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Objective The study aims to explore the perceptions and experiences of menopausal women living in Karachi, Pakistan. Study design Using qualitative exploratory design, in-depth interviews were conducted with eleven women, aged 35–55 years. The data was collected through face-to-face interviews using semi structured interview guide. Creswell frame work for content analysis was used to analyze the data. Main outcome measures Perceptions and experiences of menopause women living in Karachi, Pakistan. Results Women described positive and negative experiences of menopause, though predominantly negative intensified by mental distress, lack of support from intimate partner, and misperceptions about menopause. A majority of the women emphasized the need for educating their husbands regarding menopausal changes. In clinical practices, health care professionals should screen the women for menopause challenges when they visit health care facilities and offer education regarding self-care and management to achieve better quality of life and positive coping. Conclusions We conducted a preliminary study on women’s perceptions and experiences of menopause in the context of Pakistan. Our study offers significant findings from an Asian cultural perspective, in which norms are predominantly patriarchal and male dominated. The study provides useful guidelines for health care providers to better address health care needs of menopausal women.

Introduction This study translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) and Brain Module (QLQ-BN20) amongst patients with primary brain tumors (PBT) in Pakistan, and assessed the correlation of QoL with resilience, depression, and anxiety. Methods Translation of the EORTC QLQ-C30 and QLQ-BN20 was performed as per EORTC guidelines. A survey comprising of Urdu translations of EORTC QLQ-C30, QLQ-BN20, Wagnild and Young Resilience Scale (RS-14) and Hospital Anxiety and Depression Scale was administered to patients with PBT at a tertiary care hospital in Pakistan. Reliability (via Cronbach alpha), content validity index (CVI) scores, construct validity, and inter-scale correlations were assessed. Results Our sample consisted of 250 patients with PBT, most commonly glioma (46.8%) and meningioma (21.2%). All patients were able to understand the Urdu translations. The Cronbach alphas for the QLQ-C30 and the QLQ-BN20 were 0.860 and 0.880, respectively. The CVI scores for clarity and relevance were high for both the EORTC QLQ-C30 (0.98 and 0.96, respectively) and the QLQ-BN20 tool (0.81 and 0.95, respectively). The global QoL domain (EORTC QLQ-C30) showed significant positive correlations with resilience (r = 0.422), and significant negative correlations with depression (r = − 0.541) and anxiety (r = − 0.502). Strong inter-scale correlations were observed between physical functioning and insomnia (r = − 0.690) and role functioning and insomnia (r = − 0.641). Conclusion Our study confirms the Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 as valid clinical tools for the measurement of QoL in primary brain tumors patients within the cultural and socioeconomic context of Pakistan. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00354-6., Plain language summary Quality of life (QoL) is an important facet of well-being for patients with primary brain tumors (PBTs), as these individuals face significant distress during the course of their illness and treatment. It is important to have valid and reliable tools to accurately measure the QoL of patients with PBTs. The EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and its brain tumor-specific module EORTC QLQ-BN20 (EORTC QLQ-Brain Neoplasms 20) are exactly that. However, the use of the EORTC QLQ-C30 and QLQ-BN20 is limited in Pakistan, where the national language is Urdu, and the majority of patients are of low socioeconomic backgrounds. Since no Urdu translations of the EORTC QLQ-C30 and QLQ-BN20 exist, we aimed to translate and validate these tools to enable their applicability in Pakistan. The Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 demonstrated good validity amongst patients with PBTs. Thus, our study confirms the EORTC QLQ-C30 and QLQ-BN20 as valuable clinical tools for the measurement of QoL in primary brain tumors patients within the linguistic, cultural and socioeconomic context of Pakistan. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00354-6.

OBJECTIVE: The study aimed to assess the need of mental wellbeing services for post graduate medical (PGME) trainees working at the Aga Khan University Hospital in Karachi, Pakistan. METHODS: A cross-sectional study was conducted among all PGME trainees working at Aga Khan University Hospital in Karachi, Pakistan. The study questionnaire was developed by the team of investigators. The data collection was done through online survey from April 2019 to May 2019 and it was analyzed using descriptive and inferential analyses. RESULTS: Out of total 623 PGME trainees, 334 trainees completed the online survey (response rate of 53.61%). A total of 292 participants (87.4%) perceived a need for mental health services. The major stressors identified were increase work hours (77.8%), excessive workload (75.1%), and difficulty balancing between work and personal life (72.8%). The perceived obstacles of utilizing mental services included lack of protected time (69.8%), fear of consequences (36.8%), lack of confidentiality (36.5%), and stigma (32.9%). The study participants indicated various suggestions to reduce their stressors such as separate relaxation space in hospital (91.3%), appreciation gestures like encouraging emails (65%), mentoring programs (43.4%), and regular surveys about resident needs (39.8%). CONCLUSION: It is evident that innovative strategies to address trainees’ mental health needs, looking at limitations of developing countries like Pakistan with large population and limited resources, need to be explored. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40670-020-01098-6) contains supplementary material, which is available to authorized users.

ObjectiveTo explore healthcare provider’s perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.Design and settingWe conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Study data were analysed manually using the conventional content analysis technique.ParticipantsKey-informant interviews (KIIs) were conducted with senior management and hospital leadership and in-depth interviews (IDIs) were conducted with front-line healthcare providers.ResultsA total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was ‘challenges faced by front-line healthcare providers working in COVID-19 wards. Healthcare workers experienced increased anxiety due to the fear of acquiring infection and transmitting it to their family members. They felt overwhelmed due to the exhaustive donning and doffing process, intense work and stigmatisation. The second theme was ‘enablers supporting healthcare providers to deal with the COVID-19 pandemic’. Front liners pointed out several enabling factors that supported hospital staff including a safe hospital environment, adequate training, a strong system of information sharing and supportive management. The third theme was ‘recommendations to support the healthcare workforce during the COVID-19 crisis’. Healthcare workers recommended measures to mitigate current challenges including providing risk allowance to front-line healthcare providers, preparing a backup health workforce, and establishing a platform to address the mental health needs of the healthcare providers.ConclusionThis study provides an initial evidence base of healthcare providers’ experiences of managing patients with COVID-19 in the early stage of the pandemic and highlights measures needed to address the encountered challenges. It offers lessons for hospitals in low-income and middle-income countries to ensure a safe working environment for front-line workers in their fight against COVID-19.

Background: The COVID-19 pandemic has paved the way for psychological crises, especially in resource-limited settings where mental health infrastructure is already crippled. This study aims to determine the prevalence and factors associated with perceived-stress in the Pakistani population during the Covid-19 pandemic. Methods: A web-based cross-sectional survey was conducted on 1679 Pakistani residents who received the study questionnaire's Google form link. A validated tool of perceived-stress scale-10 was used to screen perceived stress levels. Multiple Ordinal Regression was used to identify the factors associated perceived stress and the results are reported as adjusted odds ratios with 95% confidence intervals. Results: The mean score of perceived stress was 19.32 (SD=+6.67). Most of the participants screened positive for moderate (69%) and high levels (14%) of stress, respectively. A significant interaction was seen between generalized-anxiety and the phase of the lockdown. During the complete lockdown, the odds of high-perceived stress among severely anxious participants were 44.67(95% CI: 21.33, 93.53) times than participants with no/minimal generalized anxiety. Moreover, the odds of high levels of perceived-stress among moderately anxious respondents were 15.79(95% CI: 10.19-24.28) times compared to participants with no/minimal anxiety during the smart lockdown. Conclusion: This study evidences that the pandemic was extremely distressing for the Pakistani population causing the maximum level of perceived-stress in more than half of the population. Adequate and timely interventions are needed before high-stress levels culminate into psychological disorders.

Background Psychological impact of the COVID 19 pandemic has been expected and widely predicted, but its associated factors are not measured predominantly in low- and middle-income countries. This study aims to determine the burden and factors associated with generalized-anxiety-disorder in the Pakistani population amidst the COVID 19 pandemic Methods We conducted a web-based cross-sectional survey on 1679 Pakistani residents who had access to the study questionnaire broadcasted via the Google form. Generalized-anxiety-disorder was screened through a validated tool of the Generalized-Anxiety-Disorder 7 scale. Multiple Ordinal Regression was used to identify the factors associated generalized anxiety disorder and the results were reported as adjusted odds ratios with 95% confidence intervals. Results Most of the participants (70.8%; n = 1189) were screened positive for generalized-anxiety-disorder, out of which moderate and severe symptoms were seen in 22% (n = 365) and 18% (n = 301) of them, respectively. The mean score for generalized-anxiety was 8.57(SD = ± 5.88). A significant interaction was seen between gender and perceived stress, indicating that females with high perceived stress had 30 times greater odds of generalized-anxiety as compared to females with low perceived stress (95% CI: 20.02, 44.46). Additionally, during the complete down, the odds of generalized-anxiety among respondents who frequently watched news were 1.72(95% CI: 1.06, 2.77) times compared to participants who rarely watched the news. Furthermore, participant’s current psychiatric illness, anxiousness about uncertainty, fear of getting infected from COVID, fear of loved one getting infected from COVID 19, worrying when the first case of COVID 19 was reported, indulgence in recreational activities, and current health status were found to be significantly associated with generalized-anxiety. Conclusion Study findings indicate an alarming increase in generalized anxiety adversely affecting the psychological well-being of respondents. Immediate interventions for offering psychological support need to be implemented to curtail the rapidly increasing morbidity due to anxiety related to the pandemic.

Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide.We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan.A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics of the participants, history of domestic violence, drug abuse and details about the act of deliberate self-harm, including the methods used. To assess depression and anxiety, we used the WHO self-reporting questionnaire (SRQ-20). Matched odds ratios with 95% confidence interval using conditional logistic regression were used to determine statistically significant associations between psychosocial factors and deliberate self-harm.Family conflicts, domestic violence, interpersonal arguments and living in extended families were found to be significantly associated with deliberate self-harm.In Afghanistan, deliberate self-harm appears to be predominately related to interpersonal problems and family conflicts. About two-thirds of females and more than half of males scored positive for depression, yet none were receiving treatment for this. These findings have important policy implications for mental health and suicide prevention programmes in the country.العوامل النفسية الاجتماعية لإيذاء الذات المُتعمد في كابول بأفغانستان: دراسة للحالات والشواهد المتوافقة في المستشفيات.أكبر بيمان، مراد خان، تازين علي، نرجس أسد، إقبال عزام.تعمُّد إيذاء الذات ليس مشكلة كبرى من مشكلات الصحة العامة العالمية فحسب، بل هو أيضاً مؤشر مهم للضائقة النفسية وعامل من عوامل الخطر التي تُفضي إلى الانتحار.تمثل هدفنا في تحديد عوامل الخطر النفسية الاجتماعية التي تُفضي إلى إيذاء الذات المُتعمَّد لدى مرضى يبلغون من العمر 16 عاماً أو أكثر ويتلقون العلاج في مستشفيات الرعاية التخصصية في كابول بأفغانستان.أُجريت دراسة للحالات والشواهد المتوافقة ابتداءً من فبراير/شباط 2015 حتى مايو/أيار 2015. واستعنّا بمائة وخمسة وثمانين حالة (مرضى الإيذاء الذاتي المتعمد) و555 حالة شاهدة متوافقة من حيث السن والجنس (مرضى يعانون من حالات طبية عامة) من أربعة من مستشفيات الرعاية التخصصية في كابول. لقد صممنا استبياناً لتسجيل الخصائص الاجتماعية والسكانية للمشاركين، تاريخ التعرُّض للعنف المنزلي، تعاطي المخدرات، تفاصيل حول "تعمد إيذاء الذات"، بما في ذلك الطرق المستخدمة لذلك. ولتقييم الاكتئاب والقلق، استخدمنا استبيان منظمة الصحة العالمية (SRQ–20)، ذاتي الإبلاغ. واستُخدم الانحدار اللوجستي المشروط بنسب أرجحية متوافقة وبفاصل ثقة قدره 95٪ لتحديد العلاقات ذات الدلالة الإحصائية التي تربط بين العوامل النفسية الاجتماعية وإيذاء الذات المتعمد.تبيَّ أن تعمُّد إيذاء الذات يرتبط ارتباطاً وثيقاً بالخلافات الأسرية، والعنف المنزلي، والسجالات المتبادلة بين الأشخاص، والعيش في أسر مفككة.يبدو في أفغانستان أن تعمُّد إيذاء الذات يرتبط في الغالب بالخلافات الأسرية ومشكلات العلاقات الاجتماعية مع الآخرين. فقد تبين أن نحو ثلثي الإناث وأكثر من نصف الذكور مصابون بالاكتئاب، ولكن لم يكن أي منهم يتلقى علاجاً لذلك. ولهذه النتائج انعكاسات مهمة على سياسات برامج الصحة النفسية والوقاية من الانتحار في البلد.Facteurs psychosociaux du comportement auto-agressif, en Afghanistan : étude avec cas et témoins appariés en milieu hospitalier.Le comportement auto-agressif est non seulement un problème de santé publique mondial majeur, mais aussi un signe manifeste de détresse psychosociale et un facteur de risque de suicide.L’objectif de la présente étude était de déterminer les facteurs de risques psychosociaux du comportement auto-agressif chez des patients âgés de 16 ans et plus en consultation au sein de centres hospitaliers de soins tertiaires à Kaboul (Afghanistan).Une étude avec cas et témoins appariés a été menée de février à mai 2015. Nous avons recruté 185 cas (patients atteints de comportement auto-agressif) et 555 témoins appariés selon l’âge et le sexe (patients atteints d’autres affections générales) consultant dans quatre centres hospitaliers de soins tertiaires à Kaboul. Nous avons mis au point un questionnaire pour enregistrer les caractéristiques sociodémographiques des participants, les antécédents de violence domestique, la toxicomanie et des détails sur le comportement auto-agressif, y compris les méthodes utilisées. Pour évaluer la dépression et l’anxiété, nous avons utilisé le questionnaire d’auto-évaluation de l’OMS (SRQ-20). Des odds ratios appariés assortis d’intervalles de confiance à 95 % obtenus par la régression logistique conditionnelle ont été utilisés afin de déterminer des associations statistiquement significatives entre les facteurs psychosociaux et le comportement auto-agressif.Les conflits familiaux, la violence domestique, les différends interpersonnels et la vie au sein de familles élargies se sont révélés être associés de manière significative au comportement auto-agressif.En Afghanistan, le comportement auto-agressif semble être principalement lié à des problèmes interpersonnels, ainsi qu’à des conflits familiaux. Près de deux tiers des femmes et plus de la moitié des hommes avaient un score positif pour la dépression ; pourtant, aucun n’était en traitement pour cette affection. Ces résultats ont des incidences politiques importantes sur les programmes de santé mentale et de prévention du suicide au sein du pays.

In the winter of 2014, four terrorists attacked a school in Khyber Pakhtunkhwa (KPK), resulting in more than a hundred students’ death. Twenty-two survivors (aged 10–18 years) with physical injurie...

Aim: The aim of this study was to estimate the prevalence of psychiatric problems and to identify associated factors among hearing-impaired children and adolescents (aged 4 - 16 years) attending special education institutions in Karachi, Pakistan. Methods: A cross-sectional study, using stratified random sampling was conducted in two special education institutions in Karachi from September 2010 to July 2011 on 272 hearing-impaired children aged 4 - 16 years. Multi-informant rating (responding parent and teacher) was used to assess the prevalence of psychiatric problems on Strengths and Difficulties Questionnaire (SDQ). Kappa statistic was computed to assess agreement between parents/teachers ratings. Multivariable logistic regression analysis was conducted to identify the factors associated with psychiatric problems of children. Results: An overall parent-rated prevalence of psychiatric problems among hearing-impaired children was estimated as 18% and teacher-rated prevalence as 32.7%; poor inter-rater agreement was found between the two raters (Kappa statistic = 0.09). Multivariate model indicated protective effect of child’s age greater than 6 months at the time of diagnosis AOR: 0.49; 95% CI (0.25, 0.96). Depression among responding parents AOR: 2.61; 95% CI (1.34, 5.11) was identified as a risk factor. Children with good performance AOR: 3.09; 95% CI (1.04, 9.25) and fair/poor performance AOR: 3.43; 95% CI (1.17, 10.04) were more likely to have psychiatric problems compared to children with outstanding/excellent performance. Cronbach’s alpha of 0.71 on overall SDQ indicated an acceptable internal consistency. Conclusion: Awareness programs should be held for parents and teachers for better dealing with hearing-impaired children.

Background Research on suicidality in low to middle-income countries is scarce. We addressed this issue by investigating suicidality in a cross-national college student samples from 11 predominantly low to middle-income majority Muslim countries. Methods The sample consisted of 7427 college students (56% female) who reported to be affiliated with Islam. Data on self-construal, social support, negative life-events, acceptability of suicide, suicidal ideation, and suicide attempts were collected with self-administered questionnaires. Results Acceptability of suicide and the experience of negative life-events were positively, and perceived social support was negatively associated with suicidal ideation. Interdependent self-construal was negatively related to the acceptability of suicide and positively associated with perceived social support, implying a negative indirect effect on suicidal ideation although its direct effect was positive. The number of negative life-events was the strongest positive predictor of ever attempting suicide. The interdependent self-construal moderated the association of negative life-events with suicide attempts. Limitations Cross-sectional and self-report nature of the study were its major limitations. Participants may have suppressed their responses about suicide because of religious and legal reasons. Conclusion Remarkable similarities across 11 country samples emerged in the linkages between cultural and interpersonal factors with suicidality. Our findings highlight the value of a nuanced approach to suicidality, that can recognize the differences in the processes associated with suicidal ideation and suicide attempts, as well as the need to consider the interplay of a broad range of personal, interpersonal, and cultural influences.

Objectives This study assessed resilience in brain tumor patients at a tertiary care hospital in Pakistan (a lower-middle-income country; LMIC), and explored its relationship with patients' sociodemographic factors, clinical characteristics, social support, and mental health. Methods A cross-sectional survey was conducted amongst adult (≥18 years) patients with brain tumor at the Aga Khan University Hospital, Pakistan. Resilience was assessed by Wagnild and Young's Resilience Scale,andpatients'psychosocial characteristics by the Hospital Anxiety and Depression Scale and the Enriched Social Support Instrument. Results A total of 250 patients were included (mean age:44 years; 68% males), with majority (97.6%) having high social support and only 4.4% and 2% having symptomatic depression and anxiety, respectively.On multivariable linear regression adjusted for covariates, lower resilience was associated withnot being involved in household decision-making(Adjusted Beta Coefficient: 4.58 [95% Confidence Interval:-7.59,-1.56]), not currently working (-2.80[-4.61,-0.99]), undergoing multiple neurosurgical interventions such as tumor biopsies or resections(-8.64[-13.11,-4.16]), receiving chemotherapy (-5.17[-9.51,-0.83]) or combination adjuvant therapy (-2.91[-5.14,-0.67]), low social support (-7.77[-13.73,1.81]), milddepression (-13.00[-17.00,-8.99]) or symptomatic depression (-19.79[-24.69,-14.89]), and mild anxiety (-4.24[-7.98,-0.50]). Conclusion Our study highlights the function of familial/household role and working status in mediating resilience, and demonstrates the well-known protective effect of resilience for mental health in brain tumor patients in Pakistan, a South-Asian LMIC.These findings are of clinical relevance with regards to the development of culture-specific evidence-based resilience-building interventions that may help patients with brain tumors to cope with the psychological distress of cancer. This article is protected by copyright. All rights reserved.

Background: Children with disabilities are more likely to experience violence or injury at school and at home, but there is little evidence from Central Asia. Objective: To describe the prevalence of disability and associations with peer violence perpetration and victimization, depression, corporal punishment, school performance and school attendance, among middle school children in Pakistan and Afghanistan. Method: This is a secondary analysis of data gathered in the course of evaluations of interventions to prevent peer violence conducted in Pakistan and Afghanistan as part of the ‘What Works to Prevent Violence against Women and Girls Global Programme’. In Pakistan, the research was conducted in 40 schools, and disability was assessed at midline in 1516 interviews with Grade 7s. In Afghanistan, the data were from the baseline study conducted in 11 schools with 770 children. Generalized Linear Mixed Modeling was used to assess associations with disability. Results: In Afghanistan, the prevalence of disability was much higher for girls (22.1%) than boys (12.9%), while in Pakistan 6.0% of boys and girls reported a disability. Peer violence victimization was strongly associated with disability in Afghanistan and marginally associated in Pakistan. In Pakistan, perpetration of peer violence was associated with disability. In both countries, disability was significantly associated with higher depression scores. Food insecurity was strongly associated with disability in Afghanistan. Conclusion: Disability is highly prevalent in Afghanistan and Pakistan schools and this is associated with a greater risk of experiencing and perpetrating peer violence. It is important to ensure that all children can benefit from school-based prevention interventions.

Background In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors. Methods An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients. Results Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; − 2.757, − 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value Conclusion Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems.

To measure the psychological distress among the informal caregivers of disabled young adults with traumatic brain injuries (TBI) and to identify its associated factors.An analytical cross sectional study was conducted with 76 informal caregivers of young adults (19 - 50 years) with TBI, using admission records of one of the tertiary care hospitals in Karachi, Pakistan from 2015 to 2016. Data were collected using a structured questionnaire comprising a general demographic questionnaire and the General Health Questionnaire- 28. The effect of the predictors on the psychological distress was determined by applying multiple linear regression analysis.The mean score of the psychological distress was found to be 23.5±14.28. The findings indicated that anxiety and insomnia, and social dysfunction were the most affected domains of psychological distress; whereas, depression was the least affected. Factors including the management of finances, number of children, patient's gender, and patient's level of disability and lack of socialization were positively associated with the level of distress. As reported by participants, religious beliefs served as a coping mechanism for most of them.The study showed a high level of distress among informal caregivers of young adults with TBI. For recognizing the psychological effects of TBI in patients and their informal caregivers, it is important to initiate and ensure the provision of psychological support to the patients and their families.

Background: The rapidly evolving pandemic has stretched the healthcare system of Pakistan and outpaced the capacity of hospitals to meet demand for vital medical resources. As the numbers are increasing, healthcare providers are playing a central role in tackling this issue in the face of several challenges. This crises situation necessitates investigating frontline healthcare workers experiences of the barriers and enablers to manage Covid-19 cases. Methods: We conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Key-informant interviews were conducted with senior management and hospital leadership and in-depth interviews were conducted with front line healthcare providers. Study data was analysed manually using the conventional content analysis technique. Findings: A total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was ‘challenges faced by frontline healthcare providers working in Covid-19 wards. Healthcare workers experienced increased anxiety due to the fear of acquiring infection and transmitting it to their family members. They felt overwhelmed due to exhaustive donning and doffing process, intense work, and stigmatization. The second theme was ‘enablers supporting healthcare providers to deal with Covid-19 pandemic’. Front-liners pointed out several enabling factors that supported hospital staff including a safe hospital environment, adequate trainings, strong system of information sharing and supportive management. The third theme was ‘recommendations to support healthcare workforce during the Covid-19 crisis’. Healthcare workers recommended measures to mitigate current challenges including providing risk allowance to front-liners, preparing backup health workforce and establishing a platform to address the mental health needs of the frontliners. The study emphasises on the factors that are necessary to improve overall experiences of health-care providers dealing with Covid-19 pandemic. Interpretation: This study provides initial evidence base of healthcare providers’ experiences of managing Covid-19 patients in the early stage of the pandemic and highlights measures needed to address the encountered challenges. It offers lessons for hospitals in LMICs to ensure a safe working environment for front line workers in their fight against Covid-19. Funding Statement: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval for this study was obtained from the Aga Khan University Ethical Review Committee (AKUERC) – [2020-3694-9056].

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

Background In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC). Objectives This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. Methods A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Results Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. Conclusions The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan.

Early childhood trauma can have adverse effects on brain development. This results in higher rates of mental health and medical problems in adults. Unfortunately, psychiatry trainees are not adequately trained in dealing with trauma survivors. Hence, we implemented an online trauma curriculum and assessed its efficacy. Socratic methods of teaching, flipped classroom approach, brainstorming, role play, and case-based discussions were utilized. Participants were able to exhibit good knowledge and clinical skills as assessed through summative assessment and communication skills assessment. This curriculum showed online training can help with clinical skill development along with improving knowledge when dealing with trauma survivors.

Trauma is a major global health problem. Currently a trauma curriculum, from a psychological perspective, has not been uniformly incorporated in medical education. Nonetheless, professionals from various medical disciplines have an integral role in providing trauma care to survivors. The current COVID-19 pandemic only underscores the relevance and urgent need of this training, as studies show an uptick in mental health disorders due to this trauma. This article will present a discussion on the need for trauma curriculum for health care professionals, using information gained through trauma informed care workshops for healthcare personnel at Aga Khan University Hospital Pakistan.

The COVID-19 pandemic has overwhelmed hospitals all over the world. To reduce the risk of transmission of COVID-19 and meet the increasing mental health demands due to this trauma, psychiatry outpatient services have gone online in various countries. We describe steps taken at a tertiary care hospital in Karachi, Pakistan, to start these services during this pandemic. We also discuss the obstacles faced. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abuse is associated with short and long term psychiatric consequences. There is a need to develop more culturally competent treatment, especially in the South Asian context. We present an account of our clinical experience with hospital-based therapeutic strategies that we found to be successful in a largely conservative, developing country.

Background: Depression is one of the growing public health concerns among women worldwide. This is one of the most under-recognized and under-treated mental illnesses worldwide. Women of developing countries are inexplicably affecting with depression. Purpose: The purpose of study is to assess the prevalence and associative factors of depression among women of aged 20 to 40 years living in urban squatter settlements of Karachi, Pakistan. The identification of all the potential determinants will potentially help in formulating preventive strategies in order to decline the prevalence of depression among women and improve the wellbeing of women. Methods: An analytical cross-sectional survey was employed among women living in Reta Plot and Kala Board communities of Karachi, Pakistan. Beck Depression Inventory II (BDI-II) was used to measure depression. Systematic sampling was used to recruit 636 married women. Cox proportional hazard was run to compute prevalence ratios and their 95% confidence interval. Results: Our study estimated 33.3% of depression among study participants. The current study showed that age, possession of own vehicle, years of schooling and recent deaths in family were significantly associated with depression. Conclusion: This research was a bold step to address the issue of increasing rate of depression among Pakistani population. Our study results can convince policy makers to extend mental health support to women by improving accessibility of services. Recommendation: Our study recommends that the women of our society should be encouraged for attaining education. This study also recommends that at primary health care setting, every health professional should be trained to screen the depression. Moreover, the results of our study can also encourage policy makers to expand mental health support services for women.

Background Peer violence is common globally, but a little researched topic in low-and middle-income countries. This study presents the evaluation of a two-year randomized controlled trial of a structured play-based life-skills intervention implemented in schools in Hyderabad, Pakistan. Objective To determine the impact of the intervention on school-based peer violence (victimization and perpetration) and depression among school children. Methods 40 single-sex public schools were randomized into two study arms (20 per arm 10 of each sex). A total of 1752 grade 6 students (929 from intervention and 823 from control schools) were enrolled in the trial. The two-year intervention was a biweekly structured game led by a coach followed by critical reflection and discussion for 30 minutes. Primary outcomes (exposure to peer violence exhibited through victimization and perpetration and depression) were evaluated using generalized linear-mixed models. Results Of the enrolled children (N = 1752) 91% provided data for analysis. There were significant decreases in self-reported peer violence victimization, perpetration and depression. For peer violence victimization, the reductions in the intervention and control arms were: 33.3% versus 27.8% for boys and 58.5% versus 21.3% for girls. For peer violence perpetration, the reductions were: 25.3% versus 11.1% for boys and 55.6% versus 27.6% for girls in the intervention and control arms, respectively. There were significant drops in mean depression scores (boys 7.2% versus 4.8% intervention and control and girls 9.5% versus 5.6% intervention and control). Conclusion A well-designed and implemented play-based life-skills intervention delivered in public schools in Pakistan is able to effect a significant reduction in peer violence.

Objective The study investigated the associations of religiosity, religious coping and suicide acceptance to suicide ideation and attempts in 7427 young adults affiliating with Islam from 11 Muslim countries. Method A self-administered questionnaire was used to collect the data. We used F and χ2 tests and correlation analyses to report descriptive statistics. Multi-group path models with (i) a zero-inflated Poisson distribution and, (ii) a Binomial distribution were used to model the number of occurrences of suicidal ideation, and occurrence of a suicide attempt, respectively. Results Religiosity was negatively associated with acceptability of suicide, but it was positively related to punishment after death across the 11 countries. Religiosity was negatively associated with ever experiencing suicidal ideation, both directly and indirectly through its association with attitudes towards suicide, especially the belief in acceptability of suicide. Neither positive nor negative religious coping were related to suicidal ideation. However, religiosity was negatively related to suicide attempts among those who experienced suicidal ideation at least once. This association was mediated through the belief in acceptability of suicide and religious coping. Negative religious coping was positively associated with suicide attempts probably because it weakened the protective effects of religiosity. Conclusions Findings from this study suggest that the effects of religiosity in the suicidal process operate through attitudes towards suicide. We therefore conclude that clinical assessment as well as research in suicidology may benefit from paying due attention to attitudes towards suicide.