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Farias CE, Mendes RC, Lopes MV, França MS, Perrelli JG, Pontes CM, Mangueira SO. Clinical validation of the ineffective social support network nursing diagnosis in violence-victimized women. Int J Nurs Knowl 2024. [PMID: 39031844 DOI: 10.1111/2047-3095.12476] [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: 04/05/2024] [Accepted: 05/30/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE To verify clinical validity evidence for the ineffective social support network nursing diagnosis. METHOD A quantitative, descriptive, cross-sectional study was performed with 98 violence-victimized women treated in two reference centers for violence in the city of Recife, Pernambuco, Brazil. The women were interviewed from August 2021 to June 2022. FINDINGS The clinical indicators that best predicted the nursing diagnosis were as follows: Frustration with unmet support expectations, negative social interaction, perceived neglect of support demands, feeling of abandonment, low reciprocity, and encouragement of negative behaviors. Etiological factors that showed greater association were excessive demand for support, limited social network, social isolation, the fragility of institutional service networked organizations, and inadequate appreciation of available social support. CONCLUSIONS The clinical validity evidence for the ineffective social support network nursing diagnosis has been verified. Thus, the validated clinical indicators and etiological factors can accurately diagnose and predict the emergence of this phenomenon in violence-victimized women. IMPLICATIONS FOR NURSING PRACTICE The results contribute to advancing scientific knowledge in nursing teaching, research, and practice and support the nursing process in violence-victimized women.
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Affiliation(s)
- Camila El Farias
- Department of Nursing, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ryanne Cmg Mendes
- Department of Nursing, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Marcos Vo Lopes
- Department of Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Michelline S França
- Department of Nursing, Federal Institute of Pernambuco, Abreu e Lima, Pernambuco, Brazil
| | | | - Cleide M Pontes
- Department of Nursing, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Suzana O Mangueira
- Department of Nursing, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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Karamitanha F, Ahmadi F, Fallah Abadi V. Geographic pattern of the prevalence of intimate partner violence against women in Zanjan (Iran). Front Psychol 2024; 15:1347077. [PMID: 38708015 PMCID: PMC11067525 DOI: 10.3389/fpsyg.2024.1347077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/25/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Intimate partner violence (IPV) against women is a serious public health issue and refers to physically, sexually and psychologically harmful behaviors as well as emotionally controlling behaviors and financial abuse that occur in the form of marriage or cohabitation. Knowing the current situation of the IPV prevalence against women and high-risk areas in the Zanjan city, Iran, can help policymakers to establish better health programs for risk reduction. Methods This population-based cross-sectional study consisted of married women aged 18-55 years living in Zanjan city in 2021. 760 married women covered by 19 urban comprehensive health service centers (UCHSCs) were selected by the stratified systematic random sampling method. The prevalence of IPV against women was measured in four types: psychological, physical, sexual, and economic. Results Mean (SD) age of the women was 35.49 (8.76) years. 606 women (79.7%) experienced one type of IPV. The highest and lowest IPV prevalence against women were psychological (76.6%) and economic (12%), respectively. The highest and lowest prevalence of psychological violence were observed in CUHSCs 2 and 17, physical violence in CUHSCs 1 and 14, sexual violence in CUHSCs 2 and 17, and economic violence in CUHSCs 2 and 8, respectively. The severity of violence was higher among self-employment or workers husbands, with low monthly household income, and among younger women. Discussion The IPV rate in the target population is high, and the highest rate is related to psychological violence. These results highlight the need to intervention in the society and high-risk women for policymakers of the health system.
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Affiliation(s)
- Farzaneh Karamitanha
- Department of Community Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farzane Ahmadi
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Vahid Fallah Abadi
- Department of Environmental Health Engineering, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
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Taylor L, De Haan I. The Prevalence of Domestic Violence in the Lives of Female Heterosexual Partners of Sex Addicts. Violence Against Women 2023; 29:3263-3287. [PMID: 37697815 PMCID: PMC10629255 DOI: 10.1177/10778012231199111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
This study provides evidence that rates of domestic violence (DV) run considerably higher in the lives of heterosexual women who identify as partners of sex addicts (PSAs) than in the general population. Data collected from 558 survey participants, from a variety of high-income nations, revealed that 92.1% had ever experienced any form of DV perpetrated by their partner and 57.7% had experienced physical and/or sexual intimate partner violence with their partner. The study also tests several hypotheses about sex addiction behaviors and PSA intimate partner violence (IPV), to help those working with these populations understand what factors may be contributing to, or mitigating, these women's experiences of violence.
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Affiliation(s)
- Lisa Taylor
- Department of Counselling, Human Services and Social Work, University of Auckland, Auckland, New Zealand
| | - Irene De Haan
- Department of Counselling, Human Services and Social Work, University of Auckland, Auckland, New Zealand
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Rahman R, Khan MNA, Sara SS, Rahman MA, Khan ZI. A comparative study of machine learning algorithms for predicting domestic violence vulnerability in Liberian women. BMC Womens Health 2023; 23:542. [PMID: 37848839 PMCID: PMC10583348 DOI: 10.1186/s12905-023-02701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
Domestic violence against women is a prevalent in Liberia, with nearly half of women reporting physical violence. However, research on the biosocial factors contributing to this issue remains limited. This study aims to predict women's vulnerability to domestic violence using a machine learning approach, leveraging data from the Liberian Demographic and Health Survey (LDHS) conducted in 2019-2020. We employed seven machine learning algorithms to achieve this goal, including ANN, KNN, RF, DT, XGBoost, LightGBM, and CatBoost. Our analysis revealed that the LightGBM and RF models achieved the highest accuracy in predicting women's vulnerability to domestic violence in Liberia, with 81% and 82% accuracy rates, respectively. One of the key features identified across multiple algorithms was the number of people who had experienced emotional violence. These findings offer important insights into the underlying characteristics and risk factors associated with domestic violence against women in Liberia. By utilizing machine learning techniques, we can better predict and understand this complex issue, ultimately contributing to the development of more effective prevention and intervention strategies.
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Affiliation(s)
- Riaz Rahman
- Statistic discipline, Khulna University, Khulna, 9208, Bangladesh
| | | | | | - Md Asikur Rahman
- Statistic discipline, Khulna University, Khulna, 9208, Bangladesh
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Rafati F, Mangolian Shahrbabaki P, Dastyar N, Pilevarzadeh M, Mehralizadeh A. Relationship Between the Psychological Distress and Spiritual Well-Being in Pregnant Women Exposed to Domestic Violence: A Cross-Sectional Study in Iran. JOURNAL OF RELIGION AND HEALTH 2023; 62:3252-3266. [PMID: 36894696 DOI: 10.1007/s10943-023-01785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Maternal psychological distress is often associated with domestic violence. Spiritual well-being can affect the psychological capacity to deal with distress. This study aimed to investigate the relationship between psychological distress and spiritual well-being in pregnant women exposed to domestic violence. This cross-sectional study was conducted on 305 pregnant women subjected to domestic violence in southern Iran. The participants were selected using the census method. Data were collected using the Spiritual Well-being Scale (SWB), the Kessler Psychological Distress Scale (K10), and the Hurt, Insult, Threaten, Scream (HITS) screening tool (short form) and were analyzed with descriptive and inferential statistics (t-test, ANOVA, the Spearman correlation coefficient, and multiple linear regression) in SPSS software version 24. The mean scores ± standard deviation of the participants' psychological distress, spiritual well-being, and domestic violence were 24.68 ± 6.43, 79.89 ± 18.98, and 11.24 ± 1.5, respectively. The results showed that psychological distress had a significant negative correlation with spiritual well-being (ρ = - 0.84, P < 0.001) and domestic violence (ρ = - 0.73, P < 0.001). The results of the multiple linear regression analysis also showed that spiritual well-being and domestic violence could predict the psychological distress of pregnant women who were exposed to domestic violence, which explained 73% of the psychological distress in the participants. According to the study results, spiritually oriented education can be provided for women to reduce their psychological distress. Also, it is recommended that necessary interventions be used to reduce domestic violence and empower women to prevent it.
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Affiliation(s)
- Foozieh Rafati
- Department of Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Department of Nursing, Razi Faculty of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Haft-Bagh Highway, PO Box: 7861763730, Kerman, Iran
| | - Neda Dastyar
- Department of Midwifery, Nursing and Midwifery School, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Kerman, Iran.
| | - Motahareh Pilevarzadeh
- Department of Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Kerman, Iran
| | - Akbar Mehralizadeh
- Department of Statistics and Epidemiology, School of Medicine, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Kerman, Iran
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Ramaj K, Eisner M. Adverse Childhood Experiences, Intimate Partner Violence, and Mental Well-Being Among Mothers of Toddlers in Tirana, Albania: A Cross-Sectional Mediation Analysis. Violence Against Women 2023:10778012231203659. [PMID: 37774772 DOI: 10.1177/10778012231203659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
This article examines the relationship between maternal exposure to adverse childhood experiences (ACEs), intimate partner violence (IPV), and two aspects of maternal mental well-being-stress and depressive symptoms in the context of Tirana, Albania. Data were obtained from a representative sample of 328 mothers of 2-3-year-old children, who were registered in Tirana's public nurseries. Findings show that maternal ACEs are positively associated with stress levels (β = .210, z = 4.03, p < .001) and depressive symptoms (β = .129, z = 2.62, p < .01). In addition, IPV partially mediates the effect of ACEs on maternal stress (β = .081, z = 3.75, p < .001) and fully mediates the effect of ACEs on depressive symptoms (β = .054, z = 2.87, p < .01). These results suggest that among mothers of toddlers in Tirana, ACEs influence stress levels both directly and via IPV, while they influence depressive symptoms only via IPV. The findings demonstrate long-term effects of maternal exposure to interpersonal violence on mental well-being.
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Affiliation(s)
- Klea Ramaj
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK
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Soomar SM, Soomar SM. Determinants of domestic violence among women of reproductive age (15-49 years) in Quetta, Balochistan-a mixed-method protocol. BMJ Open 2022; 12:e057299. [PMID: 35577475 PMCID: PMC9114969 DOI: 10.1136/bmjopen-2021-057299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Worldwide, domestic violence (DV) is a cause of death and disability among women aged 15-49 years. In Pakistan, DV appears in different forms, and only 3.2% of women report any DV. There are various factors associated with DV against women. The data are sparse for the Balochistan province due to the under-reporting and scattered population. This research study aims to determine the factors associated with DV and the types of violence among women of reproductive age. Also, to understand the perspective of community leaders and healthcare workers (HCWs) for developing interventions for DV prevention against women of reproductive age in Quetta Balochistan. METHODS AND ANALYSIS A sequential explanatory mixed-method (quantitative study followed by qualitative) study design will be used to fulfil the study's objectives. Women of reproductive age (15-49 years), both married and unmarried, local residents, community leaders and community HCWs of Quetta Balochistan, will be made part of the study. A structured questionnaire will be used as the quantitative tool. Focus group discussions will be conducted using a semistructured guide for the qualitative data collection. The multivariable logistic regression analysis will be performed for the quantitative part. P value ≤0.05 will be considered significant. In the qualitative part, data will be transcribed, and recurrent themes/subthemes will be developed to understand the perspective and opinion regarding DV prevention. ETHICS AND DISSEMINATION Ethical Approval was taken from Aga Khan University, Karachi, Pakistan. Informed written consent will be obtained from all participants. The article will be published after data collection and analysis in the journal to disseminate the results.
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LeMasters K, Bates LM, Chung EO, Gallis JA, Hagaman A, Scherer E, Sikander S, Staley BS, Zalla LC, Zivich PN, Maselko J. Adverse childhood experiences and depression among women in rural Pakistan. BMC Public Health 2021; 21:400. [PMID: 33632175 PMCID: PMC7905421 DOI: 10.1186/s12889-021-10409-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women's (N = 889) depression at 36 months postpartum in rural Pakistan. METHOD Data come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women's depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity. RESULTS The majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β = 3.90; 95% CL = 2.13, 5.67) and MDE (PR = 2.43; 95% CL = 1.37, 4.32). Symptom severity (β = 2.88; 95% CL = 1.46, 4.31), and MDE (PR = 2.01; 95% CL = 1.27, 3.18) were greater for those experiencing community violence or family distress (β = 2.04; 95%; CL = 0.83, 3.25) (PR = 1.77; 95% CL = 1.12, 2.79). CONCLUSIONS Findings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women's ACEs as part of perinatal mental health interventions and highlight women's lifelong experiences as important factors to understanding current mental health. TRIAL REGISTRATION NCT02111915 . Registered 11 April 2014. NCT02658994 . Registered 22 January 2016. Both trials were prospectively registered.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, Chapel Hill, North Carolina, USA.
| | - Lisa M Bates
- Department of Epidemiology,Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY, 10032, USA
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
| | - John A Gallis
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 135 College St., Suite 200, Room 230, New Haven, CT, 06510, USA
| | - Elissa Scherer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- RTI International, 3040 E Cornwallis Rd, Durham, NC, 27709, USA
| | - Siham Sikander
- Human Development Research Foundation, H 06, Street 55, Sector F-7/4, Islamabad, 44000, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Brooke S Staley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Paul N Zivich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
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Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, Attitude, and Practices of Dental Practitioners Regarding Domestic Violence in Pakistan. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060799. [PMID: 34915749 PMCID: PMC8725044 DOI: 10.1177/00469580211060799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Domestic violence is a complex social issue worldwide that includes a wide range of physical, sexual, psychological, economic, or emotional trauma to a child or adult. A large proportion of domestic violence cases remain unreported or undocumented. Dentists can play an important role in identifying and reporting these cases, but no such local study is available assessing the dental practitioners' attitudes and knowledge of evaluating physical abuse in Pakistan. The objective of this study was to assess the knowledge and practices of dental practitioners of Pakistan about domestic violence. This cross-sectional study was carried out over 2 months, among 330 dentists across Pakistan, selected by convenience sampling technique. Data was collected via a pre-validated online questionnaire, filled anonymously after taking informed consent. The survey questionnaire collected data about dentists' demographics, awareness, and experiences about domestic violence cases via close-ended questions. Only 10.6% of participating dentists received formal training in the management of domestic violence cases. Approximately 55% of participants knew that physical abuse should be reported in all circumstances; however, half of them could not accurately identify the legal authorities where suspected cases should be reported. Only 20% of the participating dentists had ever suspected a case of physical abuse and 30% of those actually reported it to legal authorities. Participants characterized fear of anger from relatives as the most significant barrier toward reporting suspected cases. The analysis revealed that Pakistan's dentists lack adequate knowledge regarding domestic violence in terms of identification, relevant physical signs/symptoms, and social indicators. Dentists of Pakistan had insufficient knowledge about the identification, management, and reporting of domestic violence cases. However, formal training and dentists' qualification were positively associated with overall awareness and practices regarding domestic violence case management.
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Affiliation(s)
- Muhammad Nasir Saleem
- Professor of Operative Dentistry, 462516Institute of Dentistry CMH Lahore Medical College, NUMS, Lahore, Pakistan
| | - Hina Zafar Raja
- Professor Prosthodontics, 462516Institute of Dentistry CMH Lahore Medical College, NUMS, Lahore, Pakistan
| | - Asma Shakoor
- Associate Professor, 462516Institute of Dentistry CMH Lahore Medical College, NUMS, Lahore, Pakistan
| | - Haroon Rashid
- Vice President and Dy Chief Executive, 462516CMH Lahore Medical College, NUMS, Lahore, Pakistan
| | - Haiqa Nasir
- 462516Institute of Dentistry CMH Lahore Medical College, Lahore, Pakistan
| | - Elyon Yusuf
- Deceased, Former student 462516Institute of Dentistry CMH Lahore Medical College, Lahore, Pakistan
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Malik M, Munir N, Ghani MU, Ahmad N. Domestic violence and its relationship with depression, anxiety and quality of life: A hidden dilemma of Pakistani women. Pak J Med Sci 2020; 37:191-194. [PMID: 33437275 PMCID: PMC7794145 DOI: 10.12669/pjms.37.1.2893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To find out the relationship of domestic violence with depression, anxiety and quality of life in married women in hospitals of Rawalpindi and Islamabad. Methods: This co-relational study was conducted in Rawalpindi Institute of Health Sciences from January 2019 to December 2019. All the females’ patients who were the victim of domestic violence were the population of the study. Consecutive non-probability sampling technique was used for selection of sampling from the target population. The inclusion criterion for this study was diagnosed case of domestic violence. DASS 21 (The Depression, Anxiety and Stress Scale) and Quality of life (WHO) scales were administered to 116 patients. Results: The study’s key results were that domestic abuse has positive relationship with depression, anxiety, and stress. It was also found that domestic abuse has a negative relationship with quality of life of those who have been subjected to domestic violence of this sort. Conclusion: It was concluded that domestic violence whether verbal, physical, emotional or sexual has strongly effects the mental health and quality of life of abused women.
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Affiliation(s)
- Mazhar Malik
- Prof. Dr. Mazhar Malik, Professor of Psychiatry, HoD Department, Department of Psychiatry and Behavioural Sciences, Rawal Institute of Health Sciences, Rawal General and Dental Hospital, Lehtrar Road, Islamabad, Pakistan
| | - Nargis Munir
- Nargis Munir, Clinical Psychologist, Department of Psychiatry and Behavioural Sciences, Rawal Institute of Health Sciences, Rawal General and Dental Hospital, Lehtrar Road, Islamabad, Pakistan
| | - M Usman Ghani
- Dr. M. Usman Ghani, Assistant Professor of Psychiatry, Department of Psychiatry and Behavioural Sciences, Rawal Institute of Health Sciences, Rawal General and Dental Hospital, Lehtrar Road, Islamabad, Pakistan
| | - Nasir Ahmad
- Dr. Nasir Ahmad Assistant Professor Centre for Education & Staff training University of Swat, Pakistan
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