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Mirza S, Rehman A, Haque J, Khan MM. Perceptions of Suicide among Pakistanis: Results of an Online Survey. Arch Suicide Res 2024:1-18. [PMID: 38251674 DOI: 10.1080/13811118.2024.2305397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE In Pakistan, a predominantly Muslim country, information on the patterning of suicidal thoughts and behaviors, as well as associated public perceptions and opinions, is limited. We sought to advance knowledge on suicide and self-harm in Pakistan with a large, online survey. METHOD Leveraging results from a twelve-item online survey (N = 5,157) circulated by the largest English language newspaper in Pakistan, we assessed personal experiences, opinions, and attitudes toward help-seeking in the context of suicide. We calculated proportions with 95% confidence intervals for endorsed responses and implemented binomial generalized linear models with odds ratios to assess differing response tendencies by age, gender, and urban/rural residence. RESULTS Personal experiences related to suicide and self-harm as well as encounters in social circles were common. Mental illness tended to be recognized as a high likelihood contributor to suicide death over and above nonviolent interpersonal problems. Most considered suicide a way to escape pain, and few considered suicide to be immoral. Barriers to help-seeking included social deterrents, inaccessibility, and unaffordability. Women and youth emerged as higher risk groups, though the status of rural Pakistanis remained unclear. CONCLUSION The survey provides a preliminary basis for considering the unique experiences and perspectives of the public in shaping suicide prevention and intervention efforts in Pakistan.
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Wang H, Deng Y, Li M, Tao Z, Yu C. Parental Psychological Control, the Parent-Adolescent Relationship, and Non-suicidal Self-Injury Among Chinese Adolescents: The Moderating Effect of the Oxytocin Receptor Gene rs53576 Polymorphism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01646-2. [PMID: 38110758 DOI: 10.1007/s10578-023-01646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
Parental psychological control (PPC) is associated with adolescent non-suicidal self-injury (NSSI); however, its underlying mechanisms have not been extensively investigated. Considering that genetic and environmental factors interactively influence adolescent development, this study examined whether the parent-adolescent relationship mediated the link between PPC and adolescent NSSI, and whether this mediating process was moderated by the oxytocin receptor gene rs53576 polymorphism (OXTR rs53576). Participants comprised 673 adolescents (Meanage = 12.81 years, SD = 0.48 years) who completed questionnaires regarding PPC, the parent-adolescent relationship, and NSSI. DNA was extracted from each participant's saliva samples. The results indicated that the positive association between PPC and adolescent NSSI was mediated by the parent-adolescent relationship. Moreover, this indirect link was stronger for adolescents with AA homozygotes of OXTR rs53576 than for those with the GG or AG genotype. These findings extend our understanding of the association between PPC and adolescent NSSI and suggest that a simultaneous focus on PPC, the parent-adolescent relationship, and OXTR rs53576 may favor NSSI interventions.
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Affiliation(s)
- Huahua Wang
- Department of Psychology, School of Education, Guangzhou University, Guangzhou, 510006, Guangdong, China
| | - Yuting Deng
- Department of Psychology, School of Education, Guangzhou University, Guangzhou, 510006, Guangdong, China
| | - Meijin Li
- Zhangbian Primary School, Guangzhou, 511446, Guangdong, China
| | - Zhiyuan Tao
- School of Psychology, South China Normal University, Guangzhou, 510631, Guangdong, China
| | - Chengfu Yu
- Department of Psychology, School of Education, Guangzhou University, Guangzhou, 510006, Guangdong, China.
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Husain MO, Chaudhry N, Kiran T, Taylor P, Tofique S, Khaliq A, Naureen A, Shakoor S, Bassett P, Zafar SN, Chaudhry IB, Husain N. Antecedents, clinical and psychological characteristics of a large sample of individuals who have self-harmed recruited from primary care and hospital settings in Pakistan. BJPsych Open 2023; 9:e216. [PMID: 37955044 PMCID: PMC10753970 DOI: 10.1192/bjo.2023.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/01/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries. AIMS To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan. METHOD This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed. RESULTS Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals. CONCLUSIONS Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.
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Affiliation(s)
- Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; and Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Peter Taylor
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Amna Naureen
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | | | - Imran B. Chaudhry
- University of Manchester, UK; and Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Husain N, Kiran T, Chaudhry IB, Williams C, Emsley R, Arshad U, Ansari MA, Bassett P, Bee P, Bhatia MR, Chew-Graham C, Husain MO, Irfan M, Khaliq A, Minhas FA, Naeem F, Naqvi H, Nizami AT, Noureen A, Panagioti M, Rasool G, Saeed S, Bukhari SQ, Tofique S, Zadeh ZF, Zafar SN, Chaudhry N. A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm: a multi-centre randomised controlled trial. BMC Med 2023; 21:282. [PMID: 37525207 PMCID: PMC10391745 DOI: 10.1186/s12916-023-02983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. METHODS This was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016). RESULTS We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (- 3.6 (- 4.9, - 2.4)), depression (- 7.1 (- 8.7, - 5.4)), hopelessness (- 2.6 (- 3.4, - 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention. CONCLUSIONS Suicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Mersey Care NHS Foundation Trust, Kings Business Park, Trust Offices/V7 Buildings, Prescot, L34 1PJ, England, UK
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan.
| | - Imran Bashir Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
- Department of Psychiatry, Ziauddin University and Hospital, 4/B Shahrah-E-Ghalib Rd, Block 6 Clifton, Karachi, Pakistan
| | - Christopher Williams
- Institute of Health and Well Being, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK
| | - Richard Emsley
- Medical Statistics & Trials Methodology, Institute of Psychiatry, Kings College London, Strand, London, WC2R 2LS, England, UK
| | - Usman Arshad
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Moin Ahmed Ansari
- Liaquat University of Medical and Health Sciences, C7PC+337, Hyderabad, Jamshoro, Pakistan
| | - Paul Bassett
- Statistical Consultancy, Hemel Hempstead, England, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, England, UK
| | - Moti Ram Bhatia
- Peoples University of Medical & Health Science for Women Nawabshah, 6CV3+7HW, Hospital Road, Shaheed Benazirabad, Nawabshah, Pakistan
| | | | - Muhammad Omair Husain
- Department of Psychiatry, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | | | - Farooq Naeem
- CAMH, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Haider Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Pakistan
| | - Asad Tamizuddin Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Near Chandni Chowk, Murree Rd, Chah Sultan, Rawalpindi, Pakistan
| | - Amna Noureen
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, Institute for Health Policy and Organisation/Alliance Manchester Business School, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Ghulam Rasool
- Balochistan Institute of Psychiatry & Behavioural Sciences, Bolan Medical College, 5XRG+VGC, Brewery Rd, Quetta, Pakistan
| | - Sofiya Saeed
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Sumira Qambar Bukhari
- Department of Psychiatry, Services Institute of Medical Sciences, G8QM+JWR, Jail Rd, Shadman 1 Shadman, Lahore, Pakistan
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Zainab F Zadeh
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
| | - Shehla Naeem Zafar
- Institute of Nursing, Iqra University, G-16/1 Allama Rasheed Turabi Rd, Block-B Block B, North Nazimabad Town, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Suite No. 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-E-Iqbal, Clifton, Karachi, Pakistan
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Husain N, Kiran T, Chaudhry IB, Sultan S, Dawood S, Lunat F, Nizami A, Shanahan L, Qureshi A, Un Nisa Z, Husain M, Shakoor S, Alvi MH, Zadeh Z, Memon R, Chaudhry N. Integrated Moving on After Breast Cancer and Culturally Adapted Cognitive Behavior Therapy intervention for depression and anxiety among Pakistani women with breast cancer: Protocol of a randomized controlled trial. SAGE Open Med 2023; 11:20503121231177549. [PMID: 37441193 PMCID: PMC10333993 DOI: 10.1177/20503121231177549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/05/2023] [Indexed: 07/15/2023] Open
Abstract
Objective The diagnosis and treatment of breast cancer is associated with significant distress that has huge impact on survivors' quality of life. The objective of this study is to assess the effectiveness of an integrated intervention "Moving on After Breast Cancer (ABC) Plus culturally adapted Cognitive Behavior Therapy" (Moving on ABC Plus). Method This is a randomized controlled trial that aims to recruit 354 breast cancer survivors from the inpatient and outpatient oncology departments in public and private hospitals in Karachi, Hyderabad, Lahore, Multan, and Rawalpindi in Pakistan. Patients scoring 10 or above on either the Patient Health Questionnaire-9 and/or the Generalized Anxiety Disorder scale (GAD-7) will be recruited. Baseline assessments will include Functional Assessment of Cancer Therapy-Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale. Participants randomized into intervention arm, Moving on ABC Plus, will receive 12 individual therapy sessions over 4 months. Follow-up will be completed at 4- and 6-month post-randomization, using all baseline instruments along with the Client Satisfaction Questionnaire (CSQ-8). We will also explore the participants', their family members', and the therapists' experiences of the trial and intervention. Results We will be assessing the effectiveness of intervention in reducing depression and anxiety in breast cancer survivors as a primary outcome of the trial. The secondary outcomes will include effectiveness of intervention in terms of reduction in intrusive thoughts and improvement in health-related quality of life, self-esteem, and perceived social support. Conclusion The results of the study will inform the design of a future larger randomized control trial with long-term follow-up.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental
Health, University of Manchester, Manchester, UK
- Manchester Global foundation,
Manchester, UK
| | - Tayyeba Kiran
- Manchester Global foundation,
Manchester, UK
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
| | | | - Sarwat Sultan
- Department of Psychology, Bahauddin
Zakaria University, Multan, Pakistan
| | - Saima Dawood
- Center for Clinical Psychology,
University of Punjab, Lahore, Pakistan
| | - Farah Lunat
- Lancashire and South Cumbria NHS
Foundation Trust, Preston, UK
| | - Asad Nizami
- Institute of Psychiatry, Benazir Bhutto
Hospital, Rawalpindi, Pakistan
| | | | - Afshan Qureshi
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
| | - Zaib Un Nisa
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
| | - Mina Husain
- South London and Maudsley NHS
Foundation Trust, London, UK
| | - Suleman Shakoor
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
| | - Mohsin H Alvi
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
| | - Zainab Zadeh
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
| | - Rakhshi Memon
- Manchester Global foundation,
Manchester, UK
- Department of Science and Technology
Studies, University College London, London, UK
| | - Nasim Chaudhry
- Manchester Global foundation,
Manchester, UK
- Pakistan Institute of Living and
Learning, Karachi, Pakistan
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Husain N, Tofique S, Chaudhry IB, Kiran T, Taylor P, Williams C, Memon R, Aggarwal S, Alvi MH, Ananiadou S, Ansari MA, Aseem S, Beck A, Alam S, Colucci E, Davidson K, Edwards S, Emsley R, Green J, Gumber A, Hawton K, Jafri F, Khaliq A, Mason T, Mcreath A, Minhas A, Naeem F, Naqvi HA, Noureen A, Panagioti M, Patel A, Poppleton A, Shiri T, Simic M, Sultan S, Nizami AT, Zadeh Z, Zafar SN, Chaudhry N. Youth Culturally adapted Manual Assisted Problem Solving Training (YCMAP) in Pakistani adolescent with a history of self-harm: protocol for multicentre clinical and cost-effectiveness randomised controlled trial. BMJ Open 2022; 12:e056301. [PMID: 35568489 PMCID: PMC9109112 DOI: 10.1136/bmjopen-2021-056301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Suicide is a global health concern. Sociocultural factors have an impact on self-harm and suicide rates. In Pakistan, both self-harm and suicide are considered as criminal offence's and are condemned on both religious and social grounds. The proposed intervention 'Youth Culturally Adapted Manual Assisted Problem Solving Training (YCMAP)' is based on principles of problem-solving and cognitive-behavioural therapy. YCMAP is a brief, culturally relevant, scalable intervention that can be implemented in routine clinical practice if found to be effective. METHOD AND ANALYSIS A multicentre rater blind randomised controlled trial to evaluate the clinical and cost-effectiveness of YCMAP including a sample of 652 participants, aged 12-18 years, presenting to general physicians/clinicians, emergency room after self harm or self referrals. We will test the effectiveness of 8-10 individual sessions of YCMAP delivered over 3 months compared with treatment as usual. Primary outcome measure is repetition of self-harm at 12 months. The seconday outcomes include reduction in suicidal ideation, hopelessness and distress and improvement in health related quality of life. Assessments will be completed at baseline, 3, 6, 9 and 12 months postrandomisation. The nested qualitative component will explore perceptions about management of self-harm and suicide prevention among adolescents and investigate participants' experiences with YCMAP. The study will be guided by the theory of change approach to ensure that the whole trial is centred around needs of the end beneficiaries as key stakeholders in the process. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Ethics Committee of University of Manchester, the National Bioethics Committee in Pakistan. The findings of this study will be disseminated through community workshops, social media, conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04131179.
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Affiliation(s)
- Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester School of Medical Sciences, Manchester, UK
- Manchester Global Foundation, Manchester, UK
| | - Sehrish Tofique
- Division of Neuro-Cognitive Disorder, Older Adults Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Imran B Chaudhry
- Psychiatry, Greater Manchester West Mental Hlth NHS Fdn Trust, Manchester, UK
- Psychiatry, Dr Ziauddin Hospital, Karachi, Sindh, Pakistan
| | - Tayyeba Kiran
- Division of Mood Disorder, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Peter Taylor
- Psychology & Mental Health, The University of Manchester, Manchester, UK
| | | | - Rakhshi Memon
- Science and Technology Studies, University College London, London, UK
| | - Shilpa Aggarwal
- Psychiatry, SRCC Children's Hospital (Narayana Health), Mumbai, India
| | - Mohsin Hassan Alvi
- Health Economics, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - S Ananiadou
- School of Computer Science, The University of Manchester, Manchester, UK
| | | | - Saadia Aseem
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Andrew Beck
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sumira Alam
- Psychiatry, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | | | - Kate Davidson
- Psycho-social Interventions, University of Glasgow, Glasgow, UK
| | - Sarah Edwards
- Research Ethics and Governance, University College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, The University of Manchester, Manchester, UK
| | - Anil Gumber
- Health Economics, Hallam University, Sheffield, UK
| | - Keith Hawton
- Psychiatry, Centre for Suicide Research, Oxford University, Oxford, UK
| | - Farhat Jafri
- Community Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Ayesha Khaliq
- Division of Eating Feeding, Nutrition and Elimination Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Thomas Mason
- Division of Population Health, Health Services Research & Primary Care, Manchester Institute for Collaborative Research on Ageing, University of Manchester, Manchester, UK
| | | | | | - Farooq Naeem
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Haider Ali Naqvi
- Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Amna Noureen
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Anita Patel
- Health Economics, Queen Mary University, London, UK
| | - Aaron Poppleton
- Center for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Tinevimbo Shiri
- Health Economics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mima Simic
- Child and Adolescent Psychiatrist, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarwat Sultan
- Department of Applied Psychology, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | | | - Zainab Zadeh
- Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Nasim Chaudhry
- Research and Development, Pakistan Institute of Living and Learning, Karachi, Pakistan
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Ullah W, Ilyas M, Alam M, Bhak J, Tonellato PJ. A community call to action: mitigating COVID pandemic’s impact on mental health. Future Virol 2022. [PMID: 35321003 PMCID: PMC8929480 DOI: 10.2217/fvl-2021-0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Wahid Ullah
- Centre for Omic Sciences, Islamia College University Peshawar, 25120, Pakistan
| | - Muhammad Ilyas
- Centre for Omic Sciences, Islamia College University Peshawar, 25120, Pakistan
- Department of Bioengineering, University of Engineering and Applied Sciences, Swat, 19060, Pakistan
| | - Mukhtar Alam
- Dean Faculty of Sciences, University of Swabi-23430, Pakistan
| | - Jong Bhak
- School of Life Sciences, Ulsan National Institute of Science & Technology (UNIST), Ulsan, 44919, South Korea
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Depression and suicidal behavior in South Asia: a systematic review and meta-analysis. Glob Ment Health (Camb) 2022; 9:181-192. [PMID: 36618741 PMCID: PMC9806989 DOI: 10.1017/gmh.2022.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Estimates of depression in suicidal behavior in South Asia would help to formulate suicide prevention strategies in the region that hasn't been assessed yet. OBJECTIVES We aimed to systematically assess the prevalence of depression in fatal and non-fatal attempts of suicide in eight South Asian countries. METHODS We searched Medline, Embase, and PsychINFO by specific search terms to identify articles assessing depression in fatal and non-fatal attempts of suicide in South Asian countries published between 2001 and 2020. Two separate meta-analyses were conducted for fatal and non-fatal attempts. Due to the high heterogeneity of studies (96-98%), random-effects models were used to calculate pooled prevalence rates. RESULTS A total of 38 studies was identified from five south Asian countries (India [27], Pakistan [6], Sri Lanka [3], Nepal [1], and Bangladesh [1]). The majority of studies (n = 27) were published after 2010. Twenty-two studies reported non-fatal attempts, and sixteen reported suicide. The prevalence of depression among non-fatal attempts ranged from 14% to 78% where the pooled prevalence rate was 32.7% [95% CI 26-39.3%]. The prevalence of depression among suicides ranged from 8% to 79% where the pooled prevalence estimate was 37.3% [95% CI 26.9-47.6%]. CONCLUSIONS This review revealed the pooled prevalence of depression among fatal and non-fatal suicidal attempts in South Asian countries, which seems to be lower when comparedto the Western countries. However, a cautious interpretation is warranted due to the heterogeneity of study methods, sample size, and measurement of depression.
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Alvi MH, Shiri T, Iqbal N, Husain MO, Chaudhry I, Shakoor S, Ansari S, Kiran T, Chaudhry N, Husain N. Cost-Effectiveness of a Culturally Adapted Manual-Assisted Brief Psychological Intervention for Self-Harm in Pakistan: A Secondary Analysis of the Culturally Adapted Manual-Assisted Brief Psychological Randomized Controlled Trial. Value Health Reg Issues 2021; 27:65-71. [PMID: 34844061 DOI: 10.1016/j.vhri.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Self-harm is a serious public health problem. A culturally adapted manual-assisted problem-solving training (C-MAP) intervention improved and sustained a reduction in suicidal ideation, hopelessness, and depression compared with treatment as usual (TAU) alone. Here, we evaluate its cost-effectiveness. METHODS Patients admitted after an episode of self-harm were randomized individually to either C-MAP plus TAU or TAU alone in Karachi. Improvement in health-related quality-adjusted life-years (QALYs) was measured using the EQ-5D with 3 levels instrument at baseline, 3 months, and 6 months after randomization. The primary economic outcome was health service cost per QALY gained as the incremental cost-effectiveness ratio, based on 2019 US$ and a 6-month time horizon. Nonparametric bootstrapping was used to assess uncertainties and sensitivity analysis to examine the impact of hospitalization costs. RESULTS A total of 108 and 113 participants were enrolled among the intervention and standard arms, respectively. The intervention resulted in 0.04 (95% confidence interval [CI] 0.00-0.08) more QALYs 6 months after enrolment. The mean cost per participant in the intervention arm was $1001 (95% CI 968-1031), resulting in an incremental cost of the intervention of $640 (95% CI 595-679). The incremental cost-effectiveness ratio for the C-MAP intervention versus TAU was $16 254 (95% CI 7116-99 057) per QALY gained. The probability that C-MAP is cost-effective was between 66% and 83% for cost-effective thresholds between $20 000 and $30 000. Cost-effectiveness results remained robust to sensitivity analyses. CONCLUSIONS C-MAP may be a valuable self-harm intervention. Further studies with longer follow-up and larger sample sizes are needed to draw reliable conclusions.
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Affiliation(s)
- Mohsin H Alvi
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tinevimbo Shiri
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK; International Public Health, Liverpool School of Tropical Medicine, Liverpool, England, UK.
| | - Nasir Iqbal
- Pakistan Institute of Development Economics, Islamabad, Pakistan
| | - Mohammed Omair Husain
- Pakistan Institute of Learning and Living, Karachi, Pakistan; School of Biological Sciences, University of Manchester, Manchester, England, UK
| | - Imran Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan; School of Biological Sciences, University of Manchester, Manchester, England, UK; Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Sami Ansari
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK
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Alvi MH, Shiri T, Iqbal N, Husain MO, Chaudhry I, Shakoor S, Ansari S, Kiran T, Chaudhry N, Husain N. Cost-Effectiveness of a Culturally Adapted Manual-Assisted Brief Psychological Intervention for Self-Harm in Pakistan: A Secondary Analysis of the Culturally Adapted Manual-Assisted Problem-Solving Training Randomized Controlled Trial. Value Health Reg Issues 2021; 25:150-156. [PMID: 34198122 DOI: 10.1016/j.vhri.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Self-harm is a serious public health problem. A culturally adapted manual-assisted problem-solving training (C-MAP) intervention improved and sustained the reduction in suicidal ideation, hopelessness, and depression compared with treatment as usual (TAU) alone. Here, we evaluate its cost-effectiveness. METHODS Patients admitted after an episode of self-harm were randomized individually to either C-MAP plus TAU or TAU alone in Karachi. Improvement in health-related quality-adjusted life years (QALYs) was measured using the Euro Qol-5D-3L instrument at baseline and at 3 months and 6 months after randomization. The primary economic outcome was health service cost per QALY gained as the incremental cost-effectiveness ratio, based on 2019 US dollars and a 6-month time horizon. Nonparametric bootstrapping was used to assess uncertainties, and sensitivity analysis to examine the impact of hospitalization costs. RESULTS A total of 108 and 113 participants were enrolled among the intervention and standard arms, respectively. The intervention resulted in 0.04 more QALYs (95% confidence interval [CI] 0.00-0.08) 6 months after enrolment. The mean cost per participant in the intervention arm was US $1001 (95% CI 968-1031), resulting in an incremental cost of the intervention of US $640 (95% CI 595-679). The incremental cost-effectiveness ratio for the C-MAP intervention versus TAU was US $16 254 (95% CI 7116-99 057) per QALY gained. The probability that C-MAP is cost-effective was between 66% and 83% for cost-effective thresholds between US $20 000 and US $30 000. Cost-effectiveness results remained robust to sensitivity analyses. CONCLUSIONS C-MAP may be a valuable self-harm intervention. Further studies with longer follow-up and larger sample sizes are needed to draw reliable conclusions.
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Affiliation(s)
- Mohsin H Alvi
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tinevimbo Shiri
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK; International Public Health, Liverpool School of Tropical Medicine, Liverpool, England, UK.
| | - Nasir Iqbal
- Pakistan Institute of Development Economics, Islamabad, Pakistan
| | | | - Imran Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan; School of Biological Sciences, University of Manchester, Manchester, England, UK; Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Sami Ansari
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK
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Rahman F, Webb RT, Wittkowski A. Risk factors for self-harm repetition in adolescents: A systematic review. Clin Psychol Rev 2021; 88:102048. [PMID: 34119893 DOI: 10.1016/j.cpr.2021.102048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/16/2021] [Accepted: 05/25/2021] [Indexed: 01/26/2023]
Abstract
Self-harm behavior can begin in early adolescence, with the highest rates of self-harm, between 1990 and 2000 in England, being among adolescents aged 16 to 24 years and there being considerable risk of fatal and non-fatal repetition. Previous systematic reviews have identified risk factors for self-harm in adolescents, but not for the repetition of this behavior. The aim of this review was to synthesise the psychological, psychosocial and sociodemographic risk factors for self-harm repetition in adolescents. By searching four databases, 27 studies were identified and included in the review. Several psychological (e.g., psychiatric morbidity, features of previous self-harm, psychological distress), psychosocial (e.g., alcohol misuse, poor family and peer relationships) and sociodemographic (e.g., age, gender and ethnicity) risk factors were identified for self-harm repetition in adolescents. Several risk factors across all categories for self-harm overlapped with that of self-harm repetition, such as depression, alcohol misuse and female gender. The clinical implications of these findings for practitioners were discussed. As was the case with prior reviews in this area, comparability between studies was limited and a meta-analysis was not possible due to considerable heterogeneity in outcome definitions, measures and methodologies.
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Affiliation(s)
- Farhan Rahman
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK
| | - Roger T Webb
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Exploring Lived Experiences of Adolescents Presenting with Self-Harm and Their Views about Suicide Prevention Strategies: A Qualitative Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094694. [PMID: 33924930 PMCID: PMC8124784 DOI: 10.3390/ijerph18094694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/05/2023]
Abstract
Suicide is a serious global public health problem and the third leading cause of death in those 15–35 years old. Self-harm is the major predictor of future suicide attempts and completed suicide yet remains poorly understood. There is limited evidence on effective interventions for adolescents who present with self-harm. To identify and develop acceptable preventive and therapeutic interventions it is essential to understand the factors that contribute to self-harm and suicide in young people, in the context of their emotions, interpersonal difficulties, available support and prevention strategies. This qualitative study aimed at exploring the lived experiences of adolescents presenting with self-harm and their views about potential prevention strategies. Semi-structured interviews with 16 adolescents (12–18 years) presenting with a self-harm episode in a public hospital in Pakistan. A topic guide was developed to facilitate the interviews. The following themes emerged using the framework analysis; predisposing factors (interpersonal conflicts, emotional crisis etc.), regret and realization that self-harm is not the only option, perceived impact of self-harm, and suggestions for suicide prevention strategies (sharing, distraction techniques, involvement of family). This study may help in refining a contextual and culturally based explanatory model of self-harm in adolescents and in informing development of culturally acceptable interventions.
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