Developing culturally relevant intervention plan for psychological trauma: an application of community based participatory research approach for mental health

Objective: To develop culturally relevant intervention plan for psychological trauma using community based participatory research approach in times of crisis. Study Design: Qualitative study. Place and Duration of Study: Army Public School [APS] Peshawar, from Dec 2014 to May 2015

Material and Methods: The participants included 35 teachers, 60 parents and 5 administrative staff of the Army Public School [APS], Peshawar Pakistan, who participated in the consultative group meetings over a period of 6 months starting from a week after the APS attack on December 16[th], 2014. The participants through a collaborative process identified the community needs, priorities and resources. The goal was to generate realistic intervention plan which can be implemented and widely accepted by the community. Data, based on the discussions in group meetings were transcribed and analyzed for themes and developing intervention plan

Results: The participatory research approach with the community helped design the culturally sensitive intervention plan for the trauma stabilization of the affected community. The study design was helpful in addressing the needs assessed; restoring sense of safety, respecting the emotional needs as per cultural norms and helping the community reconnect and resume normal functioning

Conclusion: The study highlights the importance of adopting a culturally sensitive approach and including community in designing and delivering the intervention for psychological trauma

relationship between self-reported and clinician rated assessment of depression in clinically depressed patients

Objective: The study examines the relationship between a clinician rated measure Hamilton Rating Depression Scale [HRSD] and indigenously developed self-reported Siddiqui-Shah Depression Scale [SSDS] in clinically depressed and matched control group

Study Design: Correlational design

Place and Duration of Study: Data was collected over a span of 6 month from Department of Psychiatry Pakistan Naval Ship [PNS] Shifa Karachi and Combined Military Hospital [CMH] Malir, Karachi

Material and Methods: A purposive sample of forty-seven patients from psychiatry department and thirty-six participants in the matched group were first screened on DSM-IV criteria independently by a psychologist, and then assessed on HRSD by the psychiatrist followed by assessment of depression on SSDS by the participants

Results: SSDS has significant relationship with HRSD for both matched group [r=.74, p<.001] and depressed group [r=.38, p<.01]. SSDS also indicates moderate sensitivity index [.79] and a significant specificity index [.89]

Conclusion: Self-report measure [SSDS] correlates significantly with clinician rated assessment measure [HRSD]; it also demonstrates psychometric properties to be recommended for screening depression in general practice

Efficacy of eye movement desensitization and reprocessing beyond complex post traumatic stress disorder: a case study of EMDR in Pakistan

To demonstrate the efficacy of EMDR in complex multiple psychological trauma after failed drug treatment from selective serotonin reuptake inhibitor [SSRI] in a diagnosed case of post-traumatic stress disorder [PTSD]. Single participant of this case study, a sitting session judge of judicial governmental scaffold reported to this mental health tertiary care facility at his own accord with features of intense anxiety, depression, maladjustment issues and post- traumatic stress for a duration of several months. As a partial responder to full trial of SSRI he was enrolled for EMDR therapy to address his symptoms of intense anxiety, panic attacks, being overwhelmingly fearful, depressed, low self-esteem, inappropriate feelings of guilt, flashbacks, avoidance, nightmares, hyper-arousal and inability to perform as a judicial head in active war stricken area of northern Pakistan. Complete psychiatric evaluation was carried out and after the discontinuation of SSRIs he was scored on Impact of Event Scale [IES]. He fulfilled the diagnostic criteria for PTSD as evaluated by the English version of the PTSD module of the Structured Clinical Interview for DSM-IV administered once before commencement of EMDR. Safe place of the client was established and 8 staged protocol of EMDR was started with him. Multiple EMDR sessions were conducted. The case presented in this paper had multiple psychological trauma forms and failed drug treatment and yet it was observed that EMDR provided marked improvement in all the domains of his deficits and this was at a prompt speed as compared to cognitive behavioural therapy [CBT] which usually takes longer duration of therapy to achieve similar results. EMDR provides marked improvement in all domains of complex mental trauma and traumatic memories. Improvement attained was prompt and enduring as compared to other forms of established therapies and drug treatment indicating permanent changes happening at neurobiological levels of brain