Mass Hysteria among secondary school students in Kelantan

Introduction: Mass hysteria is a rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbances whereby physical complaints that are exhibited unconsciously have no corresponding organic etiology1 and it was believes that cultural credence acts as a catalyst in boosting mass hysteria2. Stress, anxiety, psychologic conflicts were precipitating factors of hysteria3. In Malaysia, possession-like conversion are a typical illustration of hysteria in schools, though seems odd to Western culture, but it is coherent and accepted by Malay folk beliefs4. Hysteria in Malaysia is reported to occur mainly among Malay school teenagers which can cause adverse effects on social, emotion, and psychological development of adolescent5. During the occurrence, it also posed risk to students’ physical safety6,7. The teaching and learning continuity, as well as activities, are often disrupted by this scenario, often forcing temporary school closure to deal with the occurrence of an outbreak. The objectives of this study are to explore participants’ experiences and interpretations of hysteria phenomenon as well as to explore the cultural factors that influence hysteria expressions. Methodology: Face to face interviews were conducted using semi-structured interview guide from August 2018 to July 2019 in their respective schools. To obtain the information-rich cases related to the phenomenon purposive sampling was employed. The participants were selected among secondary school students whom experienced the hysteria in mass hysteria outbreak in 2016 and consented to participate. The interview were lasted from 30- 45 minutes, audio-recorded and transcribed verbatim in the language of the participants after each interview. Interpretative Phenomenological Analysis were performed. The data extracted were managed using ATLAS.ti 8 Windows a qualitative data analysis software. To establish trustworthiness in the study, credibility was established in four primary ways: member checking, researcher reflexive journaling, field notes, as well as methodological and investigator triangulation. Result: The mean age of participants were 14.3 years and all of them are Malay Muslim. 50% of participants were either youngest or eldest siblings and majority of the participants came from low socioeconomic household. The experience and interpretation of hysteria emerged as 'Culture Stereotyping', 'Idiom of Distress' and 'Social Reinforcement Factors'. Conclusion: Mass hysteria is common among adolescents in Malaysia, and it brings major impact to various parties. The failure to intervene will cause the adolescents to be at high risk of developing psychiatry illness. Furthermore, a significant influence of culture on daily life of the Malays need to be addressed. The cultural belief system, the language of distress, the reward to the possessed and the significant peers influence are intermeshed; these interactions lead to the interpretation of hysteria expression that were unique in this study. Thus, the management would need cultural competency plus sensitivity with simultaneous psychological evaluations and supports. This integrated approached and collaborative work with folklore practitioner or spiritual leader would be critical and more acceptable to the individuals and families in our communities. [Disclaimer: Abstract text might vary slightly from what is displayed in the e-poster]