Post-traumatic Stress Disorder [PTSD], depression, fear and avoidance in destitute women, earthquake survivors of NWFP, Pakistan

To evaluate psychological consequences of traumatic stress such as Depression, Fear and Avoidance in destitute women after 8th October earthquake in NWFP, Pakistan. Cross-sectional study of a group of destitute women. The study was conducted at a Destitute Women's Shelter Camp in Mansehra in May 2006. A total of 75 women were interviewed from a Destitute Women's Shelter Camp in Mansehra. Standardized structured questionnaires were administered by the researchers following counseling and interview of individual woman in privacy. The instruments used in this study; SITSES, Depression Scale and Fear and Avoidance Scale. SITSES includes detailed Survivor Information Form SIF], Traumatic Stress Symptom Checklist [TSSC] and Severity of Disability Scale [SDS]. The mean age of the respondents was 39 years [S.D. =13.4]. 82% were illiterate. 92% were widow. 70% lost their homes. 21% lost their entire families. 81% were suffering from depression and fear and avoidance was found in 80%. 94% were suffering from Post-traumatic Stress Disorder. Loss of family members, loss of property, being trapped under rubble, history of previous trauma, previous history of psychiatric illness and intensity of fear during earthquake found to be significantly associated [p<.001] with psychiatric morbidity in survivors. Our clinical observations of these distressed destitute women coincided with statistical findings of our research survey. These highly distressed, bereaved destitute women after this catastrophic earthquake disaster were expected to show extreme effects of traumatic stress. The findings of study reconfirm that destitute women in stress have markedly high rates of PTSD, depression, fear and avoidance

psychosocial factors for depression in upper and upper-middle class urban women of Karachi

To estimate the frequency of depressive disorder in upper and upper-middle class urban women in Karachi and to identify the psychosocial factors of depressive disorders in these women. Cross-sectional descriptive survey. The study was conducted at the Psychiatric Clinic and Stress Research Centre, which is a private practice clinic located in Defence, a high socioeconomic status area. The duration was from January 2000 to December 2004.consultations. Complete information about the patients was obtained from their case history files. This information consisted of the patient's demographic characteristics, diagnosis and biological or psychosocial factors of depressive illness. Only patients from upper and upper-middle class were selected in the study.A total of 835 patients were diagnosed with depressive disorders. 33% were male patients and 67% were female patients. In single women, parental conflicts [4.3%], conflicts with boyfriends [3.3%], adjustment problems [2.3%], and father's alcohol abuse were the basic factors linked with their depression. In married women, marital conflicts [31%], bereavement [9.8%], domestic violence [3.6%], work stress [3.2%], daughter's marriage [1.3%], traumatic experiences [.7%] were found to be associated with their depression. The results that women in upper and middle class presenti ng to a private facility suffer from depressive disorders twice as much as the males. The psychological factors associated with depression in this group are mainly related to the marital and role conflicts in domestic sphere of life

Stress in women physicians in Pakistan

To understand and evaluate practicing women physicians' perception of physical and mental health, job stress, satisfaction, and level of professional knowledge. Specifically designed questionnaires for socio-demographic characteristics, physical and mental health, Self perception of medical knowledge and ability were distributed among 150 female doctors. The sample consisted of family physicians [n=41], specialists [n=57] and house officers [n=52]. Only quantitative methods were used in the study to analyze the data. Findings: 71% of the women physicians perceived their physical health as good. 34% of the women physicians reported 'high' level of stress. The level of stress was high among house officers [32%] and specialists [21%] than family physicians [12%]. Conclusions: Most of the female doctors perceived their physical health as good and level of stress as 'high' or 'moderate'. Stress in female physicians leads to more time-off work, intake of antidepressant and smoking. Stressed doctors are also less likely to enjoy their practice

Attitudes towards psychiatry in pre-clinical and post-clinical clerkships in different medical colleges of Karachi

A survey of three medical colleges' pre-clinical and post-clinical clerkship students' attitudes towards Psychiatry and their actual decision in choosing Psychiatry as a career. Design: An instrument comprising of 15 items checks the perceptions of students about psychiatry and choosing Psychiatry as a career was developed and administered upon the students of three medical schools of Karachi. Nearly more than 60% students hold positive views about Psychiatry. About 32% students believed psychiatrist are not so well-respected and 42% believe they earn less money than other specialists. 54% students were reluctant to choose Psychiatry as a career. The students of post-clinical groups hold more positive view about Psychiatry than pre-clinical groups. Differences were also observed among the responses of students belonging to different medical schools. Overall the students of all medical colleges showed positive perception about Psychiatry as a subject. However, they were reluctant to choose Psychiatry as a career. The possible factor for this reluctance is disorganised or lack of proper undergraduate teaching of psychiatry in medical colleges and the concept that psychiatrist earn less money and are less respected as compared to other specialists

Development and validation of Karachi domestic violence screening scale [KDVSS]

Domestic violence is a serious public health problem. In order to identify and treat psychological consequences associated with domestic abuse. The health care providers should be screening patients for physical, psychological and sexual forms of intimate partner violence. To design a validated instrument for screening out victims of domestic violence in both genders. A form consisting of 77 statements was developed on the basis of an operational definition and literature review of domestic abuse. It was then distributed among 300 individuals. Each statement was to be rated on 7-point scale from strongly disagreeing to strongly agreeing with the statement. Chi-square and percentages were calculated for the data. The statements, which were rated towards the agreeing point by more than 75% of the respondents irrespective of the sex, were selected for KDVSS. For validity check KDVSS was conducted on 35 known victims of domestic abuse; for statistical reliability chi-squares and percent values were used. Experts in the field were approached for checking inter-rater reliability of KDVSS. Findings: Out of 77 statements 35 had the p value above than .05, which is statistically significant. More than 75% of the participants independent of sex rated these 35 statements towards agreeing continuum. These statements comprised the final KDVSS. 82% of the Known Victims' scored above the cutoff score on KDVSS, which is indicative of adequate validity of the scale. The statistical reliability of 0.11 being sensitive statistically significant. Raters had rated the items as appropriate and adequate. In view of simplicity of use, and specific characteristic of investigating the incidence of domestic abuse [physical abuse, psychological abuse and sexual abuse] the scale represents a useful additional tool for the screening domestic abuse and facilitating appropriate help to the victims

Psychological consequences of intimate partner violence: forms of domestic abuse in both genders

To estimate the prevalence of intimate partner violence, forms of domestic abuses faced by both genders and associated psychological consequences of domestic abuse particularly incidence of depression and anxiety in the victims. Specifically designed and validated instrument by the name of Karachi Domestic Violence Screening Scale [KDVSS], was used to screen out the victims of domestic violence in the sample. Data was collected from the outpatient departments of Psychiatry, Liaquat National Hospital PNS Shifa and Sobraj Hospital in Karachi. The sample included equal representation of male and female participants. It consisted of 140 individuals with middle-age range. Most of them were married, few were separated or divorced. Standardized self-rating, depression and anxiety rating scales were used to check the incidence of depression and anxiety in victims and non-victims. 63% of the participants were identified as victims of domestic violence on Karachi Domestic Violence Screening Scale. 36% of the victims were males and 64% of the victims were females. 35% of the victims reported facing physical abuse, 52% of the victims reported psychological abuse and 30% of the victims reported sexual abuse from their partner. 60% of the victims had depression and 67% of the victims had anxiety. Moderate and severe degrees of depression and anxiety were more common in female victims, whereas mild forms of depression and anxiety were prevalent in male victims. Females are the common victims of domestic violence though males can also be the victims of domestic abuse. Clinically both depression and anxiety ratings were high among the victims of domestic abuse in both genders but the frequency of severe forms of depression and anxiety was common in female victims. Hence, the clinicians must screen the patients of domestic violence in order to identify and treat psychological consequences such as depression and anxiety in the victims

Psychiatric aspects of plastic surgery

Some of the important psychiatric issues related to plastic surgery are discussed i.e. selection for reconstructive surgery for sex change and involvement of psychiatrist as a regular team member in a plastic surgery unit. The role of pre-morbid personality in clinical management of patients as well as in the physical and social rehabilitation of plastic surgery patients is discussed