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Hamdani SU, Huma ZE, Malik A, Nizami AT, Baneen UU, Suleman N, Javed H, Wang D, van Ommeren M, Mazhar S, Khan SA, Minhas FA, Rahman A. Improving psychosocial distress for young adolescents in rural schools of Pakistan: study protocol of a cluster randomised controlled trial. BMJ Open 2022; 12:e063607. [PMID: 36153028 PMCID: PMC9511576 DOI: 10.1136/bmjopen-2022-063607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Emotional problems are leading contributors to health burden among adolescents worldwide. There is an urgent need for evidence-based psychological interventions for young people. This study aims to evaluate the effectiveness of a school-based, group psychological intervention, Early Adolescent Skills for Emotions (EASE) developed by the WHO to improve psychosocial distress in Pakistani adolescents. METHOD AND ANALYSIS A two-arm, single-blinded, cluster randomised controlled trial, with a wait-list control arm is being conducted in school settings of rural Pakistan. Forty eligible public-school clusters have been randomised (stratified by gender) on a 1:1 allocation ratio into intervention (n=20) and control arm (n=20). Following informed consent, 564 adolescents with psychosocial distress (Youth-reported Paediatric Symptoms Checklist, cut-off ≥28) from 40 schools have been enrolled into the trial (14±3 average cluster size) between 2 November 2021 and 30th November 2021. Participants in the intervention arm will receive EASE in 7-weekly adolescents and 3-biweekly caregivers group sessions in schools. The adolescent sessions involve the components of psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention. Caregivers will receive training to learn and implement active listening; spending quality time and using praise as a strategy to help their children. The primary outcome is reduction in psychosocial distress at 3 months postintervention. Secondary outcomes include symptoms of depression and anxiety, caregiver-adolescent relationship and caregivers' well-being. Outcomes will be assessed at baseline, immediate 1 week and 3-months postintervention. Qualitative process evaluation will explore barriers and facilitators to programme implementation in low-resource school settings. ETHICS Ethics approval has been obtained from Central Ethics Committee of University of Liverpool, UK, Ethics Review Committee of WHO Geneva and from the Institutional Review Board of Human Development Research Foundation (HDRF), Pakistan. DISSEMINATION The findings of the study will be disseminated by WHO and through peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN17755448.
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Affiliation(s)
- Syed Usman Hamdani
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Zill-E- Huma
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | | | - Um Ul Baneen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Nadia Suleman
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Hashim Javed
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Samra Mazhar
- Noncommunicable Diseases and Mental Health Department, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Shahzad Alam Khan
- Noncommunicable Diseases and Mental Health Department, World Health Organization, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Hamdani SU, Huma ZE, Tamizuddin-Nizami A, Baneen UU, Suleman N, Javed H, Malik A, Wang D, Mazhar S, Khan SA, Minhas FA, Rahman A. Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT). Child Adolesc Psychiatry Ment Health 2022; 16:47. [PMID: 35729589 PMCID: PMC9210054 DOI: 10.1186/s13034-022-00480-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. METHODS A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. RESULTS The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. CONCLUSIONS The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.
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Affiliation(s)
- Syed Usman Hamdani
- Human Development Research Foundation (HDRF), Islamabad, Pakistan. .,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK. .,Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan. .,Benazir Bhutto Hospital, Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan.
| | - Zill-e Huma
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Asad Tamizuddin-Nizami
- grid.415712.40000 0004 0401 3757Benazir Bhutto Hospital, Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Um-ul Baneen
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nadia Suleman
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hashim Javed
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Duolao Wang
- grid.48004.380000 0004 1936 9764Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Samra Mazhar
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Shahzad Alam Khan
- grid.475671.6World Health Organization (WHO), Pakistan Office, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Abstract
OBJECTIVE To evaluate the effectiveness of vortioxetine in major depressive disorder (MDD) when used as a first-line versus second-line treatment or later. METHODS This was a post-hoc analysis of three 3-month non-interventional, prospective studies of vortioxetine in MDD - REVIDA (Malaysia, Philippines, Singapore, Thailand), PREVIDA (Pakistan) and TREVIDA (Taiwan). Improvements in depressive symptoms (PHQ-9, CGI-S), cognitive function (PDQ-D) and work productivity (WPAI) were compared between studies, and in a pooled analysis of patients using vortioxetine as the first line versus second-line treatment or later. Safety was compared between studies. RESULTS Overall, 798 patients were analyzed (PREVIDA = 425, REVIDA = 130, TREVIDA = 243). Most patients in PREVIDA (60.5%)/REVIDA (57.4%) used vortioxetine as first-line treatment versus TREVIDA (21.8%). Generally, greater improvements from baseline were observed across outcome measures in PREVIDA/REVIDA versus TREVIDA (Month 3, p < .0001). Vortioxetine as first-line treatment was associated with greater improvements in depression severity, cognition, functioning outcomes compared to second-line or later users (PHQ-9: -16.1 [6.4] vs -10.8 [8.9]; CGI-S: -2.7 [1.1] vs -2.0 [1.4]; PDQ-D: -29.5 [17.7] vs -18.5 [21.4]; p < .0001 at Month 3) as well as greater response (PHQ-9: 88.6% vs 61.5%; p < .0001) and remission rates (PHQ-9: 75.4% vs 47.7%; p < .0001). No new adverse events were reported outside of the product label. CONCLUSIONS In the Asian real-world setting, vortioxetine showed greater improvements in depressive and cognitive symptoms, work functioning, and response and remission rates when used as first-line versus second-line treatment or later. Vortioxetine was well-tolerated irrespective of the study population across Asia.
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Affiliation(s)
- Rohini Bose
- Lundbeck Singapore Pte Ltd, Singapore, Singapore
| | - Syed Usman Hamdani
- Human Development Research Foundation, Islamabad, Pakistan
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Karakoram International University, Gilgit, Pakistan
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Hamdani SU, Huma ZE, Suleman N, Akhtar P, Nazir H, Masood A, Tariq M, Koukab A, Salomone E, Pacione L, Brown F, Shire S, Sikander S, Servili C, Wang D, Minhas FA, Rahman A. Effectiveness of a technology-assisted, family volunteers delivered, brief, multicomponent parents' skills training intervention for children with developmental disorders in rural Pakistan: a cluster randomized controlled trial. Int J Ment Health Syst 2021; 15:53. [PMID: 34059074 PMCID: PMC8165981 DOI: 10.1186/s13033-021-00476-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Globally, there is a large documented gap between needs of families and children with developmental disorders and available services. We adapted the World Health Organization’s mental health Gap-Intervention Guidelines (mhGAP-IG) developmental disorders module into a tablet-based android application to train caregivers of children with developmental disorders. We aimed to evaluate the effectiveness of this technology-assisted, family volunteers delivered, parents’ skills training intervention to improve functioning in children with developmental disorders in a rural community of Rawalpindi, Pakistan. Methods In a single-blinded, cluster randomized controlled trial, 30 clusters were randomised (1:1 ratio) to intervention (n = 15) or enhanced treatment as usual (ETAU) arm (n = 15). After screening, 540 children (18 participants per cluster) aged 2–12 years, with developmental disorders and their primary caregivers were recruited into the trial. Primary outcome was child’s functioning, measured by Childhood Disability Assessment Schedule for Developmental Disorders (DD-CDAS) at 6-months post-intervention. Secondary outcomes were parents’ health related quality of life, caregiver-child joint engagement, socio-emotional well-being of children, family empowerment and stigmatizing experiences. Intention-to-treat analyses were done using mixed-models adjusted for covariates and clusters. Results At 6-months post-intervention, no statistically significant mean difference was observed on DD-CDAS between intervention and ETAU (mean [SD], 47.65 [26.94] vs. 48.72 [28.37], Adjusted Mean Difference (AMD), − 2.63; 95% CI − 6.50 to 1.24). However, parents in the intervention arm, compared to ETAU reported improved health related quality of life (mean [SD] 65.56 [23.25] vs. 62.17 [22.63], AMD 5.28; 95% CI 0.44 to 10.11). The results were non-significant for other secondary outcomes. Conclusions In the relatively short intervention period of 6 months, no improvement in child functioning was observed; but, there were significant improvements in caregivers’ health related quality of life. Further trials with a longer follow-up are recommended to evaluate the impact of intervention. Trial registration Clinicaltrials.gov, NCT02792894. Registered April 4, 2016, https://clinicaltrials.gov/ct2/show/NCT02792894
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Affiliation(s)
- Syed Usman Hamdani
- Institute of Psychiatry, Rawalpindi Medical University (RMU) and Benazir Bhutto Hospital, Rawalpindi, Pakistan. .,University of Liverpool, Liverpool, UK. .,Human Development Research Foundation, Islamabad, Pakistan.
| | - Zill-E- Huma
- University of Liverpool, Liverpool, UK.,Human Development Research Foundation, Islamabad, Pakistan
| | - Nadia Suleman
- Human Development Research Foundation, Islamabad, Pakistan
| | - Parveen Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- Human Development Research Foundation, Islamabad, Pakistan
| | | | | | - Erica Salomone
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland.,Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Laura Pacione
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland.,Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, ON, Canada
| | - Felicity Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie Shire
- Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, USA
| | | | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Fareed Aslam Minhas
- Institute of Psychiatry, Rawalpindi Medical University (RMU) and Benazir Bhutto Hospital, Rawalpindi, Pakistan
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Hamdani SU, Huma ZE, Masood A, Zhou K, Ahmed Z, Nazir H, Amin H, Akhtar P, Bryant RA, Dawson K, van Ommeren M, Wang D, Rahman A, Minhas FA. Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial. Int J Ment Health Syst 2021; 15:11. [PMID: 33468192 PMCID: PMC7814584 DOI: 10.1186/s13033-020-00434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. METHODS A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N = 192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM + plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS 2.0) at 20 weeks after baseline. RESULTS The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20 weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, - 3.10; 95% CI, - 0.26 to - 5.76); p = 0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, - 4.35; 95% CI, - 1.45 to - 7.24); p = 0.004 in PM + plus TAU versus TAU arm. The follow-up rate was 67% at primary end-point. CONCLUSIONS Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered March 23, 2016. Retrospectively registered, https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482.
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Affiliation(s)
- Syed Usman Hamdani
- University of Liverpool, Liverpool, UK.
- Human Development Research Foundation, Islamabad, Pakistan.
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan.
| | - Zill-E- Huma
- University of Liverpool, Liverpool, UK
- Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- Human Development Research Foundation, Islamabad, Pakistan
| | - Kaina Zhou
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Zainab Ahmed
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - Hania Amin
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan
| | - Parveen Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Katie Dawson
- University of New South Wales, Sydney, Australia
| | | | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Fareed Aslam Minhas
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan
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Hamdani SU, Huma ZE, Suleman N, Warraitch A, Muzzafar N, Farzeen M, Minhas FA, Rahman A, Wissow LS. Scaling-up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach. Int J Ment Health Syst 2021; 15:8. [PMID: 33436049 PMCID: PMC7802314 DOI: 10.1186/s13033-021-00435-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ninety percent of children with mental health problems live in low or middle-income countries (LMICs). School-based programs offer opportunities for early identification and intervention, however implementation requires cross-sector collaboration to assure sustainable delivery of quality training, ongoing supervision, and outcomes monitoring at scale. In Pakistan, 35% of school-aged children are reported to have emotional and behavioral problems. As in many other LMICs, the government agencies who must work together to mount school-based programs have limited resources and a limited history of collaboration. The "Theory of Change" (ToC) process offers a way for new partners to efficiently develop mutual goals and long-term prospects for sustainable collaboration. OBJECTIVE Develop a model for scale-up of school based mental health services in public schools of Pakistan. METHODS We used ToC workshops to develop an empirically supported, 'hypothesized pathway' for the implementation of WHO's School Mental Health Program in the public schools of rural Pakistan. Three workshops included 90 stakeholders such as policy makers from education and health departments, mental health specialists, researchers, head teachers, teachers and other community stakeholders including non-governmental organizations. RESULTS The ToC process linked implementers, organizations, providers and consumers of school mental health services to develop common goals and relate them (improved child socioemotional wellbeing, grades and participation in activities) to interventions (training, monitoring and supervision of teachers; collaboration with parents, teachers and primary health care facilities and schools). Key testable assumptions developed in the process included buy-in from health care providers, education officials and professionals, community-based organizations and families. For example, teachers needed skills for managing children's problems, but their motivation might come from seeking improved school performance and working conditions. Poverty, stigma and lack of child mental health literacy among teachers, administration, and parents were identified as key hypothesized barriers. Children and their families were identified as key stakeholders to make such a program successful. DISCUSSION ToC workshops assisted in team building and served as a stakeholders' engagement tool. They helped to develop and support testable hypotheses about the structures, collaborations, and knowledge most important to scaling-up school based mental health services in Pakistan.
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Affiliation(s)
- Syed Usman Hamdani
- University of Liverpool, Liverpool, UK. .,Human Development Research Foundation, Islamabad, Pakistan. .,Institute of Psychiatry, Rawalpindi, Pakistan.
| | - Zill-E- Huma
- University of Liverpool, Liverpool, UK.,Human Development Research Foundation, Islamabad, Pakistan
| | - Nadia Suleman
- Human Development Research Foundation, Islamabad, Pakistan
| | - Azza Warraitch
- Human Development Research Foundation, Islamabad, Pakistan
| | - Naila Muzzafar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Midhat Farzeen
- Human Development Research Foundation, Islamabad, Pakistan
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Hamdani SU, Warraitch A, Suleman N, Muzzafar N, Minhas FA, Nizami AT, Sikander S, Pringle B, Hamoda HM, Wang D, Rahman A, Wissow LS. Technology-Assisted Teachers' Training to Promote Socioemotional Well-Being of Children in Public Schools in Rural Pakistan. Psychiatr Serv 2021; 72:69-76. [PMID: 32838678 PMCID: PMC7775896 DOI: 10.1176/appi.ps.202000005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The World Health Organization's (WHO) Eastern Mediterranean Regional Office (EMRO) developed a school mental health program (SMHP) to help reduce the burden of youth mental health problems. Designed in collaboration with international consultants, the SMHP draws on evidence-based interventions to train personnel to identify students in need, respond therapeutically, and engage families in seeking care. METHODS Teams from Pakistan, Egypt, Iran, and Jordan collaborated with the WHO EMRO and British and U.S. universities to form the School Health Implementation Network: Eastern Mediterranean Region (SHINE), a National Institute of Mental Health-funded global mental health hub. SHINE partners used a "theory of change" process to adapt the SMHP to be more readily adopted by school personnel and replicated with fidelity. The adapted SMHP more directly addresses teachers' priorities and uses technology to facilitate training. RESULTS A cluster-randomized implementation effectiveness trial enrolling 960 children ages 8-13 in 80 Pakistani schools will test the adapted SMHP against the original. Children who screen positive on first the teacher and subsequently the parent Strengths and Difficulties Questionnaires (SDQs) will be enrolled and tracked for 9 months. The primary trial outcome is reduction in parent-rated SDQ total difficulties scores. Secondary outcomes include children's well-being, academic performance, absenteeism, and perceived stigma; parent-teacher interaction; teachers' self-efficacy and subjective well-being; and school environment. Implementation outcomes include change in teachers' behavior and sense of program acceptability, cultural appropriateness, feasibility, penetration, and sustainability. NEXT STEPS The trial began in October 2019, and the expected completion date is March 2021. Outcomes will inform dissemination of the SMHP in Pakistan and elsewhere.
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Affiliation(s)
- Syed Usman Hamdani
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Azza Warraitch
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Nadia Suleman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Naila Muzzafar
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Fareed Aslam Minhas
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Asad Tameezuddin Nizami
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Siham Sikander
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Beverly Pringle
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Hesham M Hamoda
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Duolao Wang
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Lawrence S Wissow
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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8
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Volpe U, Amin H, Ayinde OO, Burns A, Chan WC, David R, Dejanovic SD, Djokic G, Eraslan D, Fischer GAL, Gracia-García P, Hamdani SU, Han C, Jafri H, Kallivayalil RA, Kriekaart RL, Kua EH, Lam LCW, Lecic-Tosevski D, Leroi I, Lobo A, Mihai A, Minhas FA, Mistry H, Ogundele AT, Olde Rikkert MGM, Olivera J, Palumbo C, Parker A, Pejuskovic B, Riese F, Robert P, Semrau M, Stoppe G, Sudhakar S, Tirintica AR, Tofique S, Tsoi C, Wolski L, Yalug I, Wang H, Yu X, Sartorius N. Pathways to care for people with dementia: An international multicentre study. Int J Geriatr Psychiatry 2020; 35:163-173. [PMID: 31657091 DOI: 10.1002/gps.5223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.
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Affiliation(s)
- Umberto Volpe
- Department of Neuroscience/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Hania Amin
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Rawalpindi, Pakistan
| | - Olatunde O Ayinde
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Alistair Burns
- Greater Manchester NIHR Clinical Research Network, University of Manchester, UK, Manchester, UK
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Renaud David
- CoBTEK lab, Research Memory center, University Côte d'Azur, Nice, France
| | | | | | | | - Giulia A L Fischer
- Division of Old Age Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Patricia Gracia-García
- Department of Medicine and Psychiatry, University of Zaragoza; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Syed Usman Hamdani
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Rawalpindi, Pakistan
- Human Development Research Foundation, Islamabad, Pakistan
| | - Changsu Han
- Department of Psychiatry, Mind-Medical Research Lab, Korea University, Seoul, Korea
| | | | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Roderick Leonard Kriekaart
- Department of Geriatrics, Radboud Alzheimer Centre, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ee Heok Kua
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Linda C W Lam
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | | | - Iracema Leroi
- Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Antonio Lobo
- Department of Medicine and Psychiatry, University of Zaragoza; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | | | - Heena Mistry
- Greater Manchester NIHR Clinical Research Network, University of Manchester, UK, Manchester, UK
| | | | - Marcel G M Olde Rikkert
- Department of Geriatrics, Radboud Alzheimer Centre, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Angela Parker
- Greater Manchester NIHR Clinical Research Network, University of Manchester, UK, Manchester, UK
| | - Bojana Pejuskovic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Florian Riese
- Division of Old Age Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Philippe Robert
- CoBTEK lab, Research Memory center, University Côte d'Azur, Nice, France
| | - Maya Semrau
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton; and King's College, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Sanu Sudhakar
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Andreea Raluca Tirintica
- Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Chris Tsoi
- Department of Psychological Medicine, National University Hospital, Singapore
| | | | - Irem Yalug
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, 100191, China
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, 100191, China
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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9
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Muneer A, Minhas FA. Telomere Biology in Mood Disorders: An Updated, Comprehensive Review of the Literature. Clin Psychopharmacol Neurosci 2019; 17:343-363. [PMID: 31352701 PMCID: PMC6705109 DOI: 10.9758/cpn.2019.17.3.343] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
Major psychiatric disorders are linked to early mortality and patients afflicted with these ailments demonstrate an increased risk of developing physical diseases that are characteristically seen in the elderly. Psychiatric conditions like major depressive disorder, bipolar disorder and schizophrenia may be associated with accelerated cellular aging, indicated by shortened leukocyte telomere length (LTL), which could underlie this connection. Telomere shortening occurs with repeated cell division and is reflective of a cell’s mitotic history. It is also influenced by cumulative exposure to inflammation and oxidative stress as well as the availability of telomerase, the telomere-lengthening enzyme. Precariously short telomeres can cause cells to undergo senescence, apoptosis or genomic instability; shorter LTL correlates with compromised general health and foretells mortality. Important data specify that LTL may be reduced in principal psychiatric illnesses, possibly in proportion to exposure to the ailment. Telomerase, as measured in peripheral blood monocytes, has been less well characterized in psychiatric illnesses, but a role in mood disorder has been suggested by preclinical and clinical studies. In this manuscript, the most recent studies on LTL and telomerase activity in mood disorders are comprehensively reviewed, potential mediators are discussed, and future directions are suggested. An enhanced comprehension of cellular aging in psychiatric illnesses could lead to their re-conceptualizing as systemic ailments with manifestations both inside and outside the brain. At the same time this paradigm shift could identify new treatment targets, helpful in bringing about lasting cures to innumerable sufferers across the globe.
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Affiliation(s)
- Ather Muneer
- Department of Psychiatry, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Fareed Aslam Minhas
- Department of Psychiatry, WHO Collaborating Center, Rawalpindi Medical University, Rawalpindi, Pakistan
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10
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Hamdani SU, Ahmed Z, Sijbrandij M, Nazir H, Masood A, Akhtar P, Amin H, Bryant RA, Dawson K, van Ommeren M, Rahman A, Minhas FA. Correction to: Problem Management Plus (PM+) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial. Int J Ment Health Syst 2018; 12:53. [PMID: 30275875 PMCID: PMC6158843 DOI: 10.1186/s13033-018-0231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13033-017-0147-1.].
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Affiliation(s)
- Syed Usman Hamdani
- 1Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Zainab Ahmed
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Marit Sijbrandij
- 3Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Huma Nazir
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Parveen Akhtar
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Hania Amin
- 1Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Richard A Bryant
- 4School of Psychology, University of New South Wales, Sydney, Australia
| | - Katie Dawson
- 4School of Psychology, University of New South Wales, Sydney, Australia
| | - Mark van Ommeren
- 5World Health Organization (WHO), Department of Mental Health and Substance Abuse, Geneva, Switzerland
| | | | - Fareed Aslam Minhas
- 1Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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11
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Abstract
Terrorism is often construed as a well-thought-out, extreme form of violence to perceived injustices. The after effects of terrorism are usually reported without understanding the underlying psychological and social determinants of the terrorist act. Since ‘9/11’ Pakistan has been at the epicentre of both terrorism and the war against it. This special paper helps to explain the psychosocial perspective of terrorism in Pakistan that leads to violent radicalisation. It identifies the terrorist acts in the background of Pakistan's history, current geopolitical and social scenario. The findings may also act as a guide on addressing this core issue.
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Affiliation(s)
- Asad Tamizuddin Nizami
- Assistant Professor, Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health, Benazir Bhutto Hospital, Rawalpindi Medical College, Rawalpindi, Pakistan; email
| | | | - Sadia Yasir
- Consultant Psychiatrist, Shifa International Hospital, Shifa College of Medicine, Islamabad, Pakistan
| | - Mowaddat Hussain Rana
- Director General, Centre for Trauma Research and Psychosocial Interventions, National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Head Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health, Benazir Bhutto Hospital, Rawalpindi Medical College, Rawalpindi, Pakistan
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12
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Hamdani SU, Ahmed Z, Sijbrandij M, Nazir H, Masood A, Akhtar P, Amin H, Bryant RA, Dawson K, van Ommeren M, Rahman A, Minhas FA. Problem Management Plus (PM+) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial. Int J Ment Health Syst 2017; 11:40. [PMID: 28603552 PMCID: PMC5465445 DOI: 10.1186/s13033-017-0147-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/27/2017] [Indexed: 12/23/2022] Open
Abstract
Background The World Health Organization (WHO) has developed Problem Management Plus (PM+), a 5-session, psychological intervention program delivered by trained non-specialist that addresses common mental disorders. The objectives of this study are to evaluate effectiveness and cost-effectiveness of PM+ in a specialized mental health care facility in Pakistan. Methods A single blind individual randomized controlled trial (RCT) will be carried out in the outpatient department of a specialized mental healthcare facility in Rawalpindi, Pakistan. After informed consent, patients with high psychological distress (General Health Questionnaire-12 (score >2) and functional impairment (WHO Disability Assessment Schedule 2.0 score >16) will be randomised to PM+ plus treatment as usual (n = 96) or TAU only (n = 96). The primary outcome is the psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale and improvement in functioning as measured by WHODAS at 20 weeks after baseline. Secondary outcomes include improvement in symptoms of depression, post-traumatic stress disorder, levels of social support and cost effectiveness evaluation. Qualitative interviews will be conducted to evaluate the process of implementing PM+ including barriers and facilitators in implementation and possibility of integration of PM+ program in specialized mental health care facilities in Pakistan. Discussion The results of this study will be helpful in evaluating the effectiveness of the approach of training non specialists, based in the specialized mental health care facilities in delivering evidence based psychological interventions in the low resource settings. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered Retrospectively on March 23, 2016 Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0147-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Syed Usman Hamdani
- Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Zainab Ahmed
- Human Development Research Foundation, Islamabad, Pakistan
| | - Marit Sijbrandij
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Huma Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- Human Development Research Foundation, Islamabad, Pakistan
| | - Parveen Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Hania Amin
- Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Mark van Ommeren
- World Health Organization (WHO), Department of Mental Health and Substance Abuse, Geneva, Switzerland
| | | | - Fareed Aslam Minhas
- Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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13
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Malakouti SK, Saeed K, Akhondzadeh S, Dehghani M, Minhas FA, Agoub M, Bolhari J, Mohit A, Moussaoui D, Sirous S, Kazemzadeh Atoofi M, Shenouda H, Shabani O. Regional Meeting of WHO Collaborating Centers for Mental Health in the Eastern Mediterranean Region. Arch Iran Med 2017; 20:196-198. [PMID: 28287816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Seyed Kazem Malakouti
- WHO Collaborating Centre, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Khalid Saeed
- WHO/EMRO, Regional Advisor, Mental Health and Substance Abuse unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization, Regional Office for the Eastern Mediterranean
| | | | - Mahmood Dehghani
- Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fareed Aslam Minhas
- Institute of Psychiatry, Rawalpindi Medical College, WHO Collaborating Centre for Mental Health, Pakistan
| | - Mohamed Agoub
- Laboratoire des Neurosciences Clinique et Sante Mentale UFR Neurosciences et Psychiatrie Biologique Faulte de Medecine et de Pharmacy de Casablanca Centre, Psychiatrique Universitaire Ibn Rochd, Casablanca
| | - Jafar Bolhari
- Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mohit
- WHO Collaborating Centre for Mental Health, Faculty of Behavioral Sciences and Mental Health, Tehran, Iran
| | - Driss Moussaoui
- WHO Collaborating Centre for Mental Health, Casablanca, Morocco
| | | | - Mehrdad Kazemzadeh Atoofi
- WHOcc Office, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hoda Shenouda
- WHO/EMRO, Mental Health and Substance Abuse Unit, World Health Organization, Regional Office for the Eastern Mediterranean
| | - Omolbanin Shabani
- WHOcc Office, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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14
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Abstract
As in many low-income countries, the treatment gap for developmental disorders in rural Pakistan is near 100%. We integrated social, technological, and business innovations to develop and pilot a potentially sustainable service for children with developmental disorders in 1 rural area. Families with developmental disorders were identified through a mobile phone-based interactive voice response system, and organized into "Family Networks." "Champion" family volunteers were trained in evidence-based interventions. An Avatar-assisted Cascade Training and information system was developed to assist with training, implementation, monitoring, and supervision. In a population of ∼30,000, we successfully established 1 self-sustaining Family Network consisting of 10 trained champion family volunteers working under supervision of specialists, providing intervention to 70 families of children with developmental disorders. Each champion was responsible for training and providing ongoing support to 5 to 7 families from his or her village, and the families supported each other in management of their children. A pre-post evaluation of the program indicated that there was significant improvement in disability and socioemotional difficulties in the child, reduction in stigmatizing experiences, and greater family empowerment to seek services and community resources for the child. There was no change in caregivers' well-being. To replicate this service more widely, a social franchise model has been developed whereby the integrated intervention will be "boxed" up and passed on to others to replicate with appropriate support. Such integrated social, technological, and business innovations have the potential to be applied to other areas of health in low-income countries.
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Affiliation(s)
| | | | - Zafar Iqbal
- Human Development Research Foundation, Islamabad, Pakistan
| | - Atif Rahman
- Human Development Research Foundation, Islamabad, Pakistan; University of Liverpool, Liverpool, United Kingdom
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15
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Nizami AT, Rana MH, Hassan TM, Minhas FA. Terrorism in Pakistan: a behavioral sciences perspective. Behav Sci Law 2014; 32:335-346. [PMID: 24777397 DOI: 10.1002/bsl.2118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/03/2014] [Accepted: 01/08/2014] [Indexed: 06/03/2023]
Abstract
This article reviews the behavioral science perspectives of terrorism in Pakistan. It can be argued that Pakistan has gained worldwide attention for "terrorism" and its role in the "war against terrorism". The region is well placed geopolitically for economic successes but has been plagued by terrorism in various shapes and forms. A behavioral sciences perspective of terrorism is an attempt to explain it in this part of the world as a complex interplay of historical, geopolitical, anthropological and psychosocial factors and forces. Drawing from theories by Western scholars to explain the behavioral and cognitive underpinnings of a terrorist mind, the authors highlight the peculiarities of similar operatives at individual and group levels. Thorny issues related to the ethical and human right dimensions of the topic are visited from the unique perspective of a society challenged by schisms and divergence of opinions at individual, family, and community levels. The authors have attempted to minimize the political descriptions, although this cannot be avoided entirely, because of the nature of terrorism.
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Affiliation(s)
- Asad Tamizuddin Nizami
- Director General, Centre for Trauma Research and Psychosocial Interventions, National University of Sciences & Technology (NUST), Islamabad, Pakistan
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16
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Hamdani SU, Atif N, Tariq M, Minhas FA, Iqbal Z, Rahman A. Family networks to improve outcomes in children with intellectual and developmental disorders: a qualitative study. Int J Ment Health Syst 2014; 8:7. [PMID: 24485093 PMCID: PMC3915557 DOI: 10.1186/1752-4458-8-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/27/2014] [Indexed: 11/21/2022] Open
Abstract
Background There are at least 50 million children with an intellectual or developmental disorder in South Asia. The vast majority of these children have no access to any service and there are no resources to develop such services. We aimed to explore a model of care-delivery for such children, whereby volunteer family members of affected individuals could be organized and trained to form an active, empowered group within the community that, a) using a task-sharing approach, are trained by specialists to provide evidence-based interventions to their children; b) support each other, with the more experienced FaNs i.e. family networks, providing peer-supervision and training to new family members who join the group; and c) works to reduce the stigma associated with the condition. Methods We used qualitative methods to explore carers’ perspectives about such a care-delivery model. Results The key findings of this research are that there is a huge gap between the needs of the carers and available services. Carers would welcome a volunteer-led service, and some community members would have time to volunteer. Raising community awareness in a culturally sensitive manner prior to launching such a service and linking it to the community health workers programme would increase the likelihood of success. Gender-matching would be important. It would be possible to form family networks around the more motivated volunteers, with support from local non-governmental organizations. The carers were receptive to the use of technology to assist the work of the volunteers as well as for networking. Conclusions We conclude that family volunteers delivering evidence-based packages of care after appropriate training is a feasible system that can help reduce the treatment gap for childhood intellectual and developmental disorders in under-served populations.
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Affiliation(s)
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- Human Development Research Foundation, Islamabad, Pakistan.
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Hayat AA, Ahmed MM, Minhas FA. Patients leaving against medical advice: an inpatient psychiatric hospital-based study. J Coll Physicians Surg Pak 2013; 23:342-6. [PMID: 23673174 DOI: 05.2013/jcpsp.342346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the frequency of patients leaving against medical advice (LAMA) in an inpatient psychiatric facility in Rawalpindi, Pakistan. STUDY DESIGN Descriptive cross-sectional study. PLACE AND DURATION OF STUDY Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, from August 2010 to February 2011. METHODOLOGY Patients who got admitted during study period irrespective of duration of illness and mode of admission were recruited through non-probability consecutive sampling and followed till discharge to determine their mode of leaving hospital. A thirteen-item proforma was developed and information was obtained on demographic, socioeconomic, patient related and disease related variables. Descriptive statistics were calculated on SPSS 14. RESULTS The total number (n) of participants was 246. Among the participants, 96 (39%) left against medical advice (LAMA) whereas 150 (61%) left on regular discharge on physician's advice. Frequency of patients who left against medical advice was found to be more in males (63.5%), younger age groups (21 - 30 years), lesser educated (more than half were under matric) and with the ICD-10 diagnosis of substance abuse (23.9%). About half of patients who LAMA had a prior history of psychiatric illness and a significant number (37.5%) had a history of previous psychiatric admission. CONCLUSION Leaving against medical advice is a frequent problem in psychiatric inpatients and is a matter of great concern for the treating doctors.
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Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract 2013; 30:76-87. [PMID: 22843638 DOI: 10.1093/fampra/cms037] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The World Health Organization is revising the primary care classification of mental and behavioural disorders for the International Classification of Diseases (ICD-11-Primary Health Care (PHC)) aiming to reduce the disease burden associated with mental disorders among member countries. OBJECTIVE To explore the opinions of primary care professionals on proposed new diagnostic entities in draft ICD-11-PHC, namely anxious depression and bodily stress syndrome (BSS). METHODS Qualitative study with focus groups of primary health-care workers, using standard interview schedule after draft ICD-11-PHC criteria for each proposed entity was introduced to the participants. RESULTS Nine focus groups with 4-15 participants each were held at seven locations: Austria, Brazil, Hong Kong, New Zealand, Pakistan, Tanzania and United Kingdom. There was overwhelming support for the inclusion of anxious depression, which was considered to be very common in primary care settings. However, there were concerns about the 2-week duration of symptoms being too short to make a reliable diagnosis. BSS was considered to be a better term than medically unexplained symptoms but there were disagreements about the diagnostic criteria in the number of symptoms required. CONCLUSION Anxious depression is well received by primary care professionals, but BSS requires further modification. International field trials will be held to further test these new diagnoses in draft ICD-11-PHC.
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Affiliation(s)
- T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
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Gani N, Saeed K, Minhas FA, Anjuman N, Waleed M, Fatima G. Assessment of patient satisfaction with mental health services in a tertiary care setting. J Ayub Med Coll Abbottabad 2011; 23:43-46. [PMID: 22830144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients' opinion regarding services has acquired great importance. Patient satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery. The study aimed to measure patient satisfaction in a tertiary care hospital in order to know the patients' perspectives and expectations of the services and make appropriate improvements accordingly. METHODS This was a cross-sectional study conducted at the Out-patient and Inpatient Departments of the Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, for a period of 8 months from October 2008 till June 2009. Sample size was 246 patients; which included 123 participants from Out-patient and In-patient departments each. Patients aged 18 and above, of both genders, who gave informed written consent, were consecutively recruited for the study. Learning disabled patients, frankly psychotic and those with severe cognitive impairment and severe co-morbid physical illnesses were excluded. Performa was filled in by the participants for their demographic details. The Client Satisfaction Questionnaire-8 was then orally administered in the native language (Urdu/Punjabi) to assess the degree of patient satisfaction. RESULTS Among the participants, 72% were mostly satisfied, 18.7% mildly satisfied and 9.3% dissatisfied with the psychiatric care. Age was significantly associated with satisfaction however no such associations could be found for gender and economic status. CONCLUSION Majority of the patients were satisfied with the psychiatric services. The younger people were more satisfied. Gender and economic status had no influence on patient satisfaction.
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Affiliation(s)
- Naveed Gani
- Postgraduate Resident, Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, Pakistan.
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Alvi T, Minhas FA. Type of presentation of dissociative disorder and frequency of co-morbid depressive disorder. J Coll Physicians Surg Pak 2009; 19:113-6. [PMID: 19208316 DOI: 02.2009/jcpsp.113116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 10/31/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the frequency distribution of various types of dissociative disorders, along with existing co-morbid depression and its level of severity in patients with dissociative disorder. STUDY DESIGN Observational, cross-sectional study. PLACE AND DURATION OF STUDY The Institute of Psychiatry, Rawalpindi General Hospital from October 2004 to March 2005. METHODOLOGY Fifty consecutive patients were included in the study through non-probable purposive sampling technique. Encounter form included socio-demographic profile and brief psychiatric history. ICD 10 diagnostic criteria for research were administered for determining the presentation of dissociative disorder. Present state examination was applied to make diagnosis of depressive disorder in the studied patients. Descriptive statistics for frequency analysis of sociodemographic variables, type of presentation of dissociative disorder and the frequency of depressive disorder in patients of dissociative disorder. RESULTS The mean age was 23.6+/-8.67 years with female preponderance (n=40, 80% patients). Most of them were single, unemployed and belonged to urban population. Main stress was primary support group issue. Mixed category of dissociative disorder was highest (n=18, 38%) followed by unspecified and motor symptoms (n=13, 26%) in each group. Depression was present in 42 (84%) patients. Moderate depression was most frequent (n=19, 38%). CONCLUSION Mixed dissociative symptoms were found in 38%, while 26% had motor and unspecified category of dissociative symptoms respectively. Depressive disorder was present in 42 (84%) cases of dissociative disorder with 38% having moderate depression.
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Affiliation(s)
- Tabassum Alvi
- Department of Psychiatry and Behavioural Sciences, Wah Medical College, Wah Cantt.
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Abstract
BACKGROUND Recent studies in rural areas of Pakistan have yielded high prevalence rates of common mental disorders, especially among women. AIMS To investigate emotional distress and common mental disorders in a poor urban district using the same survey method. METHOD First-stage screening of a slum district of Rawalpindi used the Bradford Somatic Inventory. Psychiatric interviews were conducted with stratified samples using the ICD-10 research diagnostic criteria. RESULTS On a conservative estimate, 25% of women and 10% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both men and women. Women living in joint households reported more distress than those living in unitary families. Higher levels of education were associated with lower risk of common mental disorders, especially in younger women. Emotional distress was negatively correlated with socio-economic variables among women. CONCLUSIONS This study found levels of emotional distress and psychiatric morbidity in a poor district of Rawalpindi to be less than half those in a nearby rural village in the Punjab, although rates in women were still double those in men. Possible explanations are that more healthy people migrate to the cities or that urban living is more conducive to good mental health in Pakistan.
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Affiliation(s)
- D B Mumford
- Division of Psychiatry, University of Bristol, Bristol, UK
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