Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan

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

Prevalence and risk factors contributing to depression among pregnant women in district Chitral, Pakistan

To estimate the prevalence of depression and its associated factors among pregnant women in district Chitral, Pakistan. A descriptive cross sectional study. The study was carried out in a public hospital in district Chitral, Pakistan from May 2008 to June 2008. A consecutive sample of 340 pregnant women was approached for recruitment in the study. A short translated Khowar version of the Aga Khan University Anxiety and Depression Scale [AKUADS] was used to detect depression and a questionnaire was used to determine the associated factors of depression. The data were analyzed by SPSS version 15 using descriptive statistics and multiple logistic regression technique. Using the AKUADS, at a cut off score of e" 13, the prevalence of antenatal depression was around 34%. The multivariate analysis showed that verbal/physical abuse [P=<0.001], unplanned pregnancy [P=<0.001], and illiteracy [P=<0.001] were independently associated with depression. More than one third of pregnant women in district Chitral suffer from depression and this is associated with illiteracy, verbal/physical abuse and unplanned pregnancy. Policies must aim to incorporate routine screening programs for depression in obstetric care. Service providers can be trained to detect and manage depression and to refer women to the appropriate services. Counseling of couples may prevent unplanned pregnancies and reduce domestic violence

Applying community participatory methods to meet women's mental health needs in Karachi, Pakistan

Poor mental health is a global epidemic with women affected more often compared to men. Compromised mental health jeopardizes women's health and functioning and also the health and wellbeing of their children. To promote women's mental health, principles of community participatory methods were used to design and implement a mental health program, which was predicated on empirical research, sensitive to community culture and needs, and delivered by Lady Health Workers in an urban slum area of Karachi, Pakistan. The sequential steps of community participation, program development, implementation and strategies for sustainability are described

Self-monitoring: a correlate of leadership style

The present study investigates the relationship between self-monitoring personality trait and leadership styles. The samples consisted of 115 [96 male, 19 female] individuals employed with private organizations and designed at the Higher and Middle Management level. Their ages ranged between [25-35 years]. It was predicted that high of self monitoring individuals will score high on participative leadership style scale and likewise low self-monitors will score high on autocratic leadership scale. For quantitative analysis, pearsons' correlation co-efficient was applied through SPSS. Findings suggest a correlation value tending in the positive direction [r =.025] between participative leadership style and self monitoring, and an inverse correlation between autocratic leadership style and self monitoring. [r =.018]. findings have been discussed with reference to their implications for organizational functioning