Health and Wellness @ Uni

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 51 3.3.7 Suicide Suicidal thoughts and behaviour do not happen only when someone is depressed. Suicide can occur in other condition such as stress, psychosis, mania, personality problem and drug addiction. Suicide is a term used when someone has died after having intention to die and kill oneself. When someone only attempts to kill oneself, but s/ he does not die following the self-harming behaviour, the act is called a suicidal attempt. Parasuicide is the behaviour of harming self without the intention to commit suicide. Many people with mental illness do not want to die, but harbour thoughts of wanting to get rid of all the stresses immediately. The stress is channelled out of their mind through inflicting self-injury or overdosing themselves. It is important for you to see your counsellor and get help immediately if you have suicidal thoughts and behaviours with or without intention to die.  Please seek help from: ◆ Career and Counselling Centre at https://careercounseling4u.uitm.edu. my. ◆ Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see the doctors or called 03-55442999 for more information ◆ Or make an appointment at UiTM Hospital and its branches at Selayang or Sungai Buloh Campus to see a psychiatrist ◆ If you know someone is attempting to harm him/herself, immediate call 03-55443999 for immediate assistance. REFLECTION Read your newspaper. Find out what are the consequences of drug addiction? What are the consequences of taking cannabis, ecstasy, and heroin? 3.3.6 Drug Abuse Taking drugs can cause physical and mental illness. Students who take drugs are violating the law too. Please immediately stop the behaviour. You may get HIV/AIDS if you are sharing needle to take drugs. HIV/AIDS may manifest with various diseases including skin, tumour, infections etc. Drugs such as cannabis or ganja, amphetamine and methamphetamine, alcohol, heroin, morphine, hallucinogen, and glue can cause various symptoms including anxiety, depression, mania, psychosis. Medications such as prolonged steroids use, illegal medications and traditional medications (such as daun ketum) may also induce symptoms of mental illness. It is important for you to discuss with your doctor if these happen.

HEALTH AND WELLNESS @ UNI 52 3.4 CAUSES OF MENTAL ILLNESS In our multiracial country, abnormal experiences such as hearing voices, seeing ‘things’ and hysterical attacks are often explained using various sociocultural and religious backgrounds. Hence, it creates a dilemma for accurate understanding of these phenomena. Such abnormal experiences are not only experienced by one ethnic group but occurs among other people around the globe. For example, people who have different ethnic and religious background, living in other places (e.g. India, Antarctica or anyway in this world) also have mental illness. Hence, thinking that not embracing to Malay culture or not being religious may predispose to mental illness, may not be the wise explanation. You should understand that there are various physical, psychological, social, and spiritual factors that interact between each other to cause mental illness. Examples of the factors are: ◆ Physical factors factors related to your body such as genes, neurotransmitter, hormones, enzymes, and brain anomalies. You may have mental illness because you are having physical disease. For example, psychosis can occur in people with severe hypothyroidism, autoimmune disease, epilepsy, and brain infection. You may also inherit the gene of the illness from your family with mental illness. ◆ Psychological factors factors related to stress management, your personality, coping skills, ways of solving problems, non-assertiveness etc. For example; you may have a mental illness if you do not know how to manage your stress properly; severe stress may lead to depression, anxiety and psychosis. ◆ Social factors factors that are related to our interaction with others and environment such traumatic events, major loss, and relationship problems. For example, you may have mental illness if you are brought up in a violent family environment; witnessing abuse and aggression can trigger post-traumatic stress disorder. Other example is when you have severe stress due to break up with your companion; this can lead to depression. ◆ Spiritual factors religious practice is an important type of coping with stress and guides you to live in an appropriate manner. Without a strong religious foundation, you may find it difficult to manage stress in your life. Hence, you are at risk for mental illness. Knowing the facts that mental illness is caused by interaction of all the above factors, you should address, manage, and treat mental illness in comprehensive manner too.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 53 3.5 HOLISTIC MANAGEMENT OF MENTAL ILLNESS All aspects of life (physical, psychological, social, and spiritual) that determine your health should be treated to ensure you are mentally healthy. You can get more information from other chapters in this book. 3.5.1 Preventive Measures It is vital to prevent mental illness by ensuring you are healthy. Table 3.3 below are the tips to prevent mental illness. REFLECTION What are the causes of mental illness? HEALTH DOMAIN PREVENTIVE MEASURES MENTAL HEALTH » Enhance your psychological skills including time management, problem solving technique, anger management, coping skills, assertiveness skills and selfefficacy. Take time for stress management and relaxation. PHYSICAL HEALTH » Get a routine medical checkup for your physical health. Do exercise routinely, take a healthy diet, and avoid smoking, taking drugs and alcohol. SOCIAL HEALTH » Choose friends with a positive vibe, avoid interpersonal conflict with others. Be caring, loving, and concerned with your neighbours and friends. Participate in co-curriculum activities to increase your social networking and social support. SPIRITUAL HEALTH » Practise and adhere to religious teaching. Participate in religious activities to enhance your knowledge and increase your networking and social support. Table 3.3 Prevention of Mental Illness 3.5.2 Treating Mental illness Chapter 1 describes the services and facilities that are available in UiTM for you to seek help for mental health problems or mental illness. Chapter 10 illustrates more examples of the flow chart and steps to be taken if you have any symptoms to suggest mental health problems or mental illness. Else, you can call 2999 or 3999 for emergency assistance. Team from Klinik Minda Sihat, is available in every UiTM campuses. You may also share your problems with trusted friends, mentors, lecturers, or counsellors. Another alternative is by calling Befrienders at 0379568145. You should have knowledge on mental illness, be aware that you have mental illness and the most important steps are seeking help, adhere with the treatment plan and practise the holistic approaches to healthy life through physical, psychological, social and spiritual interventions.

HEALTH AND WELLNESS @ UNI 54 ACTIVITY Your friend has symptoms of mental illness. Discuss with your colleague of how to help him/her? SUMMARY ▶ To be mentally healthy, you should be healthy in all aspects of life including your physical, psychological, social, and spiritual function. ▶ You are having mental illness when you feel distress, having impairment of function, manifesting behaviours which put risk to yourself or others and you have atypical behaviours. ▶ Common manifestations of mental illness including depression, suicide, psychosis, anxiety, mania, and obsession. ▶ Common types of mental illness including major depression, bipolar disorder, schizophrenia, schizoaffective disorder, substance abuse, anxiety disorder, obsessive compulsive disorder, and posttraumatic disorder ▶ All aspects of life (physical, psychological, social, and spiritual) that determine your health should be well treated to ensure you are mentally healthy ▶ Get help if you have mental illness; call Klinik Minda Sihat: 0355442999 BIBLIOGRAPHY ▶ Sadock BJ, Sadock VA and Ruiz, P (2015), Kaplan and Sadock’s Synopsis of Psychiatry: Behavioural Science/Clinical Psychiatry; Walters Kluwer, 11th Edition, New York, ISBN 978-1- 60913-971-1 ▶ Razali, Salmi (2009), ABPC 2103 Abnormal Psychology, Open University Malaysia, Kuala Lumpur, ISBN 978-967-316-521-6 ▶ David Sample and Roger Smith (2019), Oxford Handbook of Psychiatry, 4th Edition, Oxford Univerity Press; Oxford, United Kingdom; ISBN13 9780198795551 ▶ Career and Counselling Centre https://careercounselling4u.uitm.edu.my ▶ Career and Counselling Centre https://counselling2u.uitm.edu.my ▶ Bahagian Hal Ehwal Islam, UniversitiTeknologi MARA, https://masjiduitm. uitm.edu.my/index.php/direktori-staff ▶ Student Affair Division https://hep.uitm.edu.my/main/ ▶ Academic and International Division https://hea.uitm.edu.my/v4/

04 LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Define physical health. ▶ Describe the relationship between physical health and mental illness. ▶ Describe the physiology of stress. ▶ Explain the impact of mental illness on physical health. PHYSICAL HEALTH

HEALTH AND WELLNESS @ UNI 56 4.4 PHYSIOLOGY OF STRESS Stress is something everyone experiences. Despite being unpleasant, stress itself is not an illness. But there are connections between stress and mental health conditions including depression, anxiety, psychosis, and post-traumatic stress disorder (PTSD). You may want to know more about the physiology of stress, its causes, its effects on the body and its link to mental health. The more you understand stress, the better you can tackle it. 4.1 INTRODUCTION In this chapter, you will be introduced to the definition of physical health and how it relates to mental illness. The physiology of stress is also described later. At the end of chapter, the impact of mental illness on physical health will be discussed. 4.2 DEFINITION OF PHYSICAL HEALTH WHO defines health as a state of complete physical, mental, and sociocultural well-being; not merely the absence of disease or infirmity. It clearly describes the overall well-being including physical health, mental health, social health, and spiritual health. To be healthy, you must be able to cope with all the demands of daily life. In general, you are considered as having optimal physical health when you are free from illness, physical disabilities, and disorders. However, without being healthy in the other domains of life, you are yet to be considered as truly healthy. Please refer to other chapters for more information on health for the other domains. 4.3 PHYSICAL HEALTH AND MENTAL ILLNESS Your mental and physical health are fundamentally linked. There are multiple associations between mental health and physical health that significantly impact your quality of life. Poor physical health can lead to an increased risk of developing mental health problems such as depression and anxiety. Similarly, poor mental health can decrease energy levels, which can negatively impact the adoption of healthy behaviours. If you suffer from mental illness, you may lack the motivation to take good care of your health or you may inherently adopt unhealthy eating and sleeping habits, smoke, or abuse substances consequently or response to the symptoms, that contribute to worse health outcomes. People living with chronic physical conditions often experience emotional stress and chronic pain, which are both associated with the development of depression and anxiety. Good health can produce competitive individuals while at the same time positively impacting the society and the country.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 57 4.4.1 Understanding stress Stress is a biological and psychological response experienced on encountering a threat that you feel you do not have the resources to deal with. A stressor is the stimulus (or threat) that causes stress, e.g. exam, divorce, death of loved one, moving to a new house, and loss of job. When you are experiencing stress, various changes occur in your body including you feel your heart rate increase, you breath heavily, feel cold and clammy and feel as if there is a butterfly in your tummy. Why is this happening? Read further to understand the stress physiology. 4.4.2 What happens to the body when experiencing stress? Let us take “having a presentation” as a stressor. What happens to your body? For you to understand stress physiology, you must know a few parts of your brain. The brain part which controls your emotion is called Limbic System. Refer to Figure 4.1 for the diagram. When you are exposed to stress (such as having a presentation), your eyes and ears are sending information to you that people may comment on your presentation. Your brain starts interpreting that you may become the target of scrutiny; this serves as a “threat” to you. Amygdala; the control centre for your emotions is now activated. Figure 4.1 Emotional Brain or Limbic System Source: Queensland Brain Institute, University of Queensland Retrieved from https://qbi.uq.edu.au/brain/brain-anatomy/limbic-system

HEALTH AND WELLNESS @ UNI 58 Amygdala sends signal to the hypothalamus; part of the brain which functions to control your neurotransmitters and hormones. The hypothalamus then triggers the cascades of stress physiological responses called the Hypothalamic PituitaryAdrenal (HPA) and System Sympathomedullary Pathway (SAM). i. The Hypothalamic Pituitary-Adrenal (HPA) System ◆ The stressor activates the Hypothalamic Pituitary Axis. ◆ The hypothalamus stimulates the pituitary gland. ◆ The pituitary gland secretes adrenocorticotropic hormone (ACTH). ◆ ACTH in your blood stimulates the adrenal cortex to produce the hormone corticosteroid called cortisol. Cortisol is secreted by adrenal glands situated above your kidneys. ◆ Cortisol promotes metabolism of glucose (for energy), prepares your immune system (for any injury), and controls your blood pressure. ii. Sympathomedullary Pathway (SAM) ◆ The hypothalamus also activates the adrenal medulla. The adrenal medulla is part of the autonomic nervous system (ANS). ◆ The adrenal medulla secretes adrenaline hormone. This hormone gets the body ready for a fight or flight response and stimulates the sympathetic nervous system. ◆ Adrenaline causes you to feel anxious; having palpitation, shortness of breath, cold and clammy extremities and many other symptoms. You may refer to Figure 4.2. Figure 4.2 Physiology Response of Stress source: https://www.pinterest.com/pin/830421618781630455/

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 59 4.4.3 Body chemicals and stress For the brain to function, you need chemical elements such as brain neurotransmitters to send messages from one nerve cell to another nerve cells. Examples of neurotransmitters are dopamine, serotonin, adrenaline, noradrenaline, and many others. In a normal situation, neurotransmitters in your emotional brain (or limbic system) function well to maintain a stable emotional state. However, when you are stressed out, the neurotransmitters become imbalanced. When you are exposed to a prolonged, chronic, or severe acute stress, the imbalance of neurotransmitters become very prominent until your limbic system cannot function well. At this time, you may have mental disturbances. Research has shown that in people with depression, their brain serotonin level is depleted. Similarly, those with psychosis such as schizophrenia, they have an imbalance of brain dopamine. Taking drugs such as amphetamine, cannabis and alcohol may also cause such conditions. To prevent imbalance in brain neurotransmitters, you should manage stress properly, have regular exercise and practise healthy lifestyle. In severe emotional disturbances, medications such antidepressants or antipsychotics are required to correct the imbalance neurotransmitters inside your brain. 4.5 IMPACT OF STRESS ON PHYSICAL HEALTH Stress and psychological problems are health problems that significantly affect how you feel, think, behave, and interact with other people. Many people experience poor health because of prolonged stress and psychological problems such as guilt, anger, hostility, poor interpersonal skills, loneliness, anxiety, and depression. Prolonged stress can interfere with the body’s immune system and lay the foundation for the process of experiencing mental illness. The most common mental illnesses are anxiety and depressive disorders. While everyone experiences intense feelings of tension, fear, or sadness at times, mental REFLECTION Describe what happen to your body when you are stressed out?

HEALTH AND WELLNESS @ UNI 60 illness is present when these feelings become so disturbing that people have great difficulty coping with day-to-day activities, such as work, study, enjoying leisure time, and maintaining relationships. Mental illness has been shown to affect your physical health status profoundly (Refer to Chapter 3 for more information). If you experience mental illness, your physical health may be compromised for several reasons. Behavioural factors such as smoking, harmful alcohol, and other drug use, obesity, poor diet, homelessness, and poor self-care are consequences of illness symptoms that can make people with mental illness vulnerable to physical health problems. Let us continue to learn about the adverse effects of stress and psychological problems on physical health. Below are some of the examples. 4.5.1 Obesity If you experience stress or psychological problems, you may experience appetite changes; either overeating or lack of appetite. Although obesity could be hereditary, previous studies have also found that atypical depression could present with overeating and contribute to obesity. Excessive weight or obesity increases the risk of chronic diseases such as diabetes type II, hypertension, cardiovascular diseases, bone and joint problems, kidney failure, and some cancers. On the other hand, melancholic depression associated with lack of appetite causes you to become malnourished and easily predispose to infection. 4.5.2 Eating disorder One of the prevalent mental illnesses among young people is eating disorder such as anorexia nervosa and bulimia nervosa. If you have anorexia nervosa, you usually think that you are overweight despite being underweight. You refuse to maintain a healthy weight, often exercise obsessively and very choosy in terms of food that you want to eat. On the other hand, bulimia nervosa is often started with dieting to lose weight, binge eating followed by vomiting, fasting, over exercising, or using diuretics as a means of purging. Another type of eating disorder is binge eating disorder. It involves frequent overeating during a discrete period (at least once a week for three months). Table 4.1 shows the features of eating disorders. You may have an eating disorder if you have those characteristics. REFLECTION Describe what happen to your brain neurotransmitter when you are sad? Why does psychiatrist prescribe you antidepressant when you are severely depressed?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 61 4.5.3 Insomnia Mental illness is also presented with insomnia or trouble in sleeping. If you experience mental illness your sleep may be disrupted or becomes inadequate. It can lead to increased tension, irritability, and stress. The relationship between sleep and depressive illness is complicated – depression may cause sleep problems, and sleep problems may cause or contribute to depressive disorders. Researchers suggest that people with insomnia have a ten-fold risk of developing depression compared with those who sleep well. There are serious health risks associated with insomnia such as stroke, asthma, weak immune system, inflammation, and more. 4.5.4 High blood pressure Earlier, you have learned that exposure to stress causes cortisol to trigger an increase in blood pressure. Prolonged stress and mental illness have been known to contribute to high blood pressure or hypertension. Previous studies revealed that individuals experiencing depression are at high risk for developing hypertension, as well as being predisposed to stroke and heart disease. Depression and anxiety often lead people to smoke, drink excessively, and gain weight, behaviours that can promote hypertension and heart disease. 4.5.5 Osteoporosis Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Osteoporosis develops when bone formation occurs too slowly. Depression may contribute to low bone mass by reducing the amount of calcium and other minerals that cause osteoporosis. Additionally, depression is associated with lower estrogen and testosterone levels, which have been linked to decreased bone formation. Although older people are more likely to develop osteoporosis, the changes in body hormones caused by depression also increase the risk of osteoporosis. ANOREXIA NERVOSA BULIMIA NERVOSA BINGE EATING DISORDER Menstrual periods cease Chronically inflamed and sore throat Eating more rapidly than normal Hair/nails become brittle Teeth begin to decay from exposure to stomach acids Eating until feeling uncomfortably full Constipation Constant vomiting Eating large amounts of food when not feeling physically hungry Table 4.1 : The Characteristics of Eating Disorders

HEALTH AND WELLNESS @ UNI 62 4.5.6 Heart disease People with prolonged stress and severe mental illness have an average mortality rate that is 2 to 3 times higher than the general population. If you have severe stress or mental illness, you tend to be involved with smoking, physical inactivity, hypertension, and obesity. Such situations are among the factors contributing to the risk of heart diseases. Depression and stress can negatively affect the heart by causing a rapid heart rate, high blood pressure, and increased levels of stress hormones. 4.5.7 Diabetes type II In the earlier part of this chapter you have learned that cortisol stimulates glucose metabolism. Prolonged stress causes you to have disturbance in sugar control, hence increases your chance for diabetes. Diabetic patients have more than three times the risk of getting depression compared to healthy individuals. People with diabetes may have mental illness because of worrying about the future, increased personal health care, and hormone disruption. 4.6 IMPACT OF STRESS ON PHYSICAL HEALTH Physical symptoms of mental illness can vary depending on the disorder, circumstances, and other factors. Mental illness symptoms can affect emotions, thoughts, and behaviours. You may experience the symptoms below if you have a mental illness. Refer to Chapter 3 for more information. ACTIVITY physical health. Describe the physiology of stress. Stomach pain Back pain Headaches Constipation Facial pain

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 63 4.7 NUTRITION AND DIET Complete physical fitness is not just about exercise but also includes a healthy diet. You maintain a healthy body weight and body fat percentage through proper nutrition and exercise to ensure the best health, fitness, and physical performance. All these things are relevant to performing exercise and physical activity effectively. You are encouraged to follow the Malaysian Food Pyramid for suggestions on healthy diets. You are encouraged to follow the Malaysian Food Pyramid for healthy diets. Refer to Figure 4.3. the Malaysian Food Pyramid is a simple guide for individuals to vary their food intake according to the total daily food serving recommended. A balanced diet contains the combination of food that will provide all the nutrients needed by our body. There is no single food that will provide us with all the nutrients needed. The body needs many types of food in varying amounts to maintain optimal health. A food pyramid consists of four (4) levels that represent five (5) food groups including: i) carbohydrates (such as rice and noodle), ii) vegetables (such as cabbage and salad), iii) fruits (such as banana and papaya), iv) proteins (such as fish, meat and milk product, and v) fat (such as oil). Indicated beside each food group is the recommended number of servings per day from each group. From the bottom to the top of the food pyramid, the size of each food group becomes smaller indicating that an individual should eat more of the foods at the base of the pyramid and less of the foods at the top of the pyramid. Figure 4.3 Malaysian Food Pyramid Source : Kementerian Kesihatan Malaysia

HEALTH AND WELLNESS @ UNI 64 ACTIVITY Evaluate your lifestyle. What are your daily activities that can be considered as healthy lifestyle? SUMMARY ▶ Poor physical health can lead to an increased risk of developing mental health problems. ▶ Mental illness has adverse effects on health because of the body’s immune system interference. ▶ There is considerable variation in level and type of hormones released by different people and in response to different stressors – not a simple physiological process. ▶ People without adrenal glands need hormonal supplements to survive stress. ▶ Physical symptoms of mental illness can vary depending on the disorder, circumstances, and other factors. ▶ Get help if you suspect yourself suffering from mental illness; call Klinik Minda Sihat at 0355442999 BIBLIOGRAPHY ▶ American Psychological Association. (2019). Stress Effects on the Body ▶ Byrne, A., & Byrne, D. G. (1993). The effect of exercise on depression, anxiety, and other mood states: a review. Journal of psychosomatic research, 37(6), 565-574. ▶ Carney, C. P., Jones, L., & Woolson, R. F. (2006). Medical comorbidity in women and men with schizophrenia. Journal of general internal medicine, 21(11), 1133- 1137. ▶ Pollock, M. L., Gaesser, G. A., Butcher, J. D., Després, J. P., ▶ Dishman, R. K., Franklin, B. A., & Garber, C. E. (1998). ACSM position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc, 30(6), 975-991. ▶ Richardson, L. P., Davis, R., Poulton, R., McCauley, E., Moffitt, T. E., Caspi, A., & Connell, F. (2003). A longitudinal evaluation of adolescent depression and adult obesity. Archives of pediatrics & adolescent medicine, 157(8), 739-745. ▶ Swain, D. P., Brawner, C. A., & American College of Sports Medicine. (2014). ACSM’s resource manual for guidelines for exercise testing and prescription. Wolters Kluwer Health/Lippincott Williams & Wilkins. ▶ Taylor, D. J., Lichstein, K. L., Durrence, H. H., Reidel, B. W., & Bush, A. J. (2005). Epidemiology of insomnia, depression, and anxiety. Sleep, 28(11), 1457-1464.

05 LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Describe the effects of exercise on mental health. ▶ Describe types of exercise that improve mental health. ▶ Explain the dosage of exercise. ▶ Explain the principle of progression in exercise. EXERCISE & MENTAL HEALTH

HEALTH AND WELLNESS @ UNI 66 5.1 INTRODUCTION In this chapter, you will be introduced to the effects of exercise on mental health. Besides, the principles of training to achieve the maximum benefit of physical activity will also be discussed. 5.2 HOW EXERCISE AFFECTS MENTAL HEALTH? Physical health is essential for everyone, but it can be extra challenging if you suffer from mental illness. People affected by mental illness often have some of the health problems such as weight gain, high blood pressure, high cholesterol level, high blood glucose levels, and more. These problems may lead to chronic diseases such as diabetes and other illnesses. Regular exercise has been proven to prevent and reduce the risk of chronic diseases. If you have poor mental health, you are at risk for having higher rates of smoking, alcohol and drug abuse and lower educational outcomes. You may also have lower resilience, decreased social participation, increased risk of developing a range of physical health problems, and weaker social relationships. Hence, a healthy lifestyle is the most crucial component to prevent mental illness. Lifestyle modification can assume especially great importance in an individual with mental illness. An essential component of lifestyle modification is exercise. Aerobics exercise like swimming, jogging, brisk walking, and dancing has been proven to reduce anxiety and depression. Exercise leads to an increase in blood circulation to the brain and influence the hypothalamic-pituitary- adrenal (HPA) axis and, thus, on the physiologic reactivity to stress. This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system which controls motivation and mood, the amygdala, which generates fear in response to stress, and the hippocampus, which plays an essential part in memory formation as well as in mood and motivation.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 67 5.3 EXERCISE AND PHYSICAL ACTIVITY IMPROVE MENTAL HEALTH Physical activity has been widely known to benefit human physical health. In daily life, physical activity is essential to maintain and improve health. Physical activity may play an essential role in the management of mental illness, especially in depression and anxiety. Exercise is a powerful fighter for depression for several reasons. Most importantly, it promotes all kinds of changes in the brain, including neural growth, reduced inflammation, and new activity patterns that promote feelings of calm and well-being. By releasing endorphins, adrenaline and noradrenaline, exercise could restabilize the imbalanced neurotransmitters in your brain and energise your spirits. Physical activity is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances well- being through the release of endorphins. If you experience stress, you may feel muscle tense, especially in the face, neck, and shoulder. Exercise can help to overcome problems. By releasing endorphins, adrenaline and noradrenaline, physical activity helps to relax the muscles and relieve tension in the body. Finally, exercise can also serve as a distraction, allowing us to find some quiet time to break out of the cycle of negative thoughts that feed depression. In group exercise, you can also reduce the sense of social isolation which common among those who are depressed. 5.4 EXERCISES FOR MENTAL HEALTH Aerobic exercise plays an essential role in contributing to good mental health. Aerobic exercise refers to any activity that uses large muscle groups and can be continuously maintained. Exercise also trains the heart, lungs, and the cardiovascular system to process and deliver oxygen more quickly and efficiently to every part of the body. As the heart muscle becomes stronger and more efficient, a more substantial amount of blood can be pumped with each heartbeat. As a result, you can work longer, more vigorously, and improve your mental health. The following is a type of aerobic exercise that you can try to improve your mental health: ACTIVITY Evaluate your feelings. What are the activities that you should do if you feel sad and demoralised?

HEALTH AND WELLNESS @ UNI 68 Aerobic exercise increases the metabolic requirements of working muscle, which in turn induces changes in local blood circulation. An increase in blood circulation to the brain will cause an improvement in mood, which is essential for an individual with mental illness. Besides, aerobic exercise can improve physical health: • Better cardiovascular fitness • Stronger leg muscles • Lower blood pressure • Lower risk of heart diseases, diabetes, bowel cancer, and osteoporosis. Aerobic exercises are usually performed at a higher intensity and, therefore, are recommended for persons who exercise regularly such as jogging, running, aerobics, stepping exercise, and more. You can practise aerobic exercise within your campus by visiting sports complex, swimming pool, and joint any recreation activities with your friends. All these activities will enhance your physical and mental health. REFLECTION Discuss how physical exercises relate to a healthy mind. If you are depressed, what kind of exercise will you do and explain why you opt for exercise?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 69 KEY COMPONENT COMPOSITION TO BE SPECIFIED DOSE (AGE 18-65±) FREQUENCY (F) Number of days per week, number of times per day 3 – 4 days per week INTENSITY (I) How hard a person works to do the activity. It can be defined either by % V02max, training heart rate, rating of perceived exertion, the onset of blood lactate accumulation. Moderate-intensity exercise 60-75% heart rate TIME (T) The length of time in which an activity or exercise is performed. Duration is generally expressed in minutes. 30 minutes minimum; build up to 60 minutes per day TYPE OF EXERCISE (T) The mode of exercise performed. Aerobic exercises – jogging, swimming, brisk walking, and more 5.5 DOSAGE OF OPTIMUM AEROBIC EXERCISE You will gain the benefits of exercise by following the appropriate dose. To improve mental health, according to researchers, the best results you can obtain from aerobic exercises is when you have exercised for about ten weeks of regular exercise. The anti-depressant effect occurs mainly when the exercise program lasts longer than nine weeks and involves several sessions per week. The exercise session must be more than 30 minutes with moderate and high intensity with a higher number of days per week. A few organizations suggested that physical exercise has the best therapeutic effects on mental health. For example, the American College of Sports Medicine recommends that adults should exercise 3-5 times per week at moderate intensity. Dose of individual exercise refers to the amount of physical activity done by the individual. The exercise dose is usually characterised by Frequency, Intensity, Time (duration), and Type of activity. All these factors comprise the necessary components of the basic principle of exercise prescription (the FITT principle). The proper dose of exercise is essential to ensure the optimal effect of the training. FITT principles need to be followed to enhance physical and mental health. The table below describes the term and dose of exercise. Table 5.1: Terms of Exercise Dose Source : Pollock, Gaesser, Butcher,Despres, Dishman, Franklin, & Garber,(1998

HEALTH AND WELLNESS @ UNI 70 EXERCISE INTENSITY 70 % 80 % Max HR = 220- 22 (age) Max HR = 220- 22 (age) Training HR = (198-60)70% + 60 = 96.6 + 60 = 157 beat per minutes Training HR = (198-60) 80% + 60 = 110.4 + 60 = 170 beat per minutes Table 5.2: Formula for Exercise Intensity According to the above calculation, individuals aged 22 with resting heart rate at 60 beats per minute need to achieve the training heart rate between157 to 170 beats per minute if the exercise intensity is 70 % to 80 % — however, training intensity changes based on the progression. The intensity of exercise is usually determined by a few methods such as % V02max, training heart rate, rating of perceived exertion, and the onset of blood lactate accumulation. The simplest method to calculate the exercise intensity is training heart rate. Training heart rate refers to the target heart rate per minute during exercise. The American College of Sports Medicine (2014) proposed for training heart rate is between 55%-90% for aerobic exercise. The Karvonen Formula is a mathematical formula to determine training heart rate. The formula uses the maximum (max HR) and resting (resting HR) heart rate with the desired training intensity to get a target heart rate. The following is the example of the calculation for individuals aged 22 with the resting heart rate 60 beats per minute, and the target of training intensity is 70% to 80%. Figure 5.1: Karnoven Formula Training Heart Rate = [(max HR − resting HR) × % Intensity] + resting HR

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 71 EXERCISE INTENSITY Very light ≤ 20 % Light 20 % - 40 % Moderate 40 % – 60 % Vigorous (Hard) 60 % - 85 % Vigorous (very hard) 85 % - < 100 % Maximal 100 Table 5.3: Level of Exercise Intensity Source: The American College of Sport Medicine, (2014) Figure 5.2 : The Recommended Sequence of Progression of Aerobic Exercises Progression is one of the principles of exercise and it must be emphasized while planning an aerobic exercise. Progression of exercise refers to the process of increasing the intensity, duration, frequency, or amount of activity or exercise as the body adapts. ACTIVITY Choose one type of exercise. Calculate your exercise intensity. 5.6 SUITABLE SINGLE AEROBIC EXERCISE SESSION If you are 45 years old and above, and practise a sedentary lifestyle , you should carry out some form of health status screening to decide whether you can start an exercise or you should obtain further consultation with a physician. You may have an underlying illness. Hence, it is imperative to identify possible health conditions and a risk factor that could place risk for specific activities.

HEALTH AND WELLNESS @ UNI 72 5.7 OTHER BENEFITS OF PHYSICAL ACTIVITY AND SPORT Physical activity and sports involvement have been shown to enhance mental health. If you have physical activity and are involved in sports in an outdoor space, you can improve cognitive performance, self-esteem, and reduce anxiety and symptoms related to attention deficit disorder. Furthermore, your involvement in physical activity and sport with your friends can help you to develop critical social skills such as leadership, empathy, communication, and teamwork. Playing football, netball, badminton with peers can develop social skills; in turn, these skills can enhance mental health. Participation in sport is also good to improve your self - esteem, better nutrition, and inhibits you from smoking, and drug abuse. Physical activity and sports also improve your focus, sleep, and energy levels. Students who undertake regular physical activity and sports activity enjoy improved relationships and a more positive body image. REFLECTION You want to exercise at an intensity level of 60 - 85%, calculate the training heart rate to meet the goals of an exercise. Table 5.4 : Recommendations of a single exercise session for aerobic activities PHASE DESCRIPTION WARM – UP » To improve from the transition from rest to the exercise state. At least 5 to 10 mins of low to moderate intensity aerobic exercise. CONDITIONING » 0 to 60 mins of aerobic exercises. » Brisk walking, jogging, swimming, cycling, dancing, rope jumping, basketball, football, netball, badminton. » Make sure the training heart rate reaches the required training intensity. COOL DOWN » At least 5 to 10 mins of low to moderate intensity aerobic exercise.. » Slow walking, stretching exercises » To return heart rate and blood pressure toward normal. Once the health status has been analysed, and there are no risk factors, a few principles of a single exercise session need to be considered before starting an aerobic exercise. Table 5.4 shows a recommendation of a single exercise session for any aerobic activity.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 73 5.8 SAFETY CONSIDERATIONS Exercise is recognized to have benefits to health. However, physical activity or exercise also has the potential to cause injury to individuals. To ensure safety, you need to consider all the safety aspects below: ◆ You should know how to calculate the target heart-rate zone. ◆ You should know how to monitor intensity (e.g., talk test, rate of perceived exertion, heart-rate monitors). ◆ When increasing the intensity (speed, incline, and/or resistance) or duration of exercise, keep in mind the 10 percent rule (e.g., if a person is running continuously for 10 minutes per session in week 1, then in week 2 the maximum increase recommended would be to run continuously for 11 minutes per session). ◆ You should include a variety of activities to avoid overuse injuries or to prevent boredom. ◆ You should also include a cardiorespiratory cool-down. To prevent postexercise peril (e.g. dizziness, light-headedness, fainting), gradually reduce the heart rate, breathing rate, and body temperature. This could be accomplished by simply walking slowly for 5 to 10 minutes.

HEALTH AND WELLNESS @ UNI 74 BIBLIOGRAPHY ▶ Byrne, A., & Byrne, D. G. (1993). The effect of exercise on depression, anxiety and other mood states: a review. Journal of psychosomatic research, 37(6), 565-574. ▶ Pollock, M. L., Gaesser, G. A., Butcher, J. D., Despres, J. P., Dishman, R. K., Franklin, B. A., & Garber, C. E. (1998). ACSM position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc, 30(6), 975-991. ▶ Rosenbaum, S., Tiedemann, A., & Ward, P. B. (2014). Meta-analysis physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry, 75(0), 1-11. ▶ Swain, D. P., Brawner, C. A., & American College of Sports Medicine. ACSM’s resource manual for guidelines for exercise testing. SUMMARY ▶ Physical health is essential for everyone, but it can be extra challenging if you have a mental illness. ▶ People affected by mental illness often have some of the health problems. ▶ Healthy lifestyle is the most crucial component to prevent mental illness. ▶ Physical activity and exercise may play an essential role in the management of medium intensity mental disorders. ▶ Aerobic exercise has been recognized to enhance mental health. ▶ FIIT principle is essential for the maximum effect of exercise.

06 LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Describe the concept of social and socialization. ▶ Describe various social skill. ▶ Explain the concept of social health. ▶ Identify social problems. SOCIALISATION

HEALTH AND WELLNESS @ UNI 76 6.1 INTRODUCTION In this chapter, you will be introduced to the meaning of social, socialisation and social health among the youth especially the university students. In addition, you will learn of various social skills and be able to identify the social problems that are common among university students. 6.2 HOW EXERCISE AFFECTS MENTAL HEALTH? “Social” carries a few meanings but it is all related to the interaction among people in a society or community. Social interaction is about how you look at yourself through the eyes of others, learning who you are and how you fit into the world around you. Socialisation is the process where you should learn and understand societal norms and expectations, accept society’s beliefs, and be aware of societal values so that your behaviour can be relied upon to the group norms or be a competent member of a society. Socialisation is a critical and lifelong process to prepare yourselves for new social environments and expectations in every stage of your lives. Social relationships or social ties, both quantity and quality affect mental health, health behaviour, physical health, and mortality risk. Studies show that social relationships have short-term and long-term effects on health. Healthy relationships support good mental health, while social isolation and poor relationships can be risk factors for mental health conditions like depression and anxiety. Part of building strong relationships is having good, open, and regular communication. Social networks refer to the web of social relationships surrounding an individual structural features, such as the type and strength of each social relationship. Each of these aspects of social relationships affects health. Social integration refers to the overall level of involvement with informal social relationships, such as having a spouse, and with formal social relationships, such as those with religious institutions and volunteer organizations. 6.2.1 Features of Socialisation For you to have good socialisation skills, you should know a few features of socialisation. Below are the examples: i. Basic discipline ◆ You should learn to control your impulses and show a disciplined behaviour to gain social approval. REFLECTION What are some of the terms that you should know, for you to understand about the concept of socialisation?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 77 ii. Control others’ behaviour ◆ You need to get adjusted to your community and the society. In University, you should be familiar with the university’s culture and norms. Through socialisation, society intends to control the behaviour of its- members unconsciously. iii. Practising humanity and good behaviour ◆ You may socialise quickly with your new society if you and the society are more united in your ideas and skills. When there is conflict between the ideas, socialisation tends to be slower and ineffective. iv. Socialisation takes place formally and informally ◆ Formal socialisation takes through direct instruction and education in the university. Family is, however, the primary and the most influential source of education. Children learn their language, customs, norms, and values in the family. v. Socialisation is a continuous process ◆ Socialisation is a life-long process. It continues from your childhood until you become an adult; internalisation of culture continues from your earlier generation to the next generation. ACTIVITY Discuss with your friends, certain features of students culture on your campus that encourage or discourage you from socialisation. 6.3 SOCIAL SKILLS Social skills are the skills you use to communicate and interact with each other either verbally, non-verbally or both. As human beings, you are sociable creatures and you have developed many ways to communicate your messages, thoughts, and feelings with others. 6.3.1 Benefit of well-developed social skill Through socialisation, you may develop several good soft skills for positive interpersonal relationships with others. Below are some of the benefits of well-developed social skill (Refer Figure 6.1).

HEALTH AND WELLNESS @ UNI 78 BETTER RELATIONSHIPS, CHARISMATIC AND SELF-ESTEEM You will be more charismatic: a desirable trait through developing your social skills. A strong interpersonal relationship will help you get a job, get promoted and make new friends. Social skills can increase your happiness, satisfaction and boost stress. GREATER EFFICIENCY If you are good with people, you can more easily avoid being with the people who do not have similar interests and viewpoints. A good set of social skills will allow you to politely convey that you need to spend time with other people at the get together improving self-esteem and building conÞdence. GOOD COMMUNICATION Great social skills and good communication enable you to relate with people, being able to work in large groups naturally and being able to convey oneÕs thoughts and ideas through. ADVANCING CAREER PROSPECTS Most organisations are looking for individuals with a particular, tactical, skill set: the ability to work well in a team and to inßuence and motivate people to get things done. INCREASED OVERALL HAPPINESS You can simply impress your audience and add a unique zing and appeal to your presentations. Figure 6.1: BeneÞts of Well-developed Social Skill i. Better relationships, charismatic and self-esteem ◆ You will be more charismatic; a desirable trait through developing your social skills. A strong interpersonal relationship will help you get a job, get promoted and make new friends. Social skills can increase your happiness, satisfaction and boost your self- esteem and help to reduce the negative effects of stress. ii. Good communication ◆ Great social skills and good communication enable you to relate with people, being able to work in large groups naturally and being able to convey one’s thoughts and ideas through. iii. Greater efficiency ◆ If you are good with people, you can more easily avoid being with the people who do not have similar interests and viewpoints. A good set of social skills will allow you to politely convey that you need to spend time with other people at the get together improving self-esteem and building confidence. iv. Advancing career prospects ◆ Most organisations are looking for individuals with a, tactical, skill set: the ability to work well in a team and to influence and motivate people to get things done. v. Increased overall happiness ◆ Getting along and understanding people will help you to open many personal and career-related doors. A smile and ‘hello’ in a social situation may lead to a friendship being formed.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 79 6.3.2 Characteristic of social skills Below are the characteristics of social skill: ◆ Social skills are goal-directed. ◆ The behaviours are interrelated in the sense that one person may use more than one kind of behaviour at the same time, for the same goal. ◆ Should be appropriate to the situation of communication. Different social skills will be used for professional and personal communication. ◆ Can be identified as certain types of behaviour whereby an individual can be judged on how socially skilled they are. ◆ Can be taught, practised, and learned. ◆ Should be under the cognitive control of the individual - learning them involves learning when to use behaviours, as well as what behaviours to use, or how to use them. 6.3.3 How to improve social skills? You may be a person who has poor social skills. For you to be a better person, you should improve your social skills. Below are a few tips for you to improve your social skills: REFLECTION What are the beneÞts of socialisation? What would happen if you prefer to be socially isolated? Figure 6.2: Tips to Improve Social Skills

HEALTH AND WELLNESS @ UNI 80 i. Enhancing verbal communication ◆ Be aware of the volume and tone of your voice. You should not speak too softly or too loudly either. Speak at a volume that can be easily heard and suggest confidence but never shows aggression. Please remember to adjust the volume of your voice to suit the surrounding environment. If possible, speak at the same volume and tone as people in your immediate environment. If you find that you speak quickly because you’re nervous or anxious, try speaking at about a third of your normal speed. This trick is called slow talk, and it not only helps you speak clearly, it can also help you feel calmer. ii. Learn the right way to initiate a conversation ◆ You can begin by saying something that is generally or universally true, rather than overly personal statements because that might seem to be insulting or offensive to some. Comment on the weather, or maybe some current event you heard about in the news recently. You could compliment someone on what they are wearing or the way they have done their hair. Small talk is not always easy though; since it can often be difficult to think of exactly what to say. iii. Find ways to extend conversations ◆ After speaking about general issues such as current events, try bringing up more intimate or a more relatable topic. Asking questions that explore a little deeper below the surface. For example, asking polite questions about their family, employment, or hobbies can lengthen a conversation and make it more meaningful. Remember that a conversation takes two people, so avoid speaking too little or vice versa. Try as much as possible to ask open-ended questions; in other words, start with a “How,” a “Why,” or a “What,” instead of those questions to which there can only be a plain and simple “Yes” or “No” answer.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 81 iv. Steer clear of controversial topics ◆ When interacting with a person you don’t know all too well, there are some subjects you should steer clear of. In general, these would include controversial subjects like religion, politics, or the person’s ethnicity/race etc. While it seems okay to ask someone about their religious affiliation generally, it might be a bad idea to ask just about anyone about the religious views on sexuality. v. End conversations courteously ◆ Instead of abruptly cutting them off and walking away, try to be polite about it. Tell them in a sweet, non-offensive way that you must take their leave and give them the impression that you enjoyed the interaction. Try concluding with positive statements such as: » “I’ve got to run, but I hope we meet again soon.” » “Well, I have a bank appointment, but it’s been fun chatting with you.” » “I can see that you’re busy, so I’ll let you go. It was nice talking to you.” 6.3.4 Improving nonverbal communication Communication can be verbal and nonverbal. You may find nonverbal carries a lot of messages to make your conversation more interesting. Refer to Figure 6.3 for a few tips for you to improve your non-verbal communication. ACTIVITY Starting a conversation with new friends? Use the tips you have learned earlier during the conversation. Figure 6.3 Tips to Improve Nonverbal Communication

HEALTH AND WELLNESS @ UNI 82 i. Pay attention to your body language ◆ Our gestures often communicate messages more powerfully than words. Remember that body language plays an important role in social interactions. Be wary and take time to reflect on messages you give others through your posture, eye contact, and facial expressions. If you are avoiding eye contact, standing far away, or crossing your arms, you are likely telling others that you don’t want to interact. Adopt a confident pose and smile a bit more. Make frequent eye contact with people you are talking to; stand tall and unfold your arms. This way you are certainly more likely to create a good impression on people you speak to. ii. Observe how other people behave ◆ Watch their body language closely and consider why they are better at interacting with others socially. Observe their posture, their gestures, their facial expressions, and how often they make eye contact. Consider how you might replicate or improve upon your own body language while talking to people. Determine ‘how well’ the people you’re observing know each other. This is important because the body language shared among close friends who are talking differs completely from that displayed by two complete strangers even in an ordinary setting. Mentally take notes about what you see and observe. This will both guide and help you to become more aware of your own body language. Try not to focus too much on yourself and adjust in the moments, though. Focus on the people with whom you’re interacting and practise new skills with yourself or a close friend later. iii. Practise your non-verbal communication skills ◆ Home is often the best place to start learning something new because you won’t be as inhibited in a familiar setting. You could try making a video of yourself in conversation with your family members, and then consider how you can improve your body language. You could also practise non-verbal gesturing in front of a mirror. Enlist the help of family members you are close to, or even close friends- this is another effective approach, as they can give you honest useful feedback that no one else would. Some other tips include ‘pulling back’ your shoulders, keeping your spine straight, and your chin up, parallel to the floor. One of the best things about practising at home is that it’s obviously a private and a low-pressure environment. Don’t be shy! It’s just you and the mirror! Have fun trying out different types of body language signs and gestures.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 83 iv. Keeping a genuine smile ◆ A smile is universally known to be a great way to show you are open to others, and makes people feel at ease. Just focusing on smiling when you meet people will make things a little easier. v. Practise your eye contact ◆ Work on making more eye contact as you get comfortable with it. Don’t stare people in the eye, especially if you’re uncomfortable with it because that could prove annoying. Whenever you think about eye contact, make yourself look at someone in the eye for just about 3-5 seconds only. As this gets easier, you’ll be natural about it. If you’re not right next to someone, look at their earlobe, or the spot right between their eyes. This is faking it, but people won’t be able to tell the difference. If you’re nervous in making eye contact, some social psychologists suggest that you practise doing it with people on TV. Put on the news and try keeping eye contact with the anchor. vi. Getting ready to go out ◆ You’ll feel more confident with the way you look. Spending a little extra time on making sure you like the way you look and feel confident about yourself will make all other social situations easier to be in. Develop a hygiene routine, buy some new clothes or a pair of shoes you liked, and dressing your best not only improves self-confidence they make you naturally more social, too. ACTIVITY Observe your friends while they are having a conversation with someone. Analyse the nonverbal communication used by your friends. 6.3.5 Practising in the real world You should apply the previous knowledge to your real world. Start using below tips to practise: ◆ Find a place where people seem easy going. ◆ Start small, chatting with service people that helped you out to get started. ◆ Pick someone who doesn’t appear busy or uninterested. ◆ Reflect on how it went. ◆ Talk to more people. ◆ Join a support group.

HEALTH AND WELLNESS @ UNI 84 6.4 SOCIAL HEALTH Social health is important enough that the World Health Organization includes it in their definition of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” That’s because having meaningful relationships with other people can reduce your stress and provide a sense of security that promotes good emotional health. Research has shown that social health also impacts your physical health; people who have less social involvement are more likely to experience drastic health problems than those who experience more social involvement. The “supportive social ties may trigger physiological sequelae (e.g., reduced blood pressure, heart rate, and stress hormones) that are beneficial to health.” That’s why it’s so important to consider your social health as part of your overall wellbeing. 6.4.1 How to improve social health START SMALL MEET NEW PEOPLE BE YOURSELF SHARE YOUR INTEREST FOCUS ON QUALITY HEALTHY FRIENDS

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 85 Refer to Figure 6.4 for tips to improve your social health. Below are tips to improve your social health: You should start small. If becoming more social makes you nervous, practise your social skills with people you already know to build your confidence: ◆ Try meeting new people. ◆ You should be yourself. Trying to change your personality to make more friends will prove exhausting and ultimately fruitless. You already have a lot to offer, so be yourself as you work to build your social life. ◆ Find people who share your interests. For example, if you like reading, you could join a book club or sign up for a local writing class. Because you’ll already have something in common, it will be easier to form an initial connection. ◆ Focus on quality, not quantity. It’s great to have a lot of friends, but it’s important to remember that meaningful, positive relationships are most valuable. ◆ You should choose friends who will encourage you to make healthy choices. Surrounding yourself with people who want to see you succeed will help you reach your goals! ACTIVITY What should you do to improve your social health? 6.5 SOCIAL PROBLEMS 6.5.1 Definition You may have social problems when you experience that: ◆ Many people consider it undesirable and wish to correct your behaviour. ◆ Disapproval from the community and the society cannot tolerate your behaviour. ◆ Fairly large number of persons in society wish to remove or correct your behaviour. ◆ Society realise that certain cherished values are threatened by the conditions which have become acute. ◆ Your behaviour has influenced most people and they believe that this situation itself is responsible for their difficulties or displeases which may be removed. 6.5.2 Social problems among university students A few examples of social problems that are experienced by college students are premarital sex, bully, sexual assault, and drug abuse.

HEALTH AND WELLNESS @ UNI 86 i. Premarital sex ◆ Studies have shown that premarital sex or sex out of wedlock may predispose you to various negative consequences including being marginalised by the society, academic failure, having an illegitimate child, infant abandonment, and infanticide. If you or your friends practise premarital sex, before it is too late, please seek help from: » Career and Counselling Centre at: https://careercounselling4u. uitm.edu.my » Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see a doctor or call 03-55442999 for more information. ACTIVITY What are some of the examples of social problems that you see in your campus? What are the contributing factors? Discuss with your friends. Figure 6.5: Social Problems among University Students

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 87 ii. Sexual harassment and sexual assault ◆ Sexual harassment includes behaviours which relates to a sexual nature, unwelcome and inappropriate promise of rewards in exchange for sexual behaviours. Examples of sexual harassment include: » Sending sexually inappropriate messages or videos » Making inappropriate sexual gestures » Using sexual phrases or nicknames » Making sexually inappropriate behaviours Sexual assault includes rape and molest. Both genders can be the victim of sexual assault. Two third of the perpetrators of sexual assault are someone that you know including your father, brother, superior and friends. Drug rape is sexual assault which occur when the perpetrator gives the victim drug before raping the him or her. Usually, the drug is mixed in food or drinks of the victim without the victim knowing. As a result, the victim has loss of consciousness or loss of memory. This experience results in the victim feeling worried to report the case because of fussy memory of the incident. If you or your friends become the victim of sexual harassment or sexual assault, please seek help immediately from: » Career and Counselling Centre at https://careercounselling4u. uitm.edu.my » Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see a doctor or call 03-55442999 for more information » Or call emergency helpline 03-55443999 » Or go to the nearest police station to make a police report

HEALTH AND WELLNESS @ UNI 88 iii. Bully ◆ Students who bully others most often have low self-esteem but react in aggressive manners, practise psychopathic personality, and have family dysfunctions. A proportion of students who bully others may be involved with drug addiction. Students who become the victim of bullying may also have low self-esteem and non-assertiveness making them vulnerable to be the victim. If you or your friends who become the victim of bully, please seek help from: » Career and Counselling Centre at https://careercounselling4u. uitm.edu.my » Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see a doctor or call 03-55442999 for more information. iv. Drug addiction ◆ Drug addiction is a major social problem that causes substantial negative consequences including criminal behaviours, unemployment, academic failure, and mental illness. Drug addiction can cause you to have psychosis, depression, and many other psychiatric symptoms. In the worst case scenario, a drug addict may kill his family for many or having hallucinations, hearing voices instructing them to kill. Refer to Chapter 3 for more information. Before it is too late, if you or your friends abuse drugs, please seek help from: » Career and Counselling Centre at https://careercounselling4u. uitm.edu.my » Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see a doctor or call 03-55442999 for more information. 6.5.3 Possible contributing factors for social problems i. Adjustment to new life ◆ The first year of university is always extra hard when it comes to adjustment to university life so you should be expecting to at least get a culture shock because of how different things would be compared to home or school. REFLECTION What are the common sexually related problems that may occur among university students? How do you get help if you or your friend are one of the victims?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 89 ii. Homesickness ◆ Since it is the first time being away from home for most students, homesickness can strike very hard. However, thanks to the modern means of communication, most students feeling homesick can stay connected with their parents, family members and friends over the internet. iii. Pressure from studies ◆ University and parents expect good results from the students. Competition from other students, pressure to achieve good grades is immense for those who pay for their education expenses through scholarships, which is another issue of pressure among the university students. iv. Finding new friends ◆ It is difficult to make friends at a new place, but don’t make the mistake of thinking that you will have to fit in with people who have different interests to make new friends at university. v. Residency problems ◆ You may get a place in the hostel or dorm, but it is difficult to find student accommodation that is right for you. You must consider factors such as distance, rent rates, facilities, roommates, etc. Students face residency problems all the time so if you can, have a place ready before you leave home. Student accommodation is a big issue in UiTM and you would do well to have a solution prepared. vi. Poor time management ◆ From trying to study to living alone and doing the required chores, to maintaining a social life, to possibly working some sort of a job to help with expenses, students don’t have the “time” to manage and think about their time. They sleep in irregular patterns and do everything at the last minute. vii. Loneliness and social isolation ◆ As university students, based on their increasing independence and individualization in their new role, start making decisions autonomously and the transition to college life certainly can trigger the development of loneliness. Those who feel lonely may experience low level of self-esteem, or do not obtain the same amount of social support from the individuals around them, whether this is from being uncomfortable when around others, or perhaps not being as proficient in social skills Several studies have linked depression with the experience of loneliness and social isolation.

HEALTH AND WELLNESS @ UNI 90 viii.Level of belongingness ◆ You may feel some level of belonging in response to social interactions and environmental features. Sense of belonging including the five factors: perceived peer support, perceived faculty support/comfort, perceived classroom comfort, perceived isolation, and empathetic understanding. ix. Minority group stress ◆ The minority group such as the students with disabilities, bumiputera but non-Muslim student, male students, international students sometimes need to struggle to cope with the university environment especially related to religious practises, the facilities, physical abilities and will increase the stress among these minority groups. A study showed that there is a relation between minority group stress to depression symptoms. Findings revealed that minority group stress in the areas of academic concerns and negative perceptions of the campus climate contributed unique variance to depression symptoms. ACTIVITY Your friend prefers to be alone. S/he refuses to socialise with other class mates. What could be the contributing factors to his/her condition? 6.5.4 Handling social problems Before it is too late, if you or your friends are involved in any social problems, please contact: ◆ Career and Counselling Centre at https://careercounselling4u.uitm. edu.my ◆ Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see a doctor or call 03-55442999 for more information You may also practise these tips to handle your social problems. Get help immediately before it is too late. Refer to Figure 6.6 for tips on how to handle social problems using the key acronyms CHARITY.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 91 ACTIVITY Observe your environment, your class, and your campus. Do you notice friends who experience social problems? What would you do to help? Figure 6.6: Wheel Tips to Manage Social Problems

HEALTH AND WELLNESS @ UNI 92 SUMMARY ▶ Any interaction among people in a society or community is called “social” while the process where you should learn and understand the societal norms and expectations is “socialisation”. ▶ Socialisation can be learned through direct and indirect observations and experience during childhood and need to be changed accordingly during adulthood or any anticipatory situation. ▶ Communication is an important element for good social skills; in which enable to boost self-esteem, self-confident and helps to reduce the negative effects of stress. ▶ It is good to maintain good social health to have a complete “health”. ▶ Loneliness, social isolation, and belonging is part of contributing factors for social problems among university students. ▶ Get help if you suspect that you may be suffering from mental illness; ▶ (https://careercounselling4u.uitm.edu.my/) BIBLIOGRAPHY ▶ Britannica retrieved from https://www.britannica.com/topic/minority ▶ The Editors of Encyclopaedia Britannica, Poverty, Encyclopædia Britannica, Encyclopædia Britannica, inc. October 18, 2019, https://www.britannica.com/ topic/poverty; November 18, 2019. ▶ Diehl K, Jansen C, Ishchanova K, Hilger-Kolb J. Loneliness at Universities: Determinants of Emotional and Social Loneliness among Students. Int J Environ Res Public Health. 2018 Aug 29;15(9):1865. doi: 10.3390/ ijerph15091865. PMID: 30158447; PMCID: PMC6163695

07 LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Describe the concept of social support. ▶ Identify types of social support. ▶ Discuss the available support systems in your university. ▶ Explain regarding social skills. SOCIAL SUPPORT

HEALTH AND WELLNESS @ UNI 94 7.1 INTRODUCTION This chapter will introduce to you the concept related to social support, type of social support available for help seeking, types of social problems, immediate action on handling social problems and the social skills used among university students. 7.2 WHAT IS SOCIAL SUPPORT? 7.1.1 Concept of social support Social support refers to the social and psychological support an individual receives or perceives in her or his environment such as respect, care, and help. Social support provides university students with a sense of security and competence, which helps them to address intellectual challenges more efficiently as a return. Social support can provide solutions for individuals facing stressful problems, reduce the perceived importance of problems, or facilitate positive psychological reactions and behavioural responses. Those with stronger social support are better embedded in a supportive network and are more socially integrated in their university academic environments, thus they are better positioned to improve their academic achievements. In conclusion, social support serves as an effective remedy to improve students’ stress resilience, which may be particularly helpful in contending with emotional exhaustion. 7.1.2 Types of support There are four different ways for you to support other people. Figure 7.1 shows the summary of type of support. i. Emotional support: ◆ This type of support often involves physical comfort such as hugs or pats on the back, as well as listening and empathising. With emotional support, a friend might give you a big hug and listen to your problems, letting you know that they’ve felt the same way, too. ii. Esteem support: ◆ This type of social support is shown in expressions of confidence or encouragement. Someone offering esteem support might point out the strengths you’re forgetting you have, or just let you know that they believe in you. Life coaches and many therapists offer this type of support to let their clients know that they believe in them; this often leads to clients believing in themselves more. REFLECTION Explain the concept of social support. As a student, why is social support important?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 95 REFLECTION Your roommate is sick. What are the supports that you may iii. Informational support: ◆ Those offering informational support do so in the form of advicegiving, or in gathering and sharing information that can help people know of potential next steps that may work well. iv. Tangible support: : ◆ It includes taking on responsibilities for someone else so they can deal with a problem or in other ways taking an active stance to help someone manage a problem they’re experiencing. Someone who offers you tangible support may bring you dinner when you’re sick, help you brainstorm solutions (rather than telling you what you should do, as with informational support), or in other ways help you actively deal with the issue at hand.

HEALTH AND WELLNESS @ UNI 96 7.4 WHAT ARE THE SOCIAL SUPPORTS AVAILABLE IN THIS UNIVERSITY? Universiti Teknologi MARA offers various supports to you and other students. Below are some of the available supports for you. Refer to Chapter 1 for more information. 7.3.1 Educational Social Support There are various types of social support which you can easily seek for help in this university, such as in the: Figure 7.2: Socio-Ecological Model 7.3 THE CONCEPT OF SUPPORT SYSTEM A support system provides tools and technologies to leverage the power of the human capacity to think and to solve problems. A person’s behaviour is influenced by many factors both at the individual level and beyond. The levels of influence on behaviour can be summarised by the socioecological framework. This framework recognises that behaviour change can be achieved through activities that target four levels: Individual, interpersonal (family/peer), community and social/structural. 7.2.1 Socio-ecological model A person’s behaviour is influenced by many factors both at the individual level and beyond (Refer Figure 7.2). The levels of influence on behaviour can be summarised by the socioecological framework. This framework recognizes that behaviour change can be achieved through activities that target four levels: individual, interpersonal (family/peer), community and social/structural.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 97 ◆ Division of Academic Affair (HEA), you can also seek help from your Academic Advisor or any lecturer that you are comfortable with. ◆ Division of Student Affair (HEP) is one of the most important divisions in this university that provides services related to students’ welfare. You can get the support at the faculty level, on campuses including from the residential college. ◆ As at the faculty, the person that you can consult with is the team from the HEP office that include the Deputy Dean and the Students’ Association Advisors. ◆ While in the campus level, you can seek help from the units that are associated with the HEP Division such as Unit Kesihatan, Unit Sukan, Unit Kerjaya dan Kaunseling, Unit Kegiatan Pelajar, Pusat Kokurikulum, Institut Kepimpinan Pelajar, Pusat Kebudayaan, Unit Kemudahan Kolej, Unit Kenderaan, Unit Informasi, Komunikasi dan Penyelidikan, Unit Pembangunan Perniagaan, Unit Teknikal and Unit Biasiswa dan Bantuan Kewangan. ◆ You also can seek help through the HEP team in the residential college such as from the Unit Pengurusan Kolej, Pengetua Kolej and Staf Residen Kolej. ◆ Malaysian Academy of SME & Entrepreneurship Development (MASMED) helms the Tunas Mekar Project if you are interested in small business while continuing with your study. This university also provides trained and registered student support groups such as the Majlis Perwakilan Pelajar (MPP), Sekretariat Mahasiswa Fakulti (SMF), Jawatankuasa Perwakilan Kolej, Spiritual Support Group (Persatuan Rakan Masjid / Persatuan Mahasiswa Hadhari), RAKAN / Peer Support Group or any student association that exists in the university. 7.3.2 Family as social support Family is the primary source of support system for students. Besides financial support, family is important for emotional, tangible, informational and esteemed support. Family members are essential components in the process of healing because mental illness is not just a condition of an individual; it is an illness that gives impact to family and significant others.

HEALTH AND WELLNESS @ UNI 98 7.3.3 Other support systems Below are other supports that may help you when you are in a crisis: i. Government Sector or any agencies that are related to Social and Mental Health issues / problems ◆ Kementerian Pengajian Tinggi (Bahagian Psikologi dan Kaunseling) Kementerian Pembangunan Wanita, Keluarga and Masyarakat; JKM, LPPKN. ◆ Kementerian Kesihatan – any nearest hospital or clinics, One-Stop Crisis Centre (OSCC), Ministry of Home Affairs – Polis and Agensi AntiDadah Kebangsaan (AADK). ii. Non-Government Organizations ◆ In Malaysia there are several Non-governmental organizations (NGOs) that you can seek help from especially in dealing with social and mental problems such as the Mental Illness Awareness and Support Association (MIASA), Malaysian Mental Health Association (MMHA), Community Mental Health Centre, and Malaysian Association of Youth Clubs (MAYC) in which you can easily access through websites. iii. Community Social Support ◆ The involvement of the local community around your area such as the persatuan penduduk, Jawatankuasa Masjid, etc. could also be a platform for you to seek help from. ACTIVITY By applying the socioecological model, how would you help him/her?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 99 7.5 HOW CAN YOU IMPROVE YOUR SOCIAL SUPPORT NETWORK? Below are tips that you can apply to improve your social support network: i. Don’t be afraid to take social risks Seeking out new people and introducing yourself to them may be a useful way to meet others. For example, you may decide to go to a gathering, even though you won’t know anyone else at the event. Informal gatherings, community centres, recreational courses or clubs, volunteer positions, schools and workplaces are also common places to meet people. ii. Get more from the support you have It’s easy to assume that other people know what you need, but this usually isn’t true. You may need to tell others what you need. Be as specific as possible in your requests. However, be careful not to overwhelm your support providers. iii. Reach out Ask the people you know to help you broaden your networks. If you have no close friend, ask your seniors to introduce you to other colleagues or people of your age. Ask your friends to introduce you to others in the community. iv. Create new opportunities You may create new opportunities to meet others when you step outside of your usual activities. For example, you may meet new people when you join a club or group or get involved in an organisation. v. Let go of unhealthy ties Walking away from any relationship is painful – even when the relationship is causing harm – but it may be necessary. For example, if you’re trying to quit drinking and your friends only ever want to spend time in bars and clubs, you may decide to let them go. Use your judgement, though. It may be possible to spend less time with certain people without fully abandoning the friendship. vi. Make a plan Figure out what supports you needs and figure out how you might find it. vii. Be a joiner Sometimes, the best way to find the support you need is through a support group. If you need support for a highly specific problem, like managing a health problem, a formal support group may be the best option. viii.Be patient Making new friends can take time. You may need to meet many new people to make just one new friend. Building intimacy also takes time. It can take several months to feel close to someone and feel like you can count on their support.

HEALTH AND WELLNESS @ UNI 100 ix. Avoid negative relationships Negative relationships are hard on your emotional health. Some negative aspects may be obvious, such as abuse. Other times, they may be subtler, such as excessive dependence or control issues. You aren’t responsible for the other person’s behaviour, but it can still take a toll on your own well-being. You may find yourself dealing with the problems in an unhealthy way. It can be hard to avoid certain negative relationships, especially when these relationships are with family members. In this case, it may be best to limit the amount of contact with these people (or buffer that contact with other helpful supporters) and avoid relying on them for support. x. Take care of your relationships You’re more likely to build strong friendships if you are a good friend, too. Keep in touch with your support network, offer support to others when they need it and let them know that you appreciate them. ACTIVITY As a student in your faculty, how would you give support for your friends in need? Discuss a project with your friends of how to support him or her. 7.6 METHODS OF IMPROVING SOCIAL SKILLS To improve your social skills, you should have good communication skills. Communication is an important skill for every modern student to master. Advances in digital media, changing career landscapes, and greater competition in colleges and workplaces makes improving student communication skills a must. When it comes to acquiring indispensable communication skills, there’s no time like the present. Below are the tips to improve communication skills. These eight tips can help you immensely with improving student communication skills. They can be adapted for most student from kindergarten to high school.