Comparison of the personal health questionnaire and the self reporting questionnaire in rural Pakistan

To apply ROC analysis to select the best threshold scores for the PHQ and SRQ; to compare the sensitivity and specificity of the PHQ and SRQ against a criterion diagnosis of depressive disorder in a community sample in rural Pakistan, and to examine the influence of socio-demographic factors on misclassification. The study used a two-stage design. Receiver Operating Characteristic [ROC] analysis was used to estimate the optimal threshold score and to compare the ability of the Self Reporting Questionnaire [SRQ] and the Personal Health Questionnaire [PHQ] to discriminate between cases of depressive disorder and non-cases. The results of the ROC analysis suggest that the SRQ is superior to the PHQ, and at the threshold of 5/6, the SRQ has superior sensitivity, negative predictive value and percentage agreement compared with the PHQ. When the SRQ threshold is raised it gains specificity, and at a cut-off threshold of 7/8 it is superior to the PHQ [5/6] in all validity coefficients and percentage agreement. Only gender and the presence of a confidant had a significant effect on misclassification using the SRQ among the cases. Both questionnaires performed better for females based on comparison of the areas under the ROC curves. This study has demonstrated that the Urdu translations of both the PHQ and SRQ can be used as screening tests for depressive disorder in the Pakistani population. People with little or no education answer both somatic and psychological items with equal ease. In conclusion, the PHQ does not appear to have any advantage over the SRQ

Mental health and service developments in the Rawalpindi district of Pakistan

The innovative community mental health programme of the Institute of Psychiatry and WHO Collaborating Centre for Mental Health Research and Training, Rawalpindi General Hospital has revolutionized the concept of community mental health globally and is echoing in the international corridors. Various studies have evaluated this indigenous and low-cost programme and is being replicated in many countries. This brief summary tries to encompass the evaluation of this programme by various independent assessors, and its impact on the community mental health in particular and community health in general. Various studies published in indexed journals around the world by local and foreign authors for evaluation and impact of this programme are included. The success of the programme is visible by not only the decrease in mental health problems in the community but in increased utility of general care services, reproductive health care facilities and immunization rates. This exciting innovative model of health care developed at the WHO Collaborating Centre at Rawalpindi is transforming the health care scenario in Rawalpindi district. There is great need for replication of this model not only in other areas of Pakistan but other developing and developed countries

Reaching the unreached - evaluation of training of primary health caer physicians

District Health Development is responsible for in service training of primary health care personnel to improver them to handle new and emerging conditions. Mental health has been integrated in the ongoing training programmes of DHDC in Rawalpindi division as part of National Programme of integrating mental health in primary health care. The object of the study was to evaluate impact of training imparted to doctors working in primary health care. The study has a pre and post intervention design, using the primary care physicians as their own control. Training and evaluation was carried out at Institute of Psychiatry, Rawalpindi over a period of three months. The study revolves around training of primary care physician [n= 70] working in Rawalpindi district. A pre-training evaluation was carried by administrating a validated questionnaire having 20 items addressing the issue of care, knowledge, attitudes and skills required for recognition and management of mental illness in primary care. Training focused on knowledge and skill acquisition to recognize and manage priority disorder. Post-training evaluation was carried out again at the end of training with the same questionnaire. Data was entered and analyzed using SPSS in windows Programme to assess the change in individual and total items scores. The results of Pre and post training evaluation show significant gain over all. [Mean score pre-training 47.77 to mean score post training 79.5]. Item by item analysis reveals maximum improvement in Communication skills, recognition and management of Depressive illness and Physical Methods of treatment. It would be safe to conclude that focused training can empower Primary Care Physicians with skills to recognize and manage priority disorder in addition to changing their clinical behaviour. The study has wider implications for integration of mental health in primary health care at national level