A cross-sectional study of Malaysian low-income drug addict wives: Relationship between family impact, coping and mental wellbeing

Haikal Anuar Adnan; Zarinah Arshat; Nurul Saidatus Shaja’ah Ahmad Shahril

doi:10.12688/f1000research.122476.2

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Research Article

Revised

A cross-sectional study of Malaysian low-income drug addict wives: Relationship between family impact, coping and mental wellbeing

[version 2; peer review: 2 approved with reservations]

Haikal Anuar Adnan^1,2, Zarinah Arshat ^2,3, Nurul Saidatus Shaja’ah Ahmad Shahril²

PUBLISHED 19 Mar 2025

Author details Author details

¹ Centre for Research in Psychology and Human Wellbeing, Faculty of Social Sciences and Humanities, National University of Malaysia, Bangi, Selangor, 43600, Malaysia
² Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
³ Family, Adolescent and Child Research Centre of Excellence (FACE), Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia

Haikal Anuar Adnan
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Zarinah Arshat
Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing

Nurul Saidatus Shaja’ah Ahmad Shahril
Roles: Data Curation, Project Administration, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Addiction and Related Behaviors gateway.

Abstract

Background

The involvement of the husbands in the issue of drug addiction has impacted the wives’ livelihoods. Due to drug addiction amongst husbands, the wives experience stress and strain. The Stress Strain Coping Support Model (SSCS) was established to better comprehend how coping influences stress and strain. Thus, the purpose of this study was to determine the relationship between the stress which refers to family impact experienced by the wives of drug addicts, in terms of economic difficulties and marital conflict, and mental wellbeing. Furthermore, this study examines the role of coping as a mediating factor between family impact and mental wellbeing.

Methods

This study involved 132 wives of low-income drug addicts in Malaysia, who were selected using a purposive sampling method. Economic Strain Scale (ESS) and Braiker-Kelly Marital Conflict Scale (BKMCS) were used to measure family impact. Coping and Adaptation Processing Scale Short Form (CAPS-SF) and Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) were used to measure coping and mental wellbeing of the respective respondents.

Results

Path analysis using SmartPLS software version 3.3.7 showed that there is a direct association between family impact and coping, and between coping and mental wellbeing. The results also showed that family impact was associated indirectly with mental wellbeing through coping.

Conclusions

The findings benefited drug addict wives and practitioners related to this field in terms of enhancing the use of coping mechanisms in managing family impact and improving mental wellbeing, specifically amongst low-income drug addict wives.

Keywords

marital conflict; economic strain; stress; family impact; coping; mental wellbeing; drug addict wives; low income

Corresponding author: Zarinah Arshat

Competing interests: No competing interests were disclosed.

Grant information: This research was funded by Ministry of Higher Education through Fundamental Research Grant Scheme (FRGS) (Reference No: FRGS/1/2019/SS05/UPM/02/6). This research is under a big project entitle ‘Modelling of Coping, Adaptation and Psychological Well-Being among B40 Wives to Drug Addicts in Malaysia’. Special thanks to the National Anti-Drugs Agency in Malaysia and respondents who involved in the study for their cooperation in making this project a success.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2025 Adnan HA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Adnan HA, Arshat Z and Ahmad Shahril NSS. A cross-sectional study of Malaysian low-income drug addict wives: Relationship between family impact, coping and mental wellbeing [version 2; peer review: 2 approved with reservations]. F1000Research 2025, 11:683 (https://doi.org/10.12688/f1000research.122476.2) First published: 21 Jun 2022, 11:683 (https://doi.org/10.12688/f1000research.122476.1) Latest published: 19 Mar 2025, 11:683 (https://doi.org/10.12688/f1000research.122476.2)

Revised Amendments from Version 1

This revised version of the article incorporates significant expansions and refinements based on reviewer feedback. The primary change is an expanded Discussion section, which now includes a broader international and cross-cultural perspective. Specifically, the revised discussion situates the study’s findings within the context of research conducted in Western, Asian, and Middle Eastern countries, highlighting how cultural and religious factors influence coping mechanisms and mental well-being.
Additionally, the role of religious coping strategies—such as prayer, spiritual guidance, and faith—has been discussed in relation to different populations, including Muslim-majority societies (e.g., Malaysia, Indonesia, Middle Eastern countries) and Christian and Hindu communities. This provides a more nuanced understanding of how coping functions as a mediator in diverse cultural contexts.
Moreover, the revised version includes additional references to support cross-cultural comparisons, incorporating studies on coping mechanisms among spouses of individuals with substance use disorders across different countries. The methodological distinctions between prior research and the present study are also clarified, emphasizing differences in the measurement of stress, coping, and family impact.
By expanding the theoretical and empirical framework, this version strengthens the study’s generalizability and relevance to a broader audience. Future research directions are also elaborated, particularly the need for cross-cultural interventions tailored to individuals facing family-related stress and mental health challenges.
These revisions enhance the clarity, depth, and contextual relevance of the study, ensuring that its contributions are more comprehensive and globally applicable.

See the authors' detailed response to the review by Marek A. Motyka
See the authors' detailed response to the review by Mohd Radzi Tarmizi A Halim

Introduction

Drug addiction is a global issue that affects every country, including Malaysia. According to Ref. 1, around 275 million people worldwide have engaged in drug misuse, with up to 36 million of those people suffering from substance abuse disorders. Meanwhile the statistics from Ref. 2 shown there were 142,199 drug misuse cases in Malaysia in 2019, compared to a population of approximately 32.4 million to 32.6 million Malaysians. These figures indicate that around one person in every 229 people in Malaysia is a drug user. At least 95.5 percent of drug addicts are men, while women make up only 4.5 percent.

Drug abuse has a harmful impact not only on the addicted person, but also on their family members. A previous study found that people who live with drug abusers are stressed out a lot³ and women who are drug addicts’ wives or mothers face more severe negative consequences than other family members.⁴^–⁷ For the wives of drug addicts, mental health is a major issue.⁸^–¹⁶ Wives of drug addicts also often have problems with their social networks, like not being able to get help from others and not being able to keep in touch with family and friends,¹⁰^,¹³^,¹⁶^–¹⁸ experiencing violence and persecution,¹⁰^,¹²^,¹⁷^,¹⁹^–²¹ experiencing issues related to marital conflict⁸^,¹⁰^,¹⁸^,²² and experiencing economic strain.¹²^,¹⁴^–¹⁷^,²²^–²⁵ It is predicted that the wives of drug users will have a negative impact on their overall wellbeing as a result of having to deal with a large number of negative situations. However, although the wives of drug addicts face a variety of difficulties in their lives, not everyone wishes for the marriage to end in a dissolution. One of the reasons wives want to stay with their husbands is a sense of obligation to help their husbands deal with addiction and worry about life after separation because they have strong physical and emotional ties with their partners.¹⁸ Thus, a study should be conducted to see how they deal with them. This is because living with drug addicts without the right coping skills will have a negative effect on their wellbeing.

The Stress Strain Coping Support Model is one of the models that focuses on the stress and strain experienced by the wife of a drug addict.²⁶ The main idea behind this model is that people who are stressed because family members have addiction problems can respond to that stress and reduce the amount of strain they experience. The stress that families feel because of their loved one’s addiction problems can come in many different forms, including family problems, life management issues, and concerns about money and resources.²⁷ The concept of stress was measured in this study using the concept of family impact, which includes marital conflict and economic strain. The strain felt by family members of addicts is a direct result of the environment in which they live. According to this model, family member strain refers to the health of family members. These health problems arise as a result of the addict’s immediate family members experiencing behavioural disorders, distinctive changes, and serious challenges. Health issues that affect direct family members can range from physical to psychological. The concept of strain was measured in this study using mental wellbeing. It is assumed that the stress that drug users’ wives suffer contributes to their poor mental wellbeing. The existence of symptoms of either happy feelings or positive functioning in life can be regarded as mental wellbeing.²⁸ The concept of mental wellbeing, according to Ref. 29, encompasses two perspectives: a subjective experience perspective on happiness (affect) and life satisfaction (hedonic perspective); and a positive psychological functioning perspective on good relationships with others and self-realization (eudaimonia perspective).

Coping is an important concept in the SSCS model, which means that family members who face problems in their lives because of the involvement of immediate family members with addiction problems must figure out how to understand and respond to family problems. The way a family understands and responds to the problems they face is a sign of how well they are coping. Coping is a broad term that refers to an effort that entails cognitive and behavioural processes in order to deal with an unpleasant event in life³⁰ while Ref. 31 define coping as the variety of ways in which individuals think and behave in response to problems and stress. Coping is a fundamental premise of the SSCS model because it assumes that family members are not helpless but capable of improving their own health.³² Describe three coping strategies used by family members to deal with their family members’ addictions: putting up, withdrawing, and engaging in active coping, or standing up. Even though the SSCS model is often used to look at the relationships between these variables, some of the model’s flaws have been found. To begin with, it is ineffective at examining how stress affects strain because it uses data from European countries such as Mexico, England, and Italy. However, it excludes data from Asian and Muslim countries.²⁷ Second, the SSCS model focuses on interpersonal coping, and an examination of intrapersonal coping is necessary.¹¹ Third, the role of coping as a moderating or mediating factor in the relationship between stress and strain remains unclear and requires additional research.³³

As a result, this study was conducted to close the gap that currently exists: 1) The respondents in this study are Muslim wives of drug addicts in Malaysia. 2) Recognise the scope of coping specifically through concept of coping process introduced by Ref. 32. According to Ref. 32 coping is a behaviour in which the process of adaptation occurs during a stressful situation and is classified into four adaptive modes: physiology, self-concept, role function and interdependence. 3) This study determined the role of coping as a mediating factor in the relationship between family impact and mental wellbeing.

Based on the preceding discussion, the purpose of this study was to identify the association between the family impact experienced by wives of drug addicts in terms of economic strain and marital conflict, as well as their ability to cope and their mental wellbeing. In addition, this study looks into the role of coping as a mediator between family impact and mental wellbeing relationship. The conceptual framework of this study is as shown in Figure 1.

Figure 1. Conceptual framework.

Literature review

Marriage is a natural part of practically everyone’s life. According to a prior study, married individuals had a higher sense of wellbeing than unmarried, divorced, or widowed individuals.³⁴^–³⁷ However, the problems that married couples have because their husbands are addicted to drugs have a negative effect on the quality of their marriage.³⁸^–⁴⁰ Numerous previous studies have examined the relationship between family impact such as marital conflict and various aspects of wellbeing. The majority of previous research has established a direct link between marital conflict and aspects of life quality, such as mental health,⁴¹^–⁴⁴ subjective wellbeing,⁴⁵ life satisfaction⁴⁶ and suicide ideation.⁴⁴^,⁴⁷ However,⁴⁸ study contradicts the findings of other researchers, as he discovered that marital conflict has no significant relationship with psychological wellbeing.

Additionally, previous researchers examined the relationship between the variables in this study. A study conducted by Refs. 3, 49 discovered a significant relationship between family impact, coping, and strain among addicts’ family members. In a study of infertile couples,⁵⁰ found that marital satisfaction, marital communication, conflict resolution style, and coping were all linked to each other.³³ conducted a study to examine the association between family impact and involvement coping, tolerance coping, depression, anxiety, stress, and quality of life, and discovered a strong relationship between these variables. Withdrawal coping, on the other hand, has not been linked to stress. The study by Ref. 51 found that higher levels of burden showed significant associations with greater psychological distress and more use of coping, whereas greater acceptance of the situation showed an association with less psychological distress.

Numerous researchers have examined the capacity for coping as a mediator between the relationship between family impact and strain. However, the methods used by previous researchers to assess family impact and strain are clearly different. Study conducted by⁵ examined stress and strain using the Family Member Impact Scale and the Symptom Rating Scale. This study discovered that involvement and tolerant coping both function as partial mediators of family stress and strain.⁴⁹ Horváth and Urbán used the Zarit burden interview - short version to assess stress, while Beck hopelessness scale - short version was used to assess strain. The study’s findings indicate that tolerant inactive is a significant mediator of the stress-strain relationship. Coping’s ability to act as a mediator is also supported by Ref. 3 findings that coping acts as a significant mediator between stress and strain. However, the findings of³³ study differ from those of other researchers. Significant mediators for stress-strain relationships were not found to be coping.

According to the literature review above, the following gaps were discovered during the analysis of this previous study; First, the findings regarding the relationship between the variables are varied. Second, this previous study did not include wives of drug addicts in its sample selection; rather, it included a variety of samples, including wives of alcohol addicts,⁵² married couples in general,⁴⁶ working wives,⁴³^,⁴⁷ and patients diagnosed with depression.⁴² Third, studies involving Malaysian participants are still lacking. Fourth,⁴⁹ suggest that the measurement tools used to measure variables should also be different. Thus, a study focusing on the wives of low-income drug addicts in Malaysia is necessary to examine the relationship between family impact, coping, and mental wellbeing in the Malaysian context.

Methods

Research design

The quantitative approach was chosen because the primary goal of this study was to determine the relationship between the study variables, which were family impact, coping, and mental wellbeing. Using SMART-PLS software, this study also aimed to test the role of coping factors in mediating the relationship between family impact and mental wellbeing. This study employs a cross-sectional design and a questionnaire-based survey method. Furthermore, this is a correlation-shaped study. A correlation-shaped study, according to Refs. 53, 54, is a study that involves data collection to determine whether there is a relationship between the variables measured and to investigate the extent to which the impact of various variables is independent of the dependent variable. The independent variable in this study is family impact, and the dependent variable is mental wellbeing. While coping is a mediator variable between the family impact and mental wellbeing relationship. Because the cross-sectional study is prone to common method bias, common method variance analysis was conducted using Harman’s Single Component approach to address this issue.

Purposive sampling method was used to select the study sample, which included 132 wives of drug addicts. The subject criteria for this study were low-income wives, i.e., household income less than RM4,849 (USD1,103.56); wife of a drug addict who is in a drug rehabilitation centre; not involved in drugs; Malay; and has at least one child between the ages of 17 and under living together. Wives who do not meet all of the criteria will be left out of the study sampling process. The total amount of wives’ information received from drug addicts in NARC was 296. However, after screening, a total of 45 wives did not meet the following criteria, and a total of 85 individuals could not be reached through the use of phone calls or questionnaire posting. In addition, 32 wives declined to participate in the study, bringing the total number of respondents to 132. The GPower software was used to figure out the sample size for the study. The minimal sample size necessary for this investigation is 107 respondents at the 95 percent confidence level (α=0.05) due to the inclusion of two independent variables. The participants in the study ranged in age from 18 to 53 years old, with an average age of 37.92. This study also considered the following socio-demographic characteristics for wives of drug addicts: education level; marriage duration; and number of children younger than 17 years old.

Instruments

Permission was granted to use a questionnaire created by the original author. All the measurement instruments used in the study were created in English. Due to the fact that one of the selection criteria for study respondents is Malay, all measurement tools have been translated into Malay using back-to-back translation by professional translators from the Centre for the Advancement of Language Competence (CALC), Universiti Putra Malaysia. The instruments used in this study were checked for content validity by two experts in developmental psychology and human development before they were used in the study.

The Economic Strain Scale (ESS)⁵⁵ and the Braiker-Kelly Marital Conflict Scale (BKMCS)⁵⁶ were used to assess family impact in this study. The ESS has four items and is scored on four Likert scales that range from “strongly disagree” to “strongly agree.” The ESS is made up of four items. Cronbach’s alpha ESS values for looking at internal consistency by earlier researchers were 0.86⁵⁷ and 0.81.⁵⁵ In this study, the internal consistency coefficient for ESS was 0.83 for the pilot study and 0.89 for the actual study. The BKMCS has five items and is measured on a type 5 Likert scale, with items 1 to 3 ranging from “not very much” to “very much,” and items 4 and 5 ranging from “not very often” to “very often”. The value of Cronbach’s alpha BKMC to see the reliability by previous researchers is in the range of 0.69 to 0.89.⁵⁸^–⁶⁷ In this study, the internal consistency coefficient for ESS was 0.84 for the pilot study and 0.90 for the actual study.

The Coping and Adaptation Processing Scale Short Form (CAPS-SF)⁶⁸ was used to assess coping in this study. CAPS-SF has 15 items and is scored on a four-point Likert scale ranging from “never” to “always”. In this measurement tool, each item is a short statement about how people react to things that are stressful or hard in their lives. Cronbach’s alpha CAPS-SF values used by earlier researchers to figure out how consistent they were ranged from 0.74 to 0.87.⁶⁸^–⁷² In the current study, the internal consistency coefficient for CAPS-SF was 0.75 for the pilot study and 0.79 for the actual study.

Mental wellbeing in this study was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), developed by a group of researchers from the Universities of Warwick and Edinburgh.²⁹ SWEMWBS contains 7 items and uses a 5-likert scale that ranges from “none of the time” to “all of the time”. The study conducted by⁷³ found that SWEMWBS has a good reliability of 0.83. In the current study, the internal consistency coefficient for SWEMWBS is 0.68 for the pilot study and 0.83 for the actual study.

Procedure

The study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (Reference No.: JKEUPM-2020-406). A set of questionnaires was used to collect the data in this study. Prior to the study, permission was granted to the Malaysian National Anti-Drug Agency (AADK) to gather information about the wife from drug addicts (clients) at the Narcotics Addiction Rehabilitation Centre (PUSPEN) involved. Their wives were called by phone to ask for their permission to take part in the study after the drug addicts’ wives’ information was found. Next, the questionnaire was then distributed through WhatsApp in the form of a “Google form”. Written informed consent was also given to the respondents along with the distributed questionnaires. A pilot study, including 30 women of drug addicts whose husbands were seeking treatment at PUSPEN Batu Kurau and PUSPEN Perlop, Perak, was conducted prior to the main study.

Analysis and findings

Common method variance

Prior to the other analytic tests, a Common Method Variance analysis was performed. According to Harman’s Single Component approach,⁷⁴ the first factor explained the greatest proportion of the overall variance, at 20.203% (i.e., less than 50%). The findings of the factor analysis revealed that no general factors appeared, indicating that common technique bias was not significant in this data set.⁷⁵

Respondent’s profile

The demographic features listed in the present study include age, education level, marriage duration, and the number of children younger than 17 years old as depicted in Table 1. Referring to Table 1, majority of the respondents fell under the age group of 31 to 40 years old (i.e., 44.7%); 28.0% of the respondents were 21 to 30 years old; 24.2% of the respondents were 41 to 50 years old; 2.3% were more than 51 years old; and only 0.8% were younger than 20 years old. In terms of education level, the majority of respondents (48.5%) complete upper secondary school; 26.5% complete junior secondary school; 9.8% complete a diploma; 7.6% complete a certificate; and 4.5 percent complete a bachelor’s degree; 2.3% have completed primary school; and only 0.8 % have completed a master’s degree. For the duration of marriage, the majority of the respondents fell under the duration group of 6 to 10 years (i.e., 27.3%); 22.7% of the respondents were in the group of less than five years and the 11 to 15 years group; 12.9% were in the 16 to 20 years group; 7.6% 21 to 25 years; 6.1% 26 to 30 years; and only 0.8% fell under the group of more than 31 years.

Table 1. Respondent’s profile.

Demographic variables	Category	Frequency	Percentage (%)
Age	Below 20	1	0.8
	21-30	37	28.0
	31-40	59	44.7
	41-50	32	24.2
	More than 51	3	2.3
Education level	Primary school	3	2.3
	Junior secondary school	35	26.5
	Upper secondary school	64	48.5
	Certificate	10	7.6
	Diploma	13	9.8
	Bachelor’s degree	6	4.5
	Master’s degree	1	0.8
Marriage duration	Less than 5 years	30	22.7
	6 to 10 years	36	27.3
	11 to 15 years	30	22.7
	16 to 20 years	17	12.9
	21 to 25 years	10	7.6
	26 to 30 years	8	6.1
	More than 31 years	1	0.8
Numbers of children younger than 17 years old	One	29	22
	Two	32	24.2
	Three	39	29.5
	Four	22	16.7
	Five	7	5.3
	Six	1	0.8
	Seven	2	1.5

Model estimation

The partial least squares (PLS) technique, a variance-based structural equation modelling (SEM) was used in this investigation through the SmartPLS programme.⁷⁶ The higher-order construct using disjoint two-stage approach was analysed.⁷⁷ PLS–SEM was chosen due to the fact that it imposes fewer constraints on population size, scale measurement, and dispersion.⁷⁸ The model’s constructs were all measured reflectively.

Assessment of measurement model

Since this study used a disjoint two-stage approach, the steps that were proposed by Ref. 77 were implemented. The first step is to see if the lower order components fulfil the criteria that have been outlined, such as internal consistency, convergent validity, and discriminant validity. Then, the latent variable scores of the lower order components will be incorporated into the model in the second stage. After that, higher-order components that met the requirements (internal consistency, convergent validity, and discriminant validity) were determined.

Measurement model for lower-order components

Table 2 shows the outcomes of the measurement model evaluation. Numerous items discovered in the coping construct (i.e., CAPS_1, CAPS_5, CAPS_8, CAPS_9, CAPS_12, CAPS_13, CAPS_14) were discarded due to their extremely low loading values as suggested by Ref. 79. After removing several coping items, all constructs in this study met the standards, with the exception of several coping constructs. The accepted values suggested by Ref. 79 is the loading values exceeding 0.708, composite reliability (CR) values exceeding 0.7, and AVEs (Average Variance Exact) values over 0.5. For coping constructs, several items were retained even though the loading value fell below the 0.708 requirement. The reason for this is that indicators that have loadings between 0.40 and 0.708 should only be removed if they make internal consistency, reliability, or convergent validity better above the threshold value.⁷⁹ As a result, all constructs fulfilled the criterion for reliability and convergent validity. Discriminant validity in this study was analysed using HTMT technique.⁸⁰ As shown in Table 3, all discriminant values exceeded the HTMT threshold value. 90. As a result, discriminant validity was proven.

Table 2. Reliability and convergent validity for first stage.

Construct/associated items	Loading	Composite Reliability (CR)	Average Variance Extracted (AVE)
Economic strain		0.923	0.753
ESS_1	0.926
ESS_2	0.902
ESS_3	0.896
ESS_4	0.732
Marital conflict		0.922	0.704
BKMCS_1	0.757
BKMCS_2	0.867
BKMCS_3	0.815
BKMCS_4	0.889
BKMCS_5	0.861
Coping		0.889	0.502
CAPS_1	Item deleted due to low loading
CAPS_2	0.780
CAPS_3	0.785
CAPS_4	0.702
CAPS_5	Item deleted due to low loading
CAPS_6	0.713
CAPS_7	0.704
CAPS_8	Item deleted due to low loading
CAPS_9	Item deleted due to low loading
CAPS_10	0.647
CAPS_11	0.633
CAPS_12	Item deleted due to low loading
CAPS_13	Item deleted due to low loading
CAPS_14	Item deleted due to low loading
CAPS_15	0.689
Mental wellbeing		0.876	0.506
SWEMWBS_1	0.630
SWEMWBS_2	0.743
SWEMWBS_3	0.644
SWEMWBS_4	0.783
SWEMWBS_5	0.812
SWEMWBS_6	0.551
SWEMWBS_7	0.778

Table 3. Discriminant validity for first stage.

	1	2	3
1. Coping
2. Economic strain	0.186
3. Marital conflict	0.231	0.243
4. Mental wellbeing	0.362	0.089	0.135

Measurement model for higher-order components

For the higher-order components as shown in Table 4 and Table 5, all the values of loadings, CR, AVE and HTMT accomplish the recommended value suggested by.⁷⁹ Therefore, structural model measurements can be carried out.

Table 4. Reliability and convergent validity for second stage.

Construct/associated items	Loading	Composite Reliability (CR)	Average Variance Extracted (AVE)
Family impact		0.757	0.610
Economic strain	0.719
Marital conflict	0.838
Coping		0.889	0.502
CAPS_2	0.780
CAPS_3	0.785
CAPS_4	0.702
CAPS_6	0.713
CAPS_7	0.704
CAPS_10	0.647
CAPS_11	0.633
CAPS_15	0.689
Mental wellbeing		0.876	0.506
SWEMWBS_1	0.630
SWEMWBS_2	0.743
SWEMWBS_3	0.644
SWEMWBS_4	0.783
SWEMWBS_5	0.812
SWEMWBS_6	0.551
SWEMWBS_7	0.778

Table 5. Discriminant validity for second stage.

	1	2
Coping
Family impact	0.421
Mental wellbeing	0.362	0.164

Structural model assessment

The structural model assessment was conducted after the construct validity and reliability were verified by the measurement model assessment. The R-Square, or coefficient of determination, structure path co-efficient (B value), T-statistic value, and P-values are critical Smart PLS indicators used for determining results with a 95 percent confidence interval for the purpose of analysis interpretation. The R-square might be high (>0.75), moderate (>0.50), or low (>0.25). The Inner VIF is used to investigate the issue of collinearity. VIF readings are significantly lower than the 3.33 criterion,⁸² as shown in Table 6. As a result, there is no issue with multicollinearity in this model.

Table 6. VIF values for collinearity issue.

Relationship	VIF
Family impact $\to$ Coping	1.000
Family impact $\to$ Mental wellbeing	1.065
Coping $\to$ Mental wellbeing	1.065

Path-coefficient for structural model was assessed to examine the objective of this study using the bootstrap re-sampling technique (5000 re-sample). The R $2$ value was 0.138, which suggested that 13.8% of the variance mental wellbeing may be explained by coping and family impact. As shown in Table 7, family impact was found to be positively related (β=0.247, p<0.05) to coping. Coping was also found to be positively related (β=0.380, p<0.05) to mental wellbeing. However, results show that family impact not related (β=0.380, p>0.05) to mental wellbeing.

Table 7. Path coefficient assessment.

Relationship	Coefficient	t-Value	P Value
Coping $\to$ Mental wellbeing	0.38	6.438*	0.00**
Family impact $\to$ Coping	0.247	2.59*	0.01**
Family impact $\to$ Mental wellbeing	-0.14	1.299	0.19

* t>1.96.

** p<0.05.

The mediation effect was further investigated using bootstrapping approaches. Table 8 shows the results of the study on the influence of family impact on mental wellbeing through coping, which showed that the impact of mediation was statistically significant (β=0.094, p<0.05).

Table 8. Indirect relationship assessment.

	Indirect effect	t-value	P value
Family impact -> Coping -> Mental wellbeing	0.094	2.14	0.032**

** p<0.05.

Discussion

The purpose of this study was to examine the association between family impact, coping, and mental well-being. Additionally, the study aimed to determine the mediating role of coping in the relationship between family impact and mental well-being among low-income drug addicts’ wives. The findings indicate that family impact has a significant association with coping, and coping, in turn, is significantly associated with mental well-being. However, family impact was found to have an indirect association with mental well-being through coping rather than a direct relationship. This suggests that coping plays a crucial role in linking family impact and mental well-being.

These findings align with those of,⁵² who also found no direct association between family impact—specifically marital conflict—and mental well-being. However, they contradict the results of studies such as,⁴¹^–⁴⁷ which reported a direct relationship between these two factors. Furthermore, our results are consistent with previous research³^,³³^,⁴⁹^,⁵⁰ which suggests that family impact influences coping, and that coping serves as a mechanism for managing psychological strain. The significant mediating role of coping in the relationship between family impact and mental well-being is also in line with the findings of,³^,³³^,⁴⁹^,⁵⁰ though it contrasts with those of.³³

When comparing these findings internationally, similar results have been reported in studies involving women from different cultural and religious backgrounds. Research conducted in Western countries, such as the United States and Canada, highlights the role of coping strategies in buffering the effects of family stress on mental health among spouses of individuals with substance use disorders.³⁰^,⁸³ However, differences in coping mechanisms have been noted based on cultural expectations. In Western contexts, coping is often associated with seeking professional mental health support, engaging in social support networks, and utilizing individualistic coping strategies.⁸⁴ In contrast, studies conducted in Asian and Middle Eastern countries emphasize the role of religious coping and family cohesion as primary mechanisms for managing stress related to substance abuse within families.⁸⁵^,⁸⁶

Religion plays a significant role in shaping coping strategies across different populations. For instance, studies on Muslim-majority societies (e.g., Malaysia, Indonesia, and the Middle East) report that religious coping—such as prayer, seeking spiritual guidance, and reliance on faith—plays a central role in mitigating stress and enhancing mental well-being in the face of family crises.⁸⁵^,⁸⁶ Similarly, research on Christian and Hindu populations in other parts of the world suggests that spiritual beliefs provide a sense of hope, meaning, and resilience when dealing with family-related stressors.⁸³^,⁸⁷ These findings suggest that while coping serves as a universal mediator in the relationship between family impact and mental well-being, the specific coping strategies employed may be influenced by cultural and religious beliefs.

The dimensions found in the coping construct developed by Ref. 88 must be examined to further explain how coping functions as a mediator between family impact and mental well-being. The primary dimensions in the coping and adaptation processing construct include resourceful and focused coping, which involves utilizing available resources creatively and effectively to manage stress. In contrast, the physical and fixed dimension emphasizes physiological responses and immediate reactions to stress. Another key dimension, alert processing, incorporates behaviors that engage personal and physical resources at various levels of processing (input, central, and output). Systematic processing describes structured and methodical coping strategies, while knowing and relating involves using memory, imagination, and social relationships to manage stress. Despite cultural variations in specific coping mechanisms, the underlying process remains universal: individuals exposed to various forms of stress can achieve better mental well-being by enhancing their coping capacities in these key areas.⁸³^,⁸⁵

By situating the findings of this study within a broader international and religious context, it becomes evident that while the relationship between family impact, coping, and mental well-being is generally consistent across cultures, the specific coping strategies employed may vary depending on sociocultural and religious influences. Future research should further explore these cross-cultural variations to develop more tailored interventions for individuals facing family-related stress and mental health challenges.

Limitations and future research directions

There are some limitations to this study. For starters, the study’s cross-sectional design made it difficult for researchers to make causal findings. Second, the study’s sample size was tiny, and it was chosen using a nonprobability sampling method. As a result, generalisations are impossible. Third, one crucial feature of the SSCS model, namely social support, was not included in this study. As a result, there was no way to determine the role of social support in examining the relationship between familial impact and mental wellbeing. However, there are some positive aspects to this research. First, the findings of this study can give drug users’ wives an early sense of the necessity of building coping and mental wellbeing when dealing with family stress. Second, the findings of this study can be used by professionals in this field to help the wives of drug addicts improve their mental health. Therefore, there are some recommendations for future studies. First, a longitudinal study can be done to look at the causal relationship. Second, sample selection should be done using a probability sampling method to enable the results of the study to be generalized. Third, using the same concepts and measurements as in this study, the role of social support in the relationship between family impact and mental wellbeing needs to be explored.

Data availability

Underlying data

Figshare. Malaysian Low Income Drug Addict Wives: Family Impact, Coping and Mental Wellbeing. DOI: https://doi.org/10.6084/m9.figshare.19865176.v3.⁸⁹

This project contains the following underlying data:

‐ This data was used for an article published titled “A cross-sectional study of Malaysian low-income drug addict wives: Relationship between family impact, coping and mental wellbeing”

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Credit authorship contribution statement

Haikal Anuar Adnan: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing. Zarinah Arshat: Funding acquisition, Supervision, Methodology, Conceptualization, Writing – review & editing. Nurul Saidatus Shaja’ah Ahmad Shahril: Data Curation, Project Administration, Writing – review & editing.

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VERSION 2 PUBLISHED 21 Jun 2022

Author details Author details

Haikal Anuar Adnan
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Zarinah Arshat
Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing

Nurul Saidatus Shaja’ah Ahmad Shahril
Roles: Data Curation, Project Administration, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This research was funded by Ministry of Higher Education through Fundamental Research Grant Scheme (FRGS) (Reference No: FRGS/1/2019/SS05/UPM/02/6). This research is under a big project entitle ‘Modelling of Coping, Adaptation and Psychological Well-Being among B40 Wives to Drug Addicts in Malaysia’. Special thanks to the National Anti-Drugs Agency in Malaysia and respondents who involved in the study for their cooperation in making this project a success.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Adnan HA, Arshat Z and Ahmad Shahril NSS. A cross-sectional study of Malaysian low-income drug addict wives: Relationship between family impact, coping and mental wellbeing [version 2; peer review: 2 approved with reservations]. F1000Research 2025, 11:683 (https://doi.org/10.12688/f1000research.122476.2)

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Mohd Radzi Tarmizi A Halim, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia

Approved with Reservations

https://doi.org/10.5256/f1000research.178830.r371692

1. Avoid unnecessary explanation on correlational study that repeatedly mentioned in the research design section.
2. Instrument explanation should be more detailed, perhaps adding instrument's domain (if any), sample of item, scoring methods including scores for each domain (if any) or range of total score.
3. Some coping items were removed due to low loadings, and a few coping items with loadings below 0.708 were retained without clear justification.
Suggestion: Provide a stronger rationale for retaining these items, perhaps supported by reliability or theoretical considerations.
4. While the paper touches on cultural factors, more in-depth exploration of religious coping (a significant aspect for Malaysian Muslim populations) could enhance the discussion. Suggestion: Include qualitative components to explore cultural and religious coping strategies more deeply.
5. While ethics approval is noted, the paper could better explain how participants’ confidentiality and emotional safety were handled during data collection.
6. The direct effect of family impact on mental wellbeing was non-significant (β = -0.14, p = 0.19), correctly noted, but the discussion could elaborate more on why this non-significance exists, considering cultural or sample-related factors.

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: suicide; adolescent mental health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 24 Mar 2025

Zarinah Arshat, Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Malaysia

24 Mar 2025

Author Response
We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the ... Continue reading
We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the comments:

Comment 1: Avoid unnecessary explanation on correlational study that repeatedly mentioned in the research design section.
Response: Thank you for the observation. We have revised the "Research Design" section to avoid repetition and have streamlined the explanation of the correlational study design to ensure conciseness and clarity. The revised section is as follows:

This study employed a quantitative, cross-sectional survey design to examine the relationship between family impact, coping, and mental wellbeing among wives of drug addicts. Data analysis was conducted using SmartPLS software to assess both direct and indirect (mediated) relationships, particularly the mediating role of coping in the relationship between family impact and mental wellbeing.
A purposive sampling method was used to select 132 respondents who met the following inclusion criteria: (i) low-income wives (household income less than RM4,849 or USD1,103.56); (ii) wife of a drug addict undergoing rehabilitation at a government facility; (iii) not involved in drug abuse; (iv) Malay ethnicity; and (v) has at least one child aged 17 or younger living at home.
Of the 296 potential participants referred by the National Anti-Drug Agency (NARC), 45 did not meet the inclusion criteria, 85 could not be reached, and 32 declined to participate, resulting in a final sample of 132. Sample size estimation was conducted using G*Power software, which determined that a minimum of 107 respondents was needed to achieve adequate statistical power at a 95% confidence level (α = 0.05), based on the inclusion of two independent variables. Participants ranged in age from 18 to 53 years (M = 37.92). Additional socio-demographic data collected included education level, marriage duration, and number of children under the age of 17. To address potential common method bias, Harman’s single-factor test was performed using the single-component approach, which confirmed that no significant bias was present in the dataset.

Comment 2: Instrument explanation should be more detailed, perhaps adding instrument's domain (if any), sample of item, scoring methods including scores for each domain (if any) or range of total score.

Response:
Thank you for this valuable suggestion. We have revised the "Instruments" section to provide a more comprehensive explanation for each measurement tool used in the study. The updated section now includes:

The domain(s) measured by each instrument (e.g., economic strain, marital conflict, coping strategies, and mental wellbeing).

Sample items for each scale.

Scoring methods used, including Likert scale ranges.

The possible total score ranges for each instrument.

Information on internal consistency (Cronbach’s alpha) from previous studies as well as from our current study.

Instruments
Economic Strain
Economic strain was measured using the Economic Strain Scale (ESS) developed by Mills, Grasmick, Morgan, and Wenk (1992). This scale has been previously employed to assess financial stress in various family contexts, such as among divorced women (Muslihah Hasbullah@Abdullah, Najibah Mohd Zin & Saodah Wok, 2009) and fathers experiencing financial pressure (Beane, 1998). The scale consists of four items, one of which is: “I am having financial problems.” Respondents rate each item using a 4-point Likert scale ranging from 1 = Strongly Disagree to 4 = Strongly Agree. The total score ranges from 4 to 16, with higher scores indicating greater economic strain. In previous studies, the Cronbach’s alpha ranged from 0.81 to 0.86, and the current study recorded an alpha of 0.89, indicating strong internal consistency.
Marital Conflict
Marital conflict was measured using the Conflict subscale of the Braiker-Kelly Partnership Questionnaire (Braiker & Kelly, 1979). This subscale has been widely used to examine various types of relationship and marital conflicts, including studies involving married couples, same-sex partners, and parents of children with autism. The scale consists of five items, including: “When you and your partner argue, how serious are the problems or arguments?” and “How often do you and your partner quarrel?” In the original version, the subscale uses a 9-point Likert scale; however, following practices from other studies (e.g., Zahid & Tariq, 2020), this study adopted a 5-point Likert scale ranging from 1 = Not at all t 5 = Very much/often. The total score ranges from 5 to 25, with higher scores indicating higher levels of conflict. Previous studies reported Cronbach’s alpha values ranging from 0.69 to 0.84. In this study, the internal consistency was 0.90.
Coping
Coping was assessed using the Coping and Adaptation Processing Scale – Short Form (CAPS-SF), developed by Roy et al. (2016). The scale measures how individuals respond cognitively and behaviorally to difficult or stressful life events. It comprises 15 items, such as: “Gather as much information as possible to increase my options” and “Use humor to handle the situation.” Each item is rated on a 4-point Likert scale ranging from 1 = Never to 4 = Always. The total score is obtained by summing the responses, with possible scores ranging from 15 to 60, where a higher score indicates more frequent use of adaptive coping strategies. The Cronbach’s alpha for this study was 0.79.
Mental Wellbeing
Mental wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) developed by researchers from the Universities of Warwick and Edinburgh (Taggart et al., 2015). This scale reflects both the emotional and psychological functioning aspects of wellbeing. It contains 7 items, including: “I’ve been feeling optimistic about the future” and “I’ve been feeling useful.” Respondents rate their experiences using a 5-point Likert scale from 1 = None of the time to 5 = All of the time. The total score ranges from 7 to 35, with higher scores representing better mental wellbeing. The scale demonstrated good internal consistency in this study, with a Cronbach’s alpha of 0.83.

Comment 3: Some coping items were removed due to low loadings, and a few coping items with loadings below 0.708 were retained without clear justification. Suggestion: Provide a stronger rationale for retaining these items, perhaps supported by reliability or theoretical considerations.

Response:
Thank you for your insightful comment. We have revised the explanation in the "Measurement Model" section to clarify the rationale for item retention and deletion within the coping construct. Specifically:

Several coping items (e.g., CAPS_1, CAPS_5, CAPS_8, CAPS_9, CAPS_12, CAPS_13, CAPS_14) were removed due to very low factor loadings, following the recommendation of Hair et al. (2021), which suggests item deletion if loading values are below 0.40 or if their removal improves model fit and internal consistency.

A few items with loading values between 0.40 and 0.708 were retained based on their theoretical relevance to the coping construct (as grounded in the Stress-Strain-Coping-Support model) and because their presence did not adversely affect composite reliability (CR), average variance extracted (AVE), or discriminant validity.

Internal consistency for the coping construct remained within acceptable thresholds (CR = 0.889), and the AVE exceeded the recommended value of 0.50, thus supporting the adequacy of the construct’s convergent validity.

Comment 4: While the paper touches on cultural factors, more in-depth exploration of religious coping (a significant aspect for Malaysian Muslim populations) could enhance the discussion. Suggestion: Include qualitative components to explore cultural and religious coping strategies more deeply.
Response: Thank you for the valuable suggestion. While this study is quantitative in nature, we have acknowledged the potential value of incorporating qualitative components in future studies to explore religious and cultural coping mechanisms more deeply.

Comment 5: While ethics approval is noted, the paper could better explain how participants’ confidentiality and emotional safety were handled during data collection.

Response: We have updated the "Procedure" section to include additional details on how participants’ confidentiality and emotional well-being were safeguarded. This includes steps such as anonymized data collection, informed consent procedures, and providing contact information for emotional support services

Procedure
The study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (Reference No.: JKEUPM-2020-406). A set of questionnaires was used to collect the data in this study. Prior to the study, permission was granted to the Malaysian National Anti-Drug Agency (AADK) to gather information about the wife from drug addicts (clients) at the Narcotics Addiction Rehabilitation Centre (PUSPEN) involved. Their wives were called by phone to ask for their permission to take part in the study after the drug addicts’ wives’ information was found. Next, the questionnaire was then distributed through WhatsApp in the form of a “Google form”.
Written informed consent was also given to the respondents along with the distributed questionnaires. Participants were informed that their responses would remain anonymous, and no identifying information was collected. All data were securely stored and accessible only to the research team. Participants were also assured that they could withdraw from the study at any point without any consequences.
To protect emotional well-being, participants were provided with contact information for professional counselling services and support hotlines, should they experience any psychological distress while answering the survey. Furthermore, the language and structure of the questionnaire were designed to be sensitive and non-triggering, and participants completed the survey at their own pace in the privacy of their own homes.
A pilot study, including 30 women of drug addicts whose husbands were seeking treatment at PUSPEN Batu Kurau and PUSPEN Perlop, Perak, was conducted prior to the main study to ensure clarity and appropriateness of the research instruments.

Comment 6: The direct effect of family impact on mental wellbeing was non-significant (β = -0.14, p = 0.19), correctly noted, but the discussion could elaborate more on why this non-significance exists, considering cultural or sample-related factors.
Response:
Thank you for this insightful comment. We have expanded the Discussion section to include possible cultural and contextual explanations for the non-significant direct relationship between family impact and mental wellbeing. Specifically, we discuss the role of religious beliefs, resilience, and collectivist family values common in Malaysian society, which may act as protective factors that buffer the negative effects of family-related stress. These cultural mechanisms may help explain why the impact of family-related stressors does not directly translate into poor mental wellbeing. Please refer to the updated Discussion section on page XX.
Suggested Addition to the Discussion Section:
Although this study found a significant indirect relationship between family impact and mental wellbeing via coping, the direct effect was not statistically significant. This result may be understood within the cultural and religious context of the sample population. As many respondents were Malay Muslim women from low-income households, they may draw upon religious coping mechanisms, such as prayer, acceptance, and faith in divine will, to endure difficult family situations. These strategies can foster inner strength and optimism, reducing the psychological toll of family conflict and economic hardship.
Furthermore, the collectivist nature of Malaysian society, where extended family networks often provide emotional and financial support, may help buffer the negative impact of stressors. In such social systems, communal resilience and shared caregiving responsibilities can alleviate the burden traditionally carried by an individual spouse. Finally, resilience—especially among women facing chronic stress—has been well-documented in similar populations and may help explain why high family impact does not always correspond with low mental wellbeing. These culturally relevant factors highlight the importance of exploring indirect or mediated pathways, such as coping, when examining the psychological outcomes of stress.
We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the comments:

Comment 1: Avoid unnecessary explanation on correlational study that repeatedly mentioned in the research design section.
Response: Thank you for the observation. We have revised the "Research Design" section to avoid repetition and have streamlined the explanation of the correlational study design to ensure conciseness and clarity. The revised section is as follows:

This study employed a quantitative, cross-sectional survey design to examine the relationship between family impact, coping, and mental wellbeing among wives of drug addicts. Data analysis was conducted using SmartPLS software to assess both direct and indirect (mediated) relationships, particularly the mediating role of coping in the relationship between family impact and mental wellbeing.
A purposive sampling method was used to select 132 respondents who met the following inclusion criteria: (i) low-income wives (household income less than RM4,849 or USD1,103.56); (ii) wife of a drug addict undergoing rehabilitation at a government facility; (iii) not involved in drug abuse; (iv) Malay ethnicity; and (v) has at least one child aged 17 or younger living at home.
Of the 296 potential participants referred by the National Anti-Drug Agency (NARC), 45 did not meet the inclusion criteria, 85 could not be reached, and 32 declined to participate, resulting in a final sample of 132. Sample size estimation was conducted using G*Power software, which determined that a minimum of 107 respondents was needed to achieve adequate statistical power at a 95% confidence level (α = 0.05), based on the inclusion of two independent variables. Participants ranged in age from 18 to 53 years (M = 37.92). Additional socio-demographic data collected included education level, marriage duration, and number of children under the age of 17. To address potential common method bias, Harman’s single-factor test was performed using the single-component approach, which confirmed that no significant bias was present in the dataset.

Comment 2: Instrument explanation should be more detailed, perhaps adding instrument's domain (if any), sample of item, scoring methods including scores for each domain (if any) or range of total score.

Response:
Thank you for this valuable suggestion. We have revised the "Instruments" section to provide a more comprehensive explanation for each measurement tool used in the study. The updated section now includes:

The domain(s) measured by each instrument (e.g., economic strain, marital conflict, coping strategies, and mental wellbeing).

Sample items for each scale.

Scoring methods used, including Likert scale ranges.

The possible total score ranges for each instrument.

Information on internal consistency (Cronbach’s alpha) from previous studies as well as from our current study.

Instruments
Economic Strain
Economic strain was measured using the Economic Strain Scale (ESS) developed by Mills, Grasmick, Morgan, and Wenk (1992). This scale has been previously employed to assess financial stress in various family contexts, such as among divorced women (Muslihah Hasbullah@Abdullah, Najibah Mohd Zin & Saodah Wok, 2009) and fathers experiencing financial pressure (Beane, 1998). The scale consists of four items, one of which is: “I am having financial problems.” Respondents rate each item using a 4-point Likert scale ranging from 1 = Strongly Disagree to 4 = Strongly Agree. The total score ranges from 4 to 16, with higher scores indicating greater economic strain. In previous studies, the Cronbach’s alpha ranged from 0.81 to 0.86, and the current study recorded an alpha of 0.89, indicating strong internal consistency.
Marital Conflict
Marital conflict was measured using the Conflict subscale of the Braiker-Kelly Partnership Questionnaire (Braiker & Kelly, 1979). This subscale has been widely used to examine various types of relationship and marital conflicts, including studies involving married couples, same-sex partners, and parents of children with autism. The scale consists of five items, including: “When you and your partner argue, how serious are the problems or arguments?” and “How often do you and your partner quarrel?” In the original version, the subscale uses a 9-point Likert scale; however, following practices from other studies (e.g., Zahid & Tariq, 2020), this study adopted a 5-point Likert scale ranging from 1 = Not at all t 5 = Very much/often. The total score ranges from 5 to 25, with higher scores indicating higher levels of conflict. Previous studies reported Cronbach’s alpha values ranging from 0.69 to 0.84. In this study, the internal consistency was 0.90.
Coping
Coping was assessed using the Coping and Adaptation Processing Scale – Short Form (CAPS-SF), developed by Roy et al. (2016). The scale measures how individuals respond cognitively and behaviorally to difficult or stressful life events. It comprises 15 items, such as: “Gather as much information as possible to increase my options” and “Use humor to handle the situation.” Each item is rated on a 4-point Likert scale ranging from 1 = Never to 4 = Always. The total score is obtained by summing the responses, with possible scores ranging from 15 to 60, where a higher score indicates more frequent use of adaptive coping strategies. The Cronbach’s alpha for this study was 0.79.
Mental Wellbeing
Mental wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) developed by researchers from the Universities of Warwick and Edinburgh (Taggart et al., 2015). This scale reflects both the emotional and psychological functioning aspects of wellbeing. It contains 7 items, including: “I’ve been feeling optimistic about the future” and “I’ve been feeling useful.” Respondents rate their experiences using a 5-point Likert scale from 1 = None of the time to 5 = All of the time. The total score ranges from 7 to 35, with higher scores representing better mental wellbeing. The scale demonstrated good internal consistency in this study, with a Cronbach’s alpha of 0.83.

Comment 3: Some coping items were removed due to low loadings, and a few coping items with loadings below 0.708 were retained without clear justification. Suggestion: Provide a stronger rationale for retaining these items, perhaps supported by reliability or theoretical considerations.

Response:
Thank you for your insightful comment. We have revised the explanation in the "Measurement Model" section to clarify the rationale for item retention and deletion within the coping construct. Specifically:

Several coping items (e.g., CAPS_1, CAPS_5, CAPS_8, CAPS_9, CAPS_12, CAPS_13, CAPS_14) were removed due to very low factor loadings, following the recommendation of Hair et al. (2021), which suggests item deletion if loading values are below 0.40 or if their removal improves model fit and internal consistency.

A few items with loading values between 0.40 and 0.708 were retained based on their theoretical relevance to the coping construct (as grounded in the Stress-Strain-Coping-Support model) and because their presence did not adversely affect composite reliability (CR), average variance extracted (AVE), or discriminant validity.

Internal consistency for the coping construct remained within acceptable thresholds (CR = 0.889), and the AVE exceeded the recommended value of 0.50, thus supporting the adequacy of the construct’s convergent validity.

Comment 4: While the paper touches on cultural factors, more in-depth exploration of religious coping (a significant aspect for Malaysian Muslim populations) could enhance the discussion. Suggestion: Include qualitative components to explore cultural and religious coping strategies more deeply.
Response: Thank you for the valuable suggestion. While this study is quantitative in nature, we have acknowledged the potential value of incorporating qualitative components in future studies to explore religious and cultural coping mechanisms more deeply.

Comment 5: While ethics approval is noted, the paper could better explain how participants’ confidentiality and emotional safety were handled during data collection.

Response: We have updated the "Procedure" section to include additional details on how participants’ confidentiality and emotional well-being were safeguarded. This includes steps such as anonymized data collection, informed consent procedures, and providing contact information for emotional support services

Procedure
The study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (Reference No.: JKEUPM-2020-406). A set of questionnaires was used to collect the data in this study. Prior to the study, permission was granted to the Malaysian National Anti-Drug Agency (AADK) to gather information about the wife from drug addicts (clients) at the Narcotics Addiction Rehabilitation Centre (PUSPEN) involved. Their wives were called by phone to ask for their permission to take part in the study after the drug addicts’ wives’ information was found. Next, the questionnaire was then distributed through WhatsApp in the form of a “Google form”.
Written informed consent was also given to the respondents along with the distributed questionnaires. Participants were informed that their responses would remain anonymous, and no identifying information was collected. All data were securely stored and accessible only to the research team. Participants were also assured that they could withdraw from the study at any point without any consequences.
To protect emotional well-being, participants were provided with contact information for professional counselling services and support hotlines, should they experience any psychological distress while answering the survey. Furthermore, the language and structure of the questionnaire were designed to be sensitive and non-triggering, and participants completed the survey at their own pace in the privacy of their own homes.
A pilot study, including 30 women of drug addicts whose husbands were seeking treatment at PUSPEN Batu Kurau and PUSPEN Perlop, Perak, was conducted prior to the main study to ensure clarity and appropriateness of the research instruments.

Comment 6: The direct effect of family impact on mental wellbeing was non-significant (β = -0.14, p = 0.19), correctly noted, but the discussion could elaborate more on why this non-significance exists, considering cultural or sample-related factors.
Response:
Thank you for this insightful comment. We have expanded the Discussion section to include possible cultural and contextual explanations for the non-significant direct relationship between family impact and mental wellbeing. Specifically, we discuss the role of religious beliefs, resilience, and collectivist family values common in Malaysian society, which may act as protective factors that buffer the negative effects of family-related stress. These cultural mechanisms may help explain why the impact of family-related stressors does not directly translate into poor mental wellbeing. Please refer to the updated Discussion section on page XX.
Suggested Addition to the Discussion Section:
Although this study found a significant indirect relationship between family impact and mental wellbeing via coping, the direct effect was not statistically significant. This result may be understood within the cultural and religious context of the sample population. As many respondents were Malay Muslim women from low-income households, they may draw upon religious coping mechanisms, such as prayer, acceptance, and faith in divine will, to endure difficult family situations. These strategies can foster inner strength and optimism, reducing the psychological toll of family conflict and economic hardship.
Furthermore, the collectivist nature of Malaysian society, where extended family networks often provide emotional and financial support, may help buffer the negative impact of stressors. In such social systems, communal resilience and shared caregiving responsibilities can alleviate the burden traditionally carried by an individual spouse. Finally, resilience—especially among women facing chronic stress—has been well-documented in similar populations and may help explain why high family impact does not always correspond with low mental wellbeing. These culturally relevant factors highlight the importance of exploring indirect or mediated pathways, such as coping, when examining the psychological outcomes of stress.
Competing Interests: The authors declare that there are no competing interests that could be construed to influence the validity or importance of the findings presented in this article. Close
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COMMENTS ON THIS REPORT

Author Response 24 Mar 2025

Zarinah Arshat, Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Malaysia

24 Mar 2025

Author Response
We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the ... Continue reading
We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the comments:

Comment 1: Avoid unnecessary explanation on correlational study that repeatedly mentioned in the research design section.
Response: Thank you for the observation. We have revised the "Research Design" section to avoid repetition and have streamlined the explanation of the correlational study design to ensure conciseness and clarity. The revised section is as follows:

This study employed a quantitative, cross-sectional survey design to examine the relationship between family impact, coping, and mental wellbeing among wives of drug addicts. Data analysis was conducted using SmartPLS software to assess both direct and indirect (mediated) relationships, particularly the mediating role of coping in the relationship between family impact and mental wellbeing.
A purposive sampling method was used to select 132 respondents who met the following inclusion criteria: (i) low-income wives (household income less than RM4,849 or USD1,103.56); (ii) wife of a drug addict undergoing rehabilitation at a government facility; (iii) not involved in drug abuse; (iv) Malay ethnicity; and (v) has at least one child aged 17 or younger living at home.
Of the 296 potential participants referred by the National Anti-Drug Agency (NARC), 45 did not meet the inclusion criteria, 85 could not be reached, and 32 declined to participate, resulting in a final sample of 132. Sample size estimation was conducted using G*Power software, which determined that a minimum of 107 respondents was needed to achieve adequate statistical power at a 95% confidence level (α = 0.05), based on the inclusion of two independent variables. Participants ranged in age from 18 to 53 years (M = 37.92). Additional socio-demographic data collected included education level, marriage duration, and number of children under the age of 17. To address potential common method bias, Harman’s single-factor test was performed using the single-component approach, which confirmed that no significant bias was present in the dataset.

Comment 2: Instrument explanation should be more detailed, perhaps adding instrument's domain (if any), sample of item, scoring methods including scores for each domain (if any) or range of total score.

Response:
Thank you for this valuable suggestion. We have revised the "Instruments" section to provide a more comprehensive explanation for each measurement tool used in the study. The updated section now includes:

The domain(s) measured by each instrument (e.g., economic strain, marital conflict, coping strategies, and mental wellbeing).

Sample items for each scale.

Scoring methods used, including Likert scale ranges.

The possible total score ranges for each instrument.

Information on internal consistency (Cronbach’s alpha) from previous studies as well as from our current study.

Instruments
Economic Strain
Economic strain was measured using the Economic Strain Scale (ESS) developed by Mills, Grasmick, Morgan, and Wenk (1992). This scale has been previously employed to assess financial stress in various family contexts, such as among divorced women (Muslihah Hasbullah@Abdullah, Najibah Mohd Zin & Saodah Wok, 2009) and fathers experiencing financial pressure (Beane, 1998). The scale consists of four items, one of which is: “I am having financial problems.” Respondents rate each item using a 4-point Likert scale ranging from 1 = Strongly Disagree to 4 = Strongly Agree. The total score ranges from 4 to 16, with higher scores indicating greater economic strain. In previous studies, the Cronbach’s alpha ranged from 0.81 to 0.86, and the current study recorded an alpha of 0.89, indicating strong internal consistency.
Marital Conflict
Marital conflict was measured using the Conflict subscale of the Braiker-Kelly Partnership Questionnaire (Braiker & Kelly, 1979). This subscale has been widely used to examine various types of relationship and marital conflicts, including studies involving married couples, same-sex partners, and parents of children with autism. The scale consists of five items, including: “When you and your partner argue, how serious are the problems or arguments?” and “How often do you and your partner quarrel?” In the original version, the subscale uses a 9-point Likert scale; however, following practices from other studies (e.g., Zahid & Tariq, 2020), this study adopted a 5-point Likert scale ranging from 1 = Not at all t 5 = Very much/often. The total score ranges from 5 to 25, with higher scores indicating higher levels of conflict. Previous studies reported Cronbach’s alpha values ranging from 0.69 to 0.84. In this study, the internal consistency was 0.90.
Coping
Coping was assessed using the Coping and Adaptation Processing Scale – Short Form (CAPS-SF), developed by Roy et al. (2016). The scale measures how individuals respond cognitively and behaviorally to difficult or stressful life events. It comprises 15 items, such as: “Gather as much information as possible to increase my options” and “Use humor to handle the situation.” Each item is rated on a 4-point Likert scale ranging from 1 = Never to 4 = Always. The total score is obtained by summing the responses, with possible scores ranging from 15 to 60, where a higher score indicates more frequent use of adaptive coping strategies. The Cronbach’s alpha for this study was 0.79.
Mental Wellbeing
Mental wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) developed by researchers from the Universities of Warwick and Edinburgh (Taggart et al., 2015). This scale reflects both the emotional and psychological functioning aspects of wellbeing. It contains 7 items, including: “I’ve been feeling optimistic about the future” and “I’ve been feeling useful.” Respondents rate their experiences using a 5-point Likert scale from 1 = None of the time to 5 = All of the time. The total score ranges from 7 to 35, with higher scores representing better mental wellbeing. The scale demonstrated good internal consistency in this study, with a Cronbach’s alpha of 0.83.

Comment 3: Some coping items were removed due to low loadings, and a few coping items with loadings below 0.708 were retained without clear justification. Suggestion: Provide a stronger rationale for retaining these items, perhaps supported by reliability or theoretical considerations.

Response:
Thank you for your insightful comment. We have revised the explanation in the "Measurement Model" section to clarify the rationale for item retention and deletion within the coping construct. Specifically:

Several coping items (e.g., CAPS_1, CAPS_5, CAPS_8, CAPS_9, CAPS_12, CAPS_13, CAPS_14) were removed due to very low factor loadings, following the recommendation of Hair et al. (2021), which suggests item deletion if loading values are below 0.40 or if their removal improves model fit and internal consistency.

A few items with loading values between 0.40 and 0.708 were retained based on their theoretical relevance to the coping construct (as grounded in the Stress-Strain-Coping-Support model) and because their presence did not adversely affect composite reliability (CR), average variance extracted (AVE), or discriminant validity.

Internal consistency for the coping construct remained within acceptable thresholds (CR = 0.889), and the AVE exceeded the recommended value of 0.50, thus supporting the adequacy of the construct’s convergent validity.

Comment 4: While the paper touches on cultural factors, more in-depth exploration of religious coping (a significant aspect for Malaysian Muslim populations) could enhance the discussion. Suggestion: Include qualitative components to explore cultural and religious coping strategies more deeply.
Response: Thank you for the valuable suggestion. While this study is quantitative in nature, we have acknowledged the potential value of incorporating qualitative components in future studies to explore religious and cultural coping mechanisms more deeply.

Comment 5: While ethics approval is noted, the paper could better explain how participants’ confidentiality and emotional safety were handled during data collection.

Response: We have updated the "Procedure" section to include additional details on how participants’ confidentiality and emotional well-being were safeguarded. This includes steps such as anonymized data collection, informed consent procedures, and providing contact information for emotional support services

Procedure
The study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (Reference No.: JKEUPM-2020-406). A set of questionnaires was used to collect the data in this study. Prior to the study, permission was granted to the Malaysian National Anti-Drug Agency (AADK) to gather information about the wife from drug addicts (clients) at the Narcotics Addiction Rehabilitation Centre (PUSPEN) involved. Their wives were called by phone to ask for their permission to take part in the study after the drug addicts’ wives’ information was found. Next, the questionnaire was then distributed through WhatsApp in the form of a “Google form”.
Written informed consent was also given to the respondents along with the distributed questionnaires. Participants were informed that their responses would remain anonymous, and no identifying information was collected. All data were securely stored and accessible only to the research team. Participants were also assured that they could withdraw from the study at any point without any consequences.
To protect emotional well-being, participants were provided with contact information for professional counselling services and support hotlines, should they experience any psychological distress while answering the survey. Furthermore, the language and structure of the questionnaire were designed to be sensitive and non-triggering, and participants completed the survey at their own pace in the privacy of their own homes.
A pilot study, including 30 women of drug addicts whose husbands were seeking treatment at PUSPEN Batu Kurau and PUSPEN Perlop, Perak, was conducted prior to the main study to ensure clarity and appropriateness of the research instruments.

Comment 6: The direct effect of family impact on mental wellbeing was non-significant (β = -0.14, p = 0.19), correctly noted, but the discussion could elaborate more on why this non-significance exists, considering cultural or sample-related factors.
Response:
Thank you for this insightful comment. We have expanded the Discussion section to include possible cultural and contextual explanations for the non-significant direct relationship between family impact and mental wellbeing. Specifically, we discuss the role of religious beliefs, resilience, and collectivist family values common in Malaysian society, which may act as protective factors that buffer the negative effects of family-related stress. These cultural mechanisms may help explain why the impact of family-related stressors does not directly translate into poor mental wellbeing. Please refer to the updated Discussion section on page XX.
Suggested Addition to the Discussion Section:
Although this study found a significant indirect relationship between family impact and mental wellbeing via coping, the direct effect was not statistically significant. This result may be understood within the cultural and religious context of the sample population. As many respondents were Malay Muslim women from low-income households, they may draw upon religious coping mechanisms, such as prayer, acceptance, and faith in divine will, to endure difficult family situations. These strategies can foster inner strength and optimism, reducing the psychological toll of family conflict and economic hardship.
Furthermore, the collectivist nature of Malaysian society, where extended family networks often provide emotional and financial support, may help buffer the negative impact of stressors. In such social systems, communal resilience and shared caregiving responsibilities can alleviate the burden traditionally carried by an individual spouse. Finally, resilience—especially among women facing chronic stress—has been well-documented in similar populations and may help explain why high family impact does not always correspond with low mental wellbeing. These culturally relevant factors highlight the importance of exploring indirect or mediated pathways, such as coping, when examining the psychological outcomes of stress.
We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the comments:

Comment 1: Avoid unnecessary explanation on correlational study that repeatedly mentioned in the research design section.
Response: Thank you for the observation. We have revised the "Research Design" section to avoid repetition and have streamlined the explanation of the correlational study design to ensure conciseness and clarity. The revised section is as follows:

This study employed a quantitative, cross-sectional survey design to examine the relationship between family impact, coping, and mental wellbeing among wives of drug addicts. Data analysis was conducted using SmartPLS software to assess both direct and indirect (mediated) relationships, particularly the mediating role of coping in the relationship between family impact and mental wellbeing.
A purposive sampling method was used to select 132 respondents who met the following inclusion criteria: (i) low-income wives (household income less than RM4,849 or USD1,103.56); (ii) wife of a drug addict undergoing rehabilitation at a government facility; (iii) not involved in drug abuse; (iv) Malay ethnicity; and (v) has at least one child aged 17 or younger living at home.
Of the 296 potential participants referred by the National Anti-Drug Agency (NARC), 45 did not meet the inclusion criteria, 85 could not be reached, and 32 declined to participate, resulting in a final sample of 132. Sample size estimation was conducted using G*Power software, which determined that a minimum of 107 respondents was needed to achieve adequate statistical power at a 95% confidence level (α = 0.05), based on the inclusion of two independent variables. Participants ranged in age from 18 to 53 years (M = 37.92). Additional socio-demographic data collected included education level, marriage duration, and number of children under the age of 17. To address potential common method bias, Harman’s single-factor test was performed using the single-component approach, which confirmed that no significant bias was present in the dataset.

Comment 2: Instrument explanation should be more detailed, perhaps adding instrument's domain (if any), sample of item, scoring methods including scores for each domain (if any) or range of total score.

Response:
Thank you for this valuable suggestion. We have revised the "Instruments" section to provide a more comprehensive explanation for each measurement tool used in the study. The updated section now includes:

The domain(s) measured by each instrument (e.g., economic strain, marital conflict, coping strategies, and mental wellbeing).

Sample items for each scale.

Scoring methods used, including Likert scale ranges.

The possible total score ranges for each instrument.

Information on internal consistency (Cronbach’s alpha) from previous studies as well as from our current study.

Instruments
Economic Strain
Economic strain was measured using the Economic Strain Scale (ESS) developed by Mills, Grasmick, Morgan, and Wenk (1992). This scale has been previously employed to assess financial stress in various family contexts, such as among divorced women (Muslihah Hasbullah@Abdullah, Najibah Mohd Zin & Saodah Wok, 2009) and fathers experiencing financial pressure (Beane, 1998). The scale consists of four items, one of which is: “I am having financial problems.” Respondents rate each item using a 4-point Likert scale ranging from 1 = Strongly Disagree to 4 = Strongly Agree. The total score ranges from 4 to 16, with higher scores indicating greater economic strain. In previous studies, the Cronbach’s alpha ranged from 0.81 to 0.86, and the current study recorded an alpha of 0.89, indicating strong internal consistency.
Marital Conflict
Marital conflict was measured using the Conflict subscale of the Braiker-Kelly Partnership Questionnaire (Braiker & Kelly, 1979). This subscale has been widely used to examine various types of relationship and marital conflicts, including studies involving married couples, same-sex partners, and parents of children with autism. The scale consists of five items, including: “When you and your partner argue, how serious are the problems or arguments?” and “How often do you and your partner quarrel?” In the original version, the subscale uses a 9-point Likert scale; however, following practices from other studies (e.g., Zahid & Tariq, 2020), this study adopted a 5-point Likert scale ranging from 1 = Not at all t 5 = Very much/often. The total score ranges from 5 to 25, with higher scores indicating higher levels of conflict. Previous studies reported Cronbach’s alpha values ranging from 0.69 to 0.84. In this study, the internal consistency was 0.90.
Coping
Coping was assessed using the Coping and Adaptation Processing Scale – Short Form (CAPS-SF), developed by Roy et al. (2016). The scale measures how individuals respond cognitively and behaviorally to difficult or stressful life events. It comprises 15 items, such as: “Gather as much information as possible to increase my options” and “Use humor to handle the situation.” Each item is rated on a 4-point Likert scale ranging from 1 = Never to 4 = Always. The total score is obtained by summing the responses, with possible scores ranging from 15 to 60, where a higher score indicates more frequent use of adaptive coping strategies. The Cronbach’s alpha for this study was 0.79.
Mental Wellbeing
Mental wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) developed by researchers from the Universities of Warwick and Edinburgh (Taggart et al., 2015). This scale reflects both the emotional and psychological functioning aspects of wellbeing. It contains 7 items, including: “I’ve been feeling optimistic about the future” and “I’ve been feeling useful.” Respondents rate their experiences using a 5-point Likert scale from 1 = None of the time to 5 = All of the time. The total score ranges from 7 to 35, with higher scores representing better mental wellbeing. The scale demonstrated good internal consistency in this study, with a Cronbach’s alpha of 0.83.

Comment 3: Some coping items were removed due to low loadings, and a few coping items with loadings below 0.708 were retained without clear justification. Suggestion: Provide a stronger rationale for retaining these items, perhaps supported by reliability or theoretical considerations.

Response:
Thank you for your insightful comment. We have revised the explanation in the "Measurement Model" section to clarify the rationale for item retention and deletion within the coping construct. Specifically:

Several coping items (e.g., CAPS_1, CAPS_5, CAPS_8, CAPS_9, CAPS_12, CAPS_13, CAPS_14) were removed due to very low factor loadings, following the recommendation of Hair et al. (2021), which suggests item deletion if loading values are below 0.40 or if their removal improves model fit and internal consistency.

A few items with loading values between 0.40 and 0.708 were retained based on their theoretical relevance to the coping construct (as grounded in the Stress-Strain-Coping-Support model) and because their presence did not adversely affect composite reliability (CR), average variance extracted (AVE), or discriminant validity.

Internal consistency for the coping construct remained within acceptable thresholds (CR = 0.889), and the AVE exceeded the recommended value of 0.50, thus supporting the adequacy of the construct’s convergent validity.

Comment 4: While the paper touches on cultural factors, more in-depth exploration of religious coping (a significant aspect for Malaysian Muslim populations) could enhance the discussion. Suggestion: Include qualitative components to explore cultural and religious coping strategies more deeply.
Response: Thank you for the valuable suggestion. While this study is quantitative in nature, we have acknowledged the potential value of incorporating qualitative components in future studies to explore religious and cultural coping mechanisms more deeply.

Comment 5: While ethics approval is noted, the paper could better explain how participants’ confidentiality and emotional safety were handled during data collection.

Response: We have updated the "Procedure" section to include additional details on how participants’ confidentiality and emotional well-being were safeguarded. This includes steps such as anonymized data collection, informed consent procedures, and providing contact information for emotional support services

Procedure
The study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (Reference No.: JKEUPM-2020-406). A set of questionnaires was used to collect the data in this study. Prior to the study, permission was granted to the Malaysian National Anti-Drug Agency (AADK) to gather information about the wife from drug addicts (clients) at the Narcotics Addiction Rehabilitation Centre (PUSPEN) involved. Their wives were called by phone to ask for their permission to take part in the study after the drug addicts’ wives’ information was found. Next, the questionnaire was then distributed through WhatsApp in the form of a “Google form”.
Written informed consent was also given to the respondents along with the distributed questionnaires. Participants were informed that their responses would remain anonymous, and no identifying information was collected. All data were securely stored and accessible only to the research team. Participants were also assured that they could withdraw from the study at any point without any consequences.
To protect emotional well-being, participants were provided with contact information for professional counselling services and support hotlines, should they experience any psychological distress while answering the survey. Furthermore, the language and structure of the questionnaire were designed to be sensitive and non-triggering, and participants completed the survey at their own pace in the privacy of their own homes.
A pilot study, including 30 women of drug addicts whose husbands were seeking treatment at PUSPEN Batu Kurau and PUSPEN Perlop, Perak, was conducted prior to the main study to ensure clarity and appropriateness of the research instruments.

Comment 6: The direct effect of family impact on mental wellbeing was non-significant (β = -0.14, p = 0.19), correctly noted, but the discussion could elaborate more on why this non-significance exists, considering cultural or sample-related factors.
Response:
Thank you for this insightful comment. We have expanded the Discussion section to include possible cultural and contextual explanations for the non-significant direct relationship between family impact and mental wellbeing. Specifically, we discuss the role of religious beliefs, resilience, and collectivist family values common in Malaysian society, which may act as protective factors that buffer the negative effects of family-related stress. These cultural mechanisms may help explain why the impact of family-related stressors does not directly translate into poor mental wellbeing. Please refer to the updated Discussion section on page XX.
Suggested Addition to the Discussion Section:
Although this study found a significant indirect relationship between family impact and mental wellbeing via coping, the direct effect was not statistically significant. This result may be understood within the cultural and religious context of the sample population. As many respondents were Malay Muslim women from low-income households, they may draw upon religious coping mechanisms, such as prayer, acceptance, and faith in divine will, to endure difficult family situations. These strategies can foster inner strength and optimism, reducing the psychological toll of family conflict and economic hardship.
Furthermore, the collectivist nature of Malaysian society, where extended family networks often provide emotional and financial support, may help buffer the negative impact of stressors. In such social systems, communal resilience and shared caregiving responsibilities can alleviate the burden traditionally carried by an individual spouse. Finally, resilience—especially among women facing chronic stress—has been well-documented in similar populations and may help explain why high family impact does not always correspond with low mental wellbeing. These culturally relevant factors highlight the importance of exploring indirect or mediated pathways, such as coping, when examining the psychological outcomes of stress.
Competing Interests: The authors declare that there are no competing interests that could be construed to influence the validity or importance of the findings presented in this article. Close
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Reviewer Report 08 Jun 2024

Mohd Radzi Tarmizi A Halim, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia

Approved

https://doi.org/10.5256/f1000research.134465.r284913

Introduction:

Cultural Context:

Gap: Existing research primarily uses data from European countries, lacking insights from Asian and Muslim contexts.
Recommendation: Emphasize how studying Muslim wives of drug addicts in Malaysia will provide unique cultural insights and contribute to a more diverse understanding of the issue.
Interpersonal vs. Intrapersonal Coping:

Gap: The SSCS model focuses on interpersonal coping, whereas intrapersonal coping needs more exploration.
Recommendation: Clearly state the importance of exploring intrapersonal coping mechanisms and how this study aims to fill that gap by examining specific coping processes.
Role of Coping as a Mediator:

Gap: The role of coping as a mediating factor between stress (family impact) and strain (mental wellbeing) remains unclear.
Recommendation: Highlight how this study will investigate the mediating role of coping, adding a new dimension to existing literature.

Recommendations for Improvement:

Clarification of Research Gap:

Make the research gap more explicit at the beginning of the introduction. Clearly state what is missing in the current literature and how this study aims to address those gaps.
Literature Citations:

Ensure all statistics and claims are properly cited. For instance, the first statistic about global drug misuse needs a reference.

Model Explanation:

While the SSCS model is introduced and explained, ensure that the connection between the model and the specific objectives of this study is clearly articulated. This will help readers understand why this model is relevant and how it will be used in the study.

Issue: While back-to-back translation was used, cultural adaptation of the instruments should be ensured.

Recommendation: Report any steps taken to culturally adapt the instruments to the Malaysian context, beyond mere translation, to ensure that the questions are culturally relevant and comprehensible to the participants.

Issue: The procedure for contacting participants and obtaining consent is described, but it could be clearer.
Recommendation: Provide more details on how confidentiality and anonymity were maintained, and how participants were supported throughout the study to ensure their comfort and safety.

Result:

Reporting of Non-Significant Relationships:

Issue: The finding that family impact is not directly related to mental wellbeing (β=0.380, p>0.05) should be discussed in more detail.
Recommendation: Provide a thorough interpretation of why this relationship might be non-significant and how it aligns or contrasts with existing literature.

Measurement Model for Lower-Order Components:

Issue: Several coping items were retained despite low loading values.
Recommendation: Explain the rationale for retaining these items in more detail, including any theoretical justification or impact on the overall model.

Discriminant Validity:

Issue: While the HTMT criterion was met, it’s important to discuss the practical implications of these findings.
Recommendation: Briefly explain the importance of discriminant validity in the context of this study and how it supports the reliability of the constructs.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: suicide; adolescent mental health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 03 Aug 2023

Marek A. Motyka, Uniwersytet Rzeszowski, Rzeszow, Podkarpackie Voivodeship, Poland

Approved with Reservations

https://doi.org/10.5256/f1000research.134465.r184781

Thank you for the opportunity to review this manuscript.

The topics are clearly presented and the paper cites current literature. One of the items cited is from the late 1970s, but it relates to a research tool, so in my opinion this citation is entirely appropriate.

I find the study design adequate. The topics taken up by the Authors are definitely relevant, especially since the use of psychoactive drugs in the world is becoming more and more popular, and already the topics concerning the coping of wives (but also husbands) of people suffering from addiction is a research area that requires research or additions to existing studies.

I consider the reviewed manuscript to be a solid scientific work. In my opinion, the methodology and sampling methodologies were clearly described, and I have nothing to complain about here. I also have no objections to the results, however, in my opinion, the "Discussion" section should be expanded to subject the results obtained to comparisons with studies conducted in other countries and with people of a different religion. In my opinion, the comparisons could prove interesting.

Sufficient details of the methods and analyses used in the study are presented. The study can be replicated by other authors. The statistical analysis and its interpretation are appropriate.

Source data are available. The study can be fully replicated.

Yes, as I indicated above I would expand the "Discussion" section, which is why I indicated that the conclusions are partially supported by the results. What I pay attention to with purposive sampling is the need to point out that the results obtained occur in this particular study population. It should be emphasized that the results cannot be generalized because repetition by others of such studies can lead to falsification of the science. Fortunately, the Authors did so in the section "limitations and future research directions." This section confirms that the Authors are aware of the limitations of the research. I found it to be very well written, including directions for future research initiatives.

Also:

I suggest instead of the term "drug addicts" to use the term "people suffering from addiction" because it is a stigma-free term. It is also important to be aware that stigma affects not only drug users but also their loved ones. Addiction has long been recognized as a disease, and the way it is written can affect how we think and how we view this not insignificant part of society (both those who use drugs and their families). I believe that, if only for this reason, some of the terms in this manuscript should be changed, especially "wives of drug addicts."

Recommended research articles to develop the discussion section:

Homish, G. G., Leonard, K. E., & Cornelius, J. R. (2008). Illicit drug use and marital satisfaction. Addictive behaviors, 33(2), 279–291.
Joolaee, S., Fereidooni, Z., Seyed Fatemi, N., Meshkibaf, M. H., & Mirlashari, J. (2014). Exploring needs and expectations of spouses of addicted men in Iran: a qualitative study. Global journal of health science, 6(5), 132–141.
Maghsoudi, J., Alavi, M., Sabzi, Z., & Mancheri, H. (2019). Experienced Psychosocial Problems of Women with Spouses of Substance Abusers: A Qualitative Study. Open access Macedonian journal of medical sciences, 7(21), 3584–3591.
Panaghi, L., Ahmadabadi, Z., Khosravi, N., Sadeghi, M. S., & Madanipour, A. (2016). Living with Addicted Men and Codependency: The Moderating Effect of Personality Traits. Addiction & health, 8(2), 98–106.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Homish GG, Leonard KE, Cornelius JR: Illicit drug use and marital satisfaction.Addict Behav. 2008; 33 (2): 279-91 PubMed Abstract | Publisher Full Text
2. Joolaee S, Fereidooni Z, Seyed Fatemi N, Meshkibaf MH, et al.: Exploring needs and expectations of spouses of addicted men in Iran: a qualitative study.Glob J Health Sci. 2014; 6 (5): 132-41 PubMed Abstract | Publisher Full Text
3. Maghsoudi J, Alavi M, Sabzi Z, Mancheri H: Experienced Psychosocial Problems of Women with Spouses of Substance Abusers: A Qualitative Study.Open Access Maced J Med Sci. 2019; 7 (21): 3584-3591 PubMed Abstract | Publisher Full Text
4. Panaghi L, Ahmadabadi Z, Khosravi N, Sadeghi MS, et al.: Living with Addicted Men and Codependency: The Moderating Effect of Personality Traits.Addict Health. 2016; 8 (2): 98-106 PubMed Abstract

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: drug addiction, youth, sociology, harm reduction, psychoactive substances, social work

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Author Response 19 Mar 2025

Zarinah Arshat, Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Malaysia

19 Mar 2025

Author Response
Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern ... Continue reading
Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern regarding the Discussion section and the need for comparisons with studies conducted in other countries and with people of different religions.
Reviewer Comment:
"The 'Discussion' section should be expanded to subject the results obtained to comparisons with studies conducted in other countries and with people of a different religion. In my opinion, the comparisons could prove interesting."
Response:
We acknowledge the importance of situating our findings within a broader cross-cultural and religious context. In response to your suggestion, we have significantly expanded the Discussion section to include comparisons with international studies and research involving diverse religious backgrounds. Specifically:

Cross-Cultural Comparisons – We have incorporated references to studies conducted in Western (United States, Canada) and Eastern (Asia, Middle East) contexts, examining how cultural variations influence coping mechanisms among spouses of individuals with substance use disorders. We highlight differences in individualistic vs. collectivistic coping strategies, as well as variations in family cohesion and social support systems across these regions.

Religious Coping Perspectives – We now discuss the role of religious coping mechanisms, including prayer, spiritual guidance, and faith, in managing stress among Muslim, Christian, and Hindu populations. These insights are supported by studies that demonstrate the significant role of religion in mental well-being across different cultural settings.

Methodological Considerations – We clarify differences in how family impact, coping, and stress have been measured in prior studies versus our approach, explaining how variations in assessment tools and conceptual frameworks may influence findings.

These additions provide a more comprehensive and globally relevant discussion of our results. We believe that these enhancements improve the manuscript’s depth, applicability, and theoretical contribution.
We appreciate your insightful suggestion, which has strengthened the manuscript, and we hope that the revisions meet your expectations. Thank you again for your time and valuable feedback.
Best regards
Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern regarding the Discussion section and the need for comparisons with studies conducted in other countries and with people of different religions.
Reviewer Comment:
"The 'Discussion' section should be expanded to subject the results obtained to comparisons with studies conducted in other countries and with people of a different religion. In my opinion, the comparisons could prove interesting."
Response:
We acknowledge the importance of situating our findings within a broader cross-cultural and religious context. In response to your suggestion, we have significantly expanded the Discussion section to include comparisons with international studies and research involving diverse religious backgrounds. Specifically:

Cross-Cultural Comparisons – We have incorporated references to studies conducted in Western (United States, Canada) and Eastern (Asia, Middle East) contexts, examining how cultural variations influence coping mechanisms among spouses of individuals with substance use disorders. We highlight differences in individualistic vs. collectivistic coping strategies, as well as variations in family cohesion and social support systems across these regions.

Religious Coping Perspectives – We now discuss the role of religious coping mechanisms, including prayer, spiritual guidance, and faith, in managing stress among Muslim, Christian, and Hindu populations. These insights are supported by studies that demonstrate the significant role of religion in mental well-being across different cultural settings.

Methodological Considerations – We clarify differences in how family impact, coping, and stress have been measured in prior studies versus our approach, explaining how variations in assessment tools and conceptual frameworks may influence findings.

These additions provide a more comprehensive and globally relevant discussion of our results. We believe that these enhancements improve the manuscript’s depth, applicability, and theoretical contribution.
We appreciate your insightful suggestion, which has strengthened the manuscript, and we hope that the revisions meet your expectations. Thank you again for your time and valuable feedback.
Best regards
Competing Interests: The authors declare that they have no competing interests that could be construed to influence the validity, interpretation, or importance of this article or the peer review process. No financial, professional, or personal relationships exist that could be perceived as having influenced the research, analysis, or conclusions presented in this study. Close
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COMMENTS ON THIS REPORT

Author Response 19 Mar 2025

Zarinah Arshat, Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Malaysia

19 Mar 2025

Author Response
Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern ... Continue reading
Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern regarding the Discussion section and the need for comparisons with studies conducted in other countries and with people of different religions.
Reviewer Comment:
"The 'Discussion' section should be expanded to subject the results obtained to comparisons with studies conducted in other countries and with people of a different religion. In my opinion, the comparisons could prove interesting."
Response:
We acknowledge the importance of situating our findings within a broader cross-cultural and religious context. In response to your suggestion, we have significantly expanded the Discussion section to include comparisons with international studies and research involving diverse religious backgrounds. Specifically:

Cross-Cultural Comparisons – We have incorporated references to studies conducted in Western (United States, Canada) and Eastern (Asia, Middle East) contexts, examining how cultural variations influence coping mechanisms among spouses of individuals with substance use disorders. We highlight differences in individualistic vs. collectivistic coping strategies, as well as variations in family cohesion and social support systems across these regions.

Religious Coping Perspectives – We now discuss the role of religious coping mechanisms, including prayer, spiritual guidance, and faith, in managing stress among Muslim, Christian, and Hindu populations. These insights are supported by studies that demonstrate the significant role of religion in mental well-being across different cultural settings.

Methodological Considerations – We clarify differences in how family impact, coping, and stress have been measured in prior studies versus our approach, explaining how variations in assessment tools and conceptual frameworks may influence findings.

These additions provide a more comprehensive and globally relevant discussion of our results. We believe that these enhancements improve the manuscript’s depth, applicability, and theoretical contribution.
We appreciate your insightful suggestion, which has strengthened the manuscript, and we hope that the revisions meet your expectations. Thank you again for your time and valuable feedback.
Best regards
Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern regarding the Discussion section and the need for comparisons with studies conducted in other countries and with people of different religions.
Reviewer Comment:
"The 'Discussion' section should be expanded to subject the results obtained to comparisons with studies conducted in other countries and with people of a different religion. In my opinion, the comparisons could prove interesting."
Response:
We acknowledge the importance of situating our findings within a broader cross-cultural and religious context. In response to your suggestion, we have significantly expanded the Discussion section to include comparisons with international studies and research involving diverse religious backgrounds. Specifically:

Cross-Cultural Comparisons – We have incorporated references to studies conducted in Western (United States, Canada) and Eastern (Asia, Middle East) contexts, examining how cultural variations influence coping mechanisms among spouses of individuals with substance use disorders. We highlight differences in individualistic vs. collectivistic coping strategies, as well as variations in family cohesion and social support systems across these regions.

Religious Coping Perspectives – We now discuss the role of religious coping mechanisms, including prayer, spiritual guidance, and faith, in managing stress among Muslim, Christian, and Hindu populations. These insights are supported by studies that demonstrate the significant role of religion in mental well-being across different cultural settings.

Methodological Considerations – We clarify differences in how family impact, coping, and stress have been measured in prior studies versus our approach, explaining how variations in assessment tools and conceptual frameworks may influence findings.

These additions provide a more comprehensive and globally relevant discussion of our results. We believe that these enhancements improve the manuscript’s depth, applicability, and theoretical contribution.
We appreciate your insightful suggestion, which has strengthened the manuscript, and we hope that the revisions meet your expectations. Thank you again for your time and valuable feedback.
Best regards
Competing Interests: The authors declare that they have no competing interests that could be construed to influence the validity, interpretation, or importance of this article or the peer review process. No financial, professional, or personal relationships exist that could be perceived as having influenced the research, analysis, or conclusions presented in this study. Close
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Marek A. Motyka, Uniwersytet Rzeszowski, Rzeszow, Poland
Mohd Radzi Tarmizi A Halim, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia

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20 Mar 2025 | for Version 2

Mohd Radzi Tarmizi A Halim, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia

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suicide; adolescent mental health

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24 Mar 2025

Zarinah Arshat, Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Malaysia

We sincerely thank Reviewer 2 for the insightful and constructive comments provided. We have carefully considered each point and revised the manuscript accordingly. Below is a point-by-point response to the comments:

Comment 1: Avoid unnecessary explanation on correlational study that repeatedly mentioned in the research design section.
Response: Thank you for the observation. We have revised the "Research Design" section to avoid repetition and have streamlined the explanation of the correlational study design to ensure conciseness and clarity. The revised section is as follows:

This study employed a quantitative, cross-sectional survey design to examine the relationship between family impact, coping, and mental wellbeing among wives of drug addicts. Data analysis was conducted using SmartPLS software to assess both direct and indirect (mediated) relationships, particularly the mediating role of coping in the relationship between family impact and mental wellbeing.
A purposive sampling method was used to select 132 respondents who met the following inclusion criteria: (i) low-income wives (household income less than RM4,849 or USD1,103.56); (ii) wife of a drug addict undergoing rehabilitation at a government facility; (iii) not involved in drug abuse; (iv) Malay ethnicity; and (v) has at least one child aged 17 or younger living at home.
Of the 296 potential participants referred by the National Anti-Drug Agency (NARC), 45 did not meet the inclusion criteria, 85 could not be reached, and 32 declined to participate, resulting in a final sample of 132. Sample size estimation was conducted using G*Power software, which determined that a minimum of 107 respondents was needed to achieve adequate statistical power at a 95% confidence level (α = 0.05), based on the inclusion of two independent variables. Participants ranged in age from 18 to 53 years (M = 37.92). Additional socio-demographic data collected included education level, marriage duration, and number of children under the age of 17. To address potential common method bias, Harman’s single-factor test was performed using the single-component approach, which confirmed that no significant bias was present in the dataset.

Comment 2: Instrument explanation should be more detailed, perhaps adding instrument's domain (if any), sample of item, scoring methods including scores for each domain (if any) or range of total score.

Response:
Thank you for this valuable suggestion. We have revised the "Instruments" section to provide a more comprehensive explanation for each measurement tool used in the study. The updated section now includes:

The domain(s) measured by each instrument (e.g., economic strain, marital conflict, coping strategies, and mental wellbeing).
Sample items for each scale.
Scoring methods used, including Likert scale ranges.
The possible total score ranges for each instrument.
Information on internal consistency (Cronbach’s alpha) from previous studies as well as from our current study.

Instruments
Economic Strain
Economic strain was measured using the Economic Strain Scale (ESS) developed by Mills, Grasmick, Morgan, and Wenk (1992). This scale has been previously employed to assess financial stress in various family contexts, such as among divorced women (Muslihah Hasbullah@Abdullah, Najibah Mohd Zin & Saodah Wok, 2009) and fathers experiencing financial pressure (Beane, 1998). The scale consists of four items, one of which is: “I am having financial problems.” Respondents rate each item using a 4-point Likert scale ranging from 1 = Strongly Disagree to 4 = Strongly Agree. The total score ranges from 4 to 16, with higher scores indicating greater economic strain. In previous studies, the Cronbach’s alpha ranged from 0.81 to 0.86, and the current study recorded an alpha of 0.89, indicating strong internal consistency.
Marital Conflict
Marital conflict was measured using the Conflict subscale of the Braiker-Kelly Partnership Questionnaire (Braiker & Kelly, 1979). This subscale has been widely used to examine various types of relationship and marital conflicts, including studies involving married couples, same-sex partners, and parents of children with autism. The scale consists of five items, including: “When you and your partner argue, how serious are the problems or arguments?” and “How often do you and your partner quarrel?” In the original version, the subscale uses a 9-point Likert scale; however, following practices from other studies (e.g., Zahid & Tariq, 2020), this study adopted a 5-point Likert scale ranging from 1 = Not at all t 5 = Very much/often. The total score ranges from 5 to 25, with higher scores indicating higher levels of conflict. Previous studies reported Cronbach’s alpha values ranging from 0.69 to 0.84. In this study, the internal consistency was 0.90.
Coping
Coping was assessed using the Coping and Adaptation Processing Scale – Short Form (CAPS-SF), developed by Roy et al. (2016). The scale measures how individuals respond cognitively and behaviorally to difficult or stressful life events. It comprises 15 items, such as: “Gather as much information as possible to increase my options” and “Use humor to handle the situation.” Each item is rated on a 4-point Likert scale ranging from 1 = Never to 4 = Always. The total score is obtained by summing the responses, with possible scores ranging from 15 to 60, where a higher score indicates more frequent use of adaptive coping strategies. The Cronbach’s alpha for this study was 0.79.
Mental Wellbeing
Mental wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) developed by researchers from the Universities of Warwick and Edinburgh (Taggart et al., 2015). This scale reflects both the emotional and psychological functioning aspects of wellbeing. It contains 7 items, including: “I’ve been feeling optimistic about the future” and “I’ve been feeling useful.” Respondents rate their experiences using a 5-point Likert scale from 1 = None of the time to 5 = All of the time. The total score ranges from 7 to 35, with higher scores representing better mental wellbeing. The scale demonstrated good internal consistency in this study, with a Cronbach’s alpha of 0.83.

Comment 3: Some coping items were removed due to low loadings, and a few coping items with loadings below 0.708 were retained without clear justification. Suggestion: Provide a stronger rationale for retaining these items, perhaps supported by reliability or theoretical considerations.

Response:
Thank you for your insightful comment. We have revised the explanation in the "Measurement Model" section to clarify the rationale for item retention and deletion within the coping construct. Specifically:

Several coping items (e.g., CAPS_1, CAPS_5, CAPS_8, CAPS_9, CAPS_12, CAPS_13, CAPS_14) were removed due to very low factor loadings, following the recommendation of Hair et al. (2021), which suggests item deletion if loading values are below 0.40 or if their removal improves model fit and internal consistency.
A few items with loading values between 0.40 and 0.708 were retained based on their theoretical relevance to the coping construct (as grounded in the Stress-Strain-Coping-Support model) and because their presence did not adversely affect composite reliability (CR), average variance extracted (AVE), or discriminant validity.
Internal consistency for the coping construct remained within acceptable thresholds (CR = 0.889), and the AVE exceeded the recommended value of 0.50, thus supporting the adequacy of the construct’s convergent validity.

Comment 4: While the paper touches on cultural factors, more in-depth exploration of religious coping (a significant aspect for Malaysian Muslim populations) could enhance the discussion. Suggestion: Include qualitative components to explore cultural and religious coping strategies more deeply.
Response: Thank you for the valuable suggestion. While this study is quantitative in nature, we have acknowledged the potential value of incorporating qualitative components in future studies to explore religious and cultural coping mechanisms more deeply.

Comment 5: While ethics approval is noted, the paper could better explain how participants’ confidentiality and emotional safety were handled during data collection.

Response: We have updated the "Procedure" section to include additional details on how participants’ confidentiality and emotional well-being were safeguarded. This includes steps such as anonymized data collection, informed consent procedures, and providing contact information for emotional support services

Procedure
The study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (Reference No.: JKEUPM-2020-406). A set of questionnaires was used to collect the data in this study. Prior to the study, permission was granted to the Malaysian National Anti-Drug Agency (AADK) to gather information about the wife from drug addicts (clients) at the Narcotics Addiction Rehabilitation Centre (PUSPEN) involved. Their wives were called by phone to ask for their permission to take part in the study after the drug addicts’ wives’ information was found. Next, the questionnaire was then distributed through WhatsApp in the form of a “Google form”.
Written informed consent was also given to the respondents along with the distributed questionnaires. Participants were informed that their responses would remain anonymous, and no identifying information was collected. All data were securely stored and accessible only to the research team. Participants were also assured that they could withdraw from the study at any point without any consequences.
To protect emotional well-being, participants were provided with contact information for professional counselling services and support hotlines, should they experience any psychological distress while answering the survey. Furthermore, the language and structure of the questionnaire were designed to be sensitive and non-triggering, and participants completed the survey at their own pace in the privacy of their own homes.
A pilot study, including 30 women of drug addicts whose husbands were seeking treatment at PUSPEN Batu Kurau and PUSPEN Perlop, Perak, was conducted prior to the main study to ensure clarity and appropriateness of the research instruments.

Comment 6: The direct effect of family impact on mental wellbeing was non-significant (β = -0.14, p = 0.19), correctly noted, but the discussion could elaborate more on why this non-significance exists, considering cultural or sample-related factors.
Response:
Thank you for this insightful comment. We have expanded the Discussion section to include possible cultural and contextual explanations for the non-significant direct relationship between family impact and mental wellbeing. Specifically, we discuss the role of religious beliefs, resilience, and collectivist family values common in Malaysian society, which may act as protective factors that buffer the negative effects of family-related stress. These cultural mechanisms may help explain why the impact of family-related stressors does not directly translate into poor mental wellbeing. Please refer to the updated Discussion section on page XX.
Suggested Addition to the Discussion Section:
Although this study found a significant indirect relationship between family impact and mental wellbeing via coping, the direct effect was not statistically significant. This result may be understood within the cultural and religious context of the sample population. As many respondents were Malay Muslim women from low-income households, they may draw upon religious coping mechanisms, such as prayer, acceptance, and faith in divine will, to endure difficult family situations. These strategies can foster inner strength and optimism, reducing the psychological toll of family conflict and economic hardship.
Furthermore, the collectivist nature of Malaysian society, where extended family networks often provide emotional and financial support, may help buffer the negative impact of stressors. In such social systems, communal resilience and shared caregiving responsibilities can alleviate the burden traditionally carried by an individual spouse. Finally, resilience—especially among women facing chronic stress—has been well-documented in similar populations and may help explain why high family impact does not always correspond with low mental wellbeing. These culturally relevant factors highlight the importance of exploring indirect or mediated pathways, such as coping, when examining the psychological outcomes of stress.

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Competing Interests

The authors declare that there are no competing interests that could be construed to influence the validity or importance of the findings presented in this article.

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Reviewer Report

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08 Jun 2024 | for Version 1

Mohd Radzi Tarmizi A Halim, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia

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Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

suicide; adolescent mental health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

25 Views

03 Aug 2023 | for Version 1

Marek A. Motyka, Uniwersytet Rzeszowski, Rzeszow, Podkarpackie Voivodeship, Poland

25 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

drug addiction, youth, sociology, harm reduction, psychoactive substances, social work

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Author Response

19 Mar 2025

Zarinah Arshat, Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Malaysia

Dear Reviewer,
Thank you for your valuable feedback on our manuscript. We sincerely appreciate your thoughtful comments and the opportunity to improve our work. Below, we address your specific concern regarding the Discussion section and the need for comparisons with studies conducted in other countries and with people of different religions.
Reviewer Comment:
"The 'Discussion' section should be expanded to subject the results obtained to comparisons with studies conducted in other countries and with people of a different religion. In my opinion, the comparisons could prove interesting."
Response:
We acknowledge the importance of situating our findings within a broader cross-cultural and religious context. In response to your suggestion, we have significantly expanded the Discussion section to include comparisons with international studies and research involving diverse religious backgrounds. Specifically:

Cross-Cultural Comparisons – We have incorporated references to studies conducted in Western (United States, Canada) and Eastern (Asia, Middle East) contexts, examining how cultural variations influence coping mechanisms among spouses of individuals with substance use disorders. We highlight differences in individualistic vs. collectivistic coping strategies, as well as variations in family cohesion and social support systems across these regions.
Religious Coping Perspectives – We now discuss the role of religious coping mechanisms, including prayer, spiritual guidance, and faith, in managing stress among Muslim, Christian, and Hindu populations. These insights are supported by studies that demonstrate the significant role of religion in mental well-being across different cultural settings.
Methodological Considerations – We clarify differences in how family impact, coping, and stress have been measured in prior studies versus our approach, explaining how variations in assessment tools and conceptual frameworks may influence findings.

These additions provide a more comprehensive and globally relevant discussion of our results. We believe that these enhancements improve the manuscript’s depth, applicability, and theoretical contribution.
We appreciate your insightful suggestion, which has strengthened the manuscript, and we hope that the revisions meet your expectations. Thank you again for your time and valuable feedback.
Best regards

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Competing Interests

The authors declare that they have no competing interests that could be construed to influence the validity, interpretation, or importance of this article or the peer review process. No financial, professional, or personal relationships exist that could be perceived as having influenced the research, analysis, or conclusions presented in this study.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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A cross-sectional study of Malaysian low-income drug addict wives: Relationship between family impact, coping and mental wellbeing

Abstract

Background

Methods

Results

Conclusions

Keywords

Revised Amendments from Version 1

Introduction

Figure 1. Conceptual framework.

Literature review

Methods

Research design

Instruments

Procedure

Analysis and findings

Common method variance

Respondent’s profile

Table 1. Respondent’s profile.

Model estimation

Assessment of measurement model

Measurement model for lower-order components

Table 2. Reliability and convergent validity for first stage.

Table 3. Discriminant validity for first stage.

Measurement model for higher-order components

Table 4. Reliability and convergent validity for second stage.

Table 5. Discriminant validity for second stage.

Structural model assessment

Table 6. VIF values for collinearity issue.

Table 7. Path coefficient assessment.

Table 8. Indirect relationship assessment.

Discussion

Limitations and future research directions

Data availability

Underlying data

Credit authorship contribution statement

References

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