title: Determinants and Effects of Voice Disorders among Secondary School Teachers in Peninsular Malaysia Using a Validated Malay Version of VHI-10.
abstract: OBJECTIVE
  To establish the prevalence of voice disorder using the Malay-Voice Handicap Index 10 (Malay-VHI-10) and to study the determinants, quality of life, depression, anxiety and stress associated with voice disorder among secondary school teachers in Peninsular Malaysia.
  
  
  METHODS
  This study was divided into two phases. Phase I tested the reliability of the Malay-VHI-10 while Phase II was a cross-sectional study with two-stage sampling. In Phase II, a self-administered questionnaire was used to collect socio-demographic and teaching characteristics, depression, anxiety and stress scale (Malay version of DASS-21); and health-related quality of life (Malay version of SF12-v2). Complex sample analysis was conducted using multivariate Poisson regression with robust variance.
  
  
  RESULTS
  In Phase I, the Spearman correlation coefficient and Cronbach alpha for total VHI-10 score was 0.72 (p < 0.001) and 0.77 respectively; showing good correlation and internal consistency. The ICCs ranged from 0.65 to 0.78 showing fair to good reliability and demonstrating the subscales to be reliable and stable. A total of 6039 teachers participated in Phase II. They were primarily Malays, females, married, had completed tertiary education and aged between 30 to 50 years. A total of 10.4% (95% CI 7.1, 14.9) of the teachers had voice disorder (VHI-10 score > 11). Compared to Malays, a greater proportion of ethnic Chinese teachers reported voice disorder while ethnic Indian teachers were less likely to report this problem. There was a higher prevalence ratio (PR) of voice disorder among single or divorced/widowed teachers. Teachers with voice disorder were more likely to report higher rates of absenteeism (PR: 1.70, 95% CI 1.33, 2.19), lower quality of life with lower SF12-v2 physical (0.98, 95% CI 0.96, 0.99) and mental (0.97, 95% CI 0.96, 0.98) component summary scales; and higher anxiety levels (1.04, 95% CI 1.02, 1.06).
  
  
  CONCLUSIONS
  The Malay-VHI-10 is valid and reliable. Voice disorder was associated with increased absenteeism, marginally associated with reduced health-related quality of life as well as increased anxiety among teachers.
authors.affiliation: Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Foong Ming
authors.initials: FM
authors.lastname: Moy
authors.affiliation: Centre for Occupational and Environmental Health-UM, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Victor Chee Wai
authors.initials: VC
authors.lastname: Hoe
authors.affiliation: Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Noran Naqiah
authors.initials: NN
authors.lastname: Hairi
authors.affiliation: Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: Anne Hin Yee
authors.initials: AH
authors.lastname: Chu
authors.affiliation: Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Awang
authors.initials: A
authors.lastname: Bulgiba
authors.affiliation: PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei, Brunei Darussalam.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Koh
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D005178:Faculty; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014831:Voice / Q000502:physiology; D014832:Voice Disorders / Q000453:epidemiology* / Q000209:etiology*; D014833:Voice Quality / Q000502:physiology