research design that combines qualitative and quantitative approaches to reduce bias and collect essential information to ensure the trustworthiness and relevance of the study findings. Therefore, this study aimed to present a brief review of a ADHD-VR digital game diagnostic tool prototype with a DL model for children and the proposed four-step method for its development., (Copyright © 2020 Wiguna, Wigantara, Ismail, Kaligis, Minayati, Bahana and Dirgantoro.)

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This article is a summary of perspectives on training curricula from child and adolescent psychiatry trainees globally. We aimed to identify the relative strengths, weaknesses and gaps in learning needs from a trainee's perspective. The 20 early-career child psychiatrists who contributed are from 16 countries and represent all the five continents. We could identify some global challenges as well as local/regional challenges that need to be addressed to develop competent child psychiatrists., (© The Authors 2020.)

Investigations on the biochemical relationship between Doriprismatica stellata (Chromodorididae, Doridoidea) nudibranchs, their egg ribbons, and the associated dietary sponge Spongia cf. agaricina (Demospongiae, Porifera) led to the isolation of the structurally new scalarane-type sesterterpene 12-deacetoxy-4-demethyl-11,24-diacetoxy-3,4-methylenedeoxoscalarin, with an unprecedented position of the cyclopropane ring annelated to the ring A. Unlike other scalaranes, which are most often functionalized at C-12 of ring C, it bears two acetoxy groups at C-11 and C-24 instead. The compound was present in all three samples, supporting the dietary relationship between chromodorid nudibranchs of the genus Doriprismatica and scalarane-containing dictyoceratid sponges of the Spongiidae family. The results also indicate that D. stellata passes the scalarane metabolite on to its egg ribbons, most likely for protective purposes. The scalarane showed antibacterial activity against the Gram-positive bacteria Arthrobacter crystallopoietes (DSM 20117) and Bacillus megaterium (DSM 32)., (Copyright © 2020, Hertzer et al.; licensee Beilstein-Institut.)

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with the burden largely borne by people living in low- and middle-income countries. Adolescents are central to NCD control through the potential to modify risks and alter the trajectory of these diseases across the life-course. However, an absence of epidemiological data has contributed to the relative exclusion of adolescents from policies and responses. This paper documents the design of a study to measure the burden of metabolic syndrome (a key risk for NCDs) and poor mental health (a key outcome) amongst Indonesian adolescents. Using a mixed-method design, we sampled 16-18-year-old adolescents from schools and community-based settings across Jakarta and South Sulawesi. Initial formative qualitative enquiry used focus group discussions to understand how young people conceptualise mental health and body weight (separately); what they perceive as determinants of these NCDs; and what responses to these NCDs should involve. These findings informed the design of a quantitative survey that adolescents self-completed electronically. Mental health was measured using the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Kessler-10 (both validated against formal psychiatric interview in a subsample), with the metabolic syndrome measured using biomarkers and anthropometry. The survey also included scales relating to victimisation, connectedness, self-efficacy, body image and quality of life. Adolescents were sampled from schools using a multistage cluster design, and from the community using respondent-driven sampling (RDS). This study will substantially advance the field of NCD measurement amongst adolescents, especially in settings like Indonesia. It demonstrates that high quality, objective measurement is acceptable and feasible, including the collection of biomarkers in a school-based setting. It demonstrates how comparable data can be collected across both in-school and out of school adolescents, allowing a more comprehensive measure of NCD burden, risk and correlates.

Purpose: Empathy is critical for medical doctors, as it enables them to conduct good patient-centred care. Medical students are expected to learn this ability as part of their education and training., Methods: Using a cross-sectional design, the present study was conducted to identify whether the empathy levels of medical students are affected by their stress levels. A translated version of the Perceived Stress Scale-10 was used to measure the students' stress levels, while the Jefferson Scale of Physician Empathy was used to measure their empathy levels., Results: A total of 464 students from one medical school in Indonesia participated in the study. Stress levels among medical students peak in their first year of study and maintain a downward trend over the following years. The students' empathy levels increased during their first 3 years, declined significantly upon entering the first clinical year, and increased during the second clinical year. However, no correlations were found between stress level and empathy level., Conclusion: These findings suggest that there may be other underlying factors that contribute to empathy decline among medical students upon entering their first clinical year. Further research should be conducted to identify these factors. The bounced-back of empathy level to a higher level in the second year highlights the importance of student adaptation in the clinical learning environment and the support system.

We describe a new species, Moridilla jobeli sp. nov., belonging to the marine heterobranch group Aeolidioidea. Up to now, it is only recorded from Bunaken National Park, North Sulawesi, Indonesia. A combination of histological, computer tomographic and scanning electron microscopic methods was applied in order to describe and illustrate the anatomy of Moridilla jobeli sp. nov. in detail. Furthermore, we conducted molecular analyses which include available partial COI and 16S rRNA sequences, as well as the nuclear gene Histone 3 (H3) of Facelinidae and Aeolidiidae. NeighborNet analyses, species delimitation tests and phylogenetic reconstruction methods show the distinctiveness of the new species from the type species Moridilla brockii Bergh, 1888 and the two recently described species Moridilla fifo Carmona Wilson, 2018 and Moridilla hermanita Carmona Wilson, 2018, as well as the monophyly of the genus. A phylogenetic analysis of the Facelinidae and Aeolidiidae does not result in a resolved tree, therefore relationship of former assumed closely related genera, Noumeaella Risbec, 1937 and Palisa Edmunds, 1964, cannot be discussed in detail.

Background: This study aimed to culturally verify and examine the empirical psychometric properties of the Indonesian versions of the Centre for Epidemiologic Studies Depression Scale - Revised (CESD-R), the Kessler Psychological Distress Scale - 10 items (K10) and a subset of 6 items of the K10, the K6 to detect depressive and anxiety disorders among older adolescents in Indonesia., Methods: The empirical psychometric properties were examined formally among students aged 16-18 years attending high schools in Jakarta. The scales were validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid) modules for major depressive episode, dysthymia, panic disorder, separation anxiety disorder, and generalized anxiety disorder., Results: In total, 196 students contributed complete data. All of the scales had Cronbach's alpha >0.8. The areas under the ROC Curve of CESD-R against MINI depressive disorders and K10/K6 against MINI depressive and anxiety disorders were at moderate to high accuracy levels (0.78 to 0.86). The optimal cut-off value of CESD-R (scores ranging: 0-60) to screen for any depressive disorder is ≥20 (sensitivity 75.0%; specificity 79.9%). The optimal cut-off value of K10 to detect any depressive/anxiety disorders is ≥18 (sensitivity 85.7%; specificity 74.7%); and K6 is ≥12 (sensitivity 81.0%; specificity 76.6%); LIMITATIONS: The school-based sample limits the generalisability of the findings to this group., Conclusions: This study suggests that the CESD-R I is a useful tool for screening for depressive disorders and both the K10 I and K6 I are useful for screening for any depressive or anxiety disorders among Indonesian adolescents., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background and Aim: Psychosis is a mental disorder resulting in high disability impacts. Many studies show that early detection of prodromal symptoms may improve prognosis. Psychotic prodromal symptoms may mimic other mental health conditions such as depression, anxiety or learning difficulties. The aim of this study was to analyze validity, reliability, sensitivity and specificity of the Prodromal Questionnaire Brief Version (PQ-B) Indonesian version to detect psychotic prodromal symptoms., Method: The PQ-B was translated into Indonesian then back-translated into English. Subjects included in this study were 50 children and adolescent psychiatric patients from Cipto Mangunkusumo National Hospital, aged 10-18 years old. Validity measurement was performed by comparing the total score and distress score of PQ-B with the categorical scale of Structured Interview for Prodromal Symptoms (SIPS) as the gold standard using Spearman correlation. Total scale and subscale reliability were examined using the Cronbach's Alpha., Results: Analysis with Spearman correlation showed significant results of both PQ-B total score with diagnosis of SIPS (r = 0.374 and p = 0.007); and PQ-B distress score with diagnosis of SIPS (r = 0.400 and p = 0.004). Cronbach Alpha coefficient was equal to 0.853 for all scales. The sensitivity of the PQ-B in the Indonesian language is 70%, and the specificity is 72%, whereas, in the original language (English), the sensitivity and specificity is 88% and 68%., Conclusion: This study provides evidence of good validity, reliability, sensitivity, and specificity of PQ-B Indonesian language to detect prodromal symptoms of those who seek help in the psychiatric outpatient clinic., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Adolescent cyberbullying and high-risk behaviour outcomes has been a major concern in the last few years. Gender discrepancy is an important component that predicts the outcomes. This study aimed to elaborate and identify the association between cyberbullying experience and high-risk behaviour outcomes based on gender differences among adolescents in Indonesia., Method: A cross sectional study that involved junior and senior high schools in Jakarta. There were 2917 adolescents who took part in this study. The cyberbullying questionnaire was used to identify the cyberbullying experienced. High-risk behaviour included in this study was tobacco smoking, alcohol consumption, and self-harm behaviour. Chi-Square test and odds ratio analysis were applied through SPSS for Mac., Results: The highest proportion in this study was composed of adolescents of both genders who acted as victim/perpetrator (52.25%). Adolescent males who indulged in cyberbullying showed an increased risk for cigarette smoking (OR = 2.97); male adolescents who were victims and victim/perpetrator of cyberbullying had a higher risk to consume alcohol (OR = 2.96 & OR = 6.93). Meanwhile, the risk of self-hurting behaviour increased for both female and male with cyberbullying victimization (OR = 3.68 & OR = 2.97). Female adolescents who acted as victim/perpetrator had a higher risk of suicidal thoughts and attempting suicide (OR = 1.90 & OR = 2.11); and they were also at risk of consuming alcohol (OR = 2.84)., Conclusion: Cyberbullying returned negative impacts on both genders of adolescents. Boys showed a greater tendency to externalize while girls showed a greater tendency to internalize. Mental health promotion that is designed specifically for both genders might address the adolescents' needs., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The species diversity of marine heterobranch sea slugs found on field trips around Bunaken Island (North Sulawesi, Indonesia) and adjacent islands of the Bunaken National Marine Park forms the basis of this review. In a survey performed in 2015, 80 species from 23 families were collected, including 17 new species. Only three of these have been investigated previously in studies from Indonesia. Combining species diversity with a former study from 2003 reveals in total 140 species from this locality. The diversity of bioactive compounds known and yet to be discovered from these organisms is summarized and related to the producer if known or suspected (might it be down the food chain, de novo synthesised from the slug or an associated bacterium). Additionally, the collection of microorganisms for the discovery of natural products of pharmacological interest from this hotspot of biodiversity that is presented here contains more than 50 species that have never been investigated before in regard to bioactive secondary metabolites. This highlights the great potential of the sea slugs and the associated microorganisms for the discovery of natural products of pharmacological interest from this hotspot of biodiversity., Competing Interests: The authors declare no conflict of interest.

Introduction: Several studies showed that DAT1 polymorphism closed related with ADHD although the results were not consistently found. Studies in China, South Korea, Japan revealed that 10-repeat allele gave a risk for ADHD. Based on that understanding, this study tried to identify whether the similar polymorphism of DAT1 was also apparent in Indonesian children with ADHD., Method: This was a case - control study. Case was 50 Indonesian origin children with ADHD and without any other mental disorders and metal retardation. Control is Indonesian origin children without ADHD, other mental disorders and mental retardation. ADHD diagnosis was taken after doing the psychiatric interview and observation based on the DSM-IV TR diagnostic criteria for ADHD at the Child and Adolescent Psychiatry Out-patient Clinic, Dr. Cipto Mangunkusumo National Referral Hospital - Faculty of Medicine Universitas Indonesia. DNA isolation, DNA purity and concentration were measured. PCR was done by using a primer based on Homo sapiens solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3), RefSeq Gene on chromosome 5 with accession number NG&#95;015885.1. To identify the serial of repeated allele, we used the sequencing technique., Results: There were 47 children with ADHD and 48 children without ADHD that involved in the final analysis. The mean of age amongst ADHD group was 9.18 (2.42) and 8.10 (2.46) years old in non-ADHD group. The 10-repeated allele of DAT1 was the highest proportion in both., Conclusion: This finding was apparently similar with other studies on DAT1 polymorphism across Asian., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Nudibranchia, marine soft-bodied organisms, developed, due to the absence of a protective shell, different strategies to protect themselves against putative predators and fouling organisms. One strategy is to use chemical weapons to distract predators, as well as pathogenic microorganisms. Hence, these gastropods take advantage of the incorporation of chemical molecules. Thereby the original source of these natural products varies; it might be the food source, de novo synthesis from the sea slug, or biosynthesis by associated bacteria. These bioactive molecules applied by the slugs can become important drug leads for future medicinal drugs. To test the potential of the associated bacteria, the latter were isolated from their hosts, brought into culture and extracts were prepared and tested for antimicrobial activities. From 49 isolated bacterial strains 35 showed antibiotic activity. The most promising extracts were chosen for further testing against relevant pathogens. In that way three strains showing activity against methicillin resistant Staphylococcus aureus and one strain with activity against enterohemorrhagic Escherichia coli , respectively, were identified. The obtained results indicate that the sea slug associated microbiome is a promising source for bacterial strains, which hold the potential for the biotechnological production of antibiotics.

Indonesian culture puts a high value on family bonding. Therefore, support and encouragement for each family member is high that any problems are the responsibility of the whole family. This paper explores the implications of the phenomena whether is a schizophrenic child in the family affected the parental relationship in Indonesian family and trying to find out the implication of parental relationship on medication adherence. This was a cross-sectional study which involved 180 parents of children with schizophrenia and parents with aged matched non-schizophrenic children as a control group; consisting of 45 parents of children with schizophrenia and 135 parents of non-schizophrenic children. The parental relationship was examined by using the Indonesian version of Family Adaptability and Cohesion Evaluation Scale IV (Indonesian version of FACES IV). Our study revealed that 75.6% parents of children with schizophrenia experienced a healthy parental relationship compared to 94.80% in the parents of non-schizophrenic children group. The most prevalent of unhealthy relationship among parents of children with schizophrenia was chaotic disengagement. Parental adherence to give medication for their child with schizophrenia was better if they had a healthy parental relationship. In conclusion, a small number of Indonesian parents with schizophrenic children experienced an unhealthy parental relationship. Therefore, psycho-education and supportive psychotherapy still needed to facilitate those families to express their emotion adapt and cope., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: To investigate the executive function among adolescents with antipsychotic-treated schizophrenia in Child and Adolescent Outpatient Clinic at Cipto Mangunkusumo General Hospital, Jakarta., Methods: This was a cross sectional study with control group. Case was defined as adolescents with antipsychotic-treated schizophrenia without any mental retardation or other physical illnesses (n=45). The control group consisted of healthy and age-matched adolescents (n=135). Executive function is determined by using Indonesian version of Behavior Rating Inventory of Executive Function (BRIEF-Indonesian version). We used SPSS 16.0 program for windows to calculate the prevalence risk ratio (PRR) and set up the p value <0.05., Results: Mean of age was 16.27 (standard deviation 1.86) year-old. Most of the case group (95%) has been treated with atypical antipsychotic such as risperidone, aripipripazole, olanzapine, and clozapine. Duration of having antipsychotic medication was ranged from one to 36 months. Adolescents with antipsychotic treated-schizophrenia had higher BRIEF T-score, except for inhibit scale, shift scale and behavior regulation index. The prevalence risk ratio on several clinical scales were higher in children with antipsychotic-treated schizophrenia compared to control group, such as on emotional state (PRR=7.43, 95% confidence interval [CI]=2.38-23.15), initiate scale (PRR=6.32, 95% CI=2.51-15.95), monitor scale (PRR=8.11, 95% CI=2.0-32.86), and behavior regulation index (PRR=4.09, 95% CI=1.05-15.98)., Conclusion: In general, the results showed that adolescents with atypical antipsychotic treated-schizophrenia had higher BRIEF T-score compared, and comparable with their normal group control.

Objective: There are multiple possible etiologies for learning difficulties in children. There is growing evidence that many students identified as having learning difficulties have significant working memory deficits. To determine, in a sample of primary school students in Jakarta, Indonesia, the prevalence of learning difficulties and learning difficulties co-morbid with working memory deficits., Methods: Subjects (N=423) were recruited via proportional random sampling from 27 primary schools. The first stage was a cross-sectional study of these students, while the second stage was a case-control study comparing all students with learning difficulties and working memory deficits with controls matched by school type, grade level, and gender., Results: Among the students, whose mean age was 9.34 years (1.78), 13.7% had a learning difficulty, while 8.04% had a learning difficulty with working memory deficit. The odds ratio of comorbid working memory deficit (in the face of a learning difficulty) was 7.0 (χ(2)= 35.96, p<0.001)., Conclusion: Learning difficulties and comorbid working memory deficits were relatively common among primary school students. Efforts should be made to identify these students and provide timely assistance, in order to optimize their educational success and mental health outcomes.

Species trees were produced for the Indo-West Pacific (IWP) gastropod genus Lunella using MrBayes, BEAST, and *BEAST with sequence data from four genes. Three fossil records were used to calibrate a molecular clock. Eight cryptic species were recognized using statistical methods for species delimitation in combination with morphological differences. However, our results suggest caution in interpreting ESUs defined solely by the general mixed Yule Coalescent model in genera like Lunella, with lower dispersal abilities. Four almost entirely allopatric species groups were recovered that differ in ecology and distribution. Three groups occur predominantly along continental coastlines and one occurs on island arrays. Sympatric species occur only in the torquata and coronata groups along coastlines, whereas species in the cinerea group, distributed in two-dimensional island arrays, occur in complete allopatry. Dispersal along island arcs has been important in the maintenance of species distributions and gene flow among populations in the cinerea group. The emergence of new islands and their eventual subsidence over geological time has had important consequences for the isolation of populations and the eventual rise of new species in Lunella., (© 2011 The Author(s). Evolution© 2011 The Society for the Study of Evolution.)