The onset and duration of benefit from counselling by minimally trained counsellors on anxiety and depression in women.

OBJECTIVE: To assess the onset and duration of benefit of counselling by minimally trained community counsellors on level of anxiety and/or depression in women of their own community. METHOD: A randomized controlled trial for assessing the effectiveness of 4 and 8 weeks of counselling by minimally trained community women in reducing the levels of anxiety and depression was carried out in a lower middle class, semi-urban community in Karachi, Pakistan. In the baseline survey, 366 anxious and/or depressed women were identified and randomized to intervention and control arms. The intervention arm was re-screened for anxiety and depression after 4 and 8 weeks of counselling and again 8 weeks after the last counselling session. As the results showed a significant benefit in the intervention arm, for ethical reasons the controls were also counselled; and were screened in the same way. This study is a sub-analysis from the RCT specifically looking at the onset and the duration of benefit. RESULTS: A significant reduction in the mean scores of both the groups was found after 4 weeks of counselling which further improved at 8 weeks. The gradient of improvement was steeper at 4 weeks. At 8 weeks post counselling some loss of effect was detected but the levels still remained below the initial mean score. CONCLUSION: This study indicates that literate women from semi urban communities can be trained as counsellors and their counselling can lead to a significant benefit in just 4 counselling sessions of 1 hour each, and could last at least till 8 weeks after the last session. Keeping in view the current high prevalence, the available facilities for treatment and the stigma attached to psychiatric treatment in our communities; this modality of intervention at the PHC level could be an alternative strategy for the management of depression.

Spontaneous recovery from depression in women: a qualitative study of vulnerabilities, strengths and resources.

OBJECTIVE: To gain insight into the perceived vulnerability and restitution factors for anxiety/or depression. METHODS: Focus group discussion of seven married women recovered spontaneously from anxiety and/or depression, belonging to a lower middle class semi-urban community of Karachi. RESULTS: Poverty, unemployment, abuse and on going difficulties were perceived as risk factors for depression. A reliable social support system, positive thinking approach, faith, prayers, and experiencing a "turning point" event were reported as factors that promoted recovery from anxiety and/or depression. CONCLUSION: Individual vulnerabilities, strengths and resources can have an important role in recovery from anxiety and/or depression in women.

The transformative effect of training in counselling and its application, on the community counsellors themselves.

OBJECTIVE: To identify the changes in community counsellors' own level of anxiety and depression as a result of learning counselling skills and to explore their subjective experiences after learning and providing counselling. DESIGN: Quantitative: Repeated Measures. / Qualitative: Focus Group Discussions. SETTING: A lower middle class semi urban community of Karachi, Pakistan. PARTICIPANTS: Twenty-one self selected women from the community. RESULTS: Reduction was seen in the post training scores of anxiety and/or depression in the trainees. As a result of learning and then providing counselling the community counsellors' self esteem, self confidence and sense of competence were enhanced and they developed a more positive attitude towards life. CONCLUSION: A minimal level of training in counselling skills and their application led to significant positive changes in the community counsellors themselves, though self-selection and information bias cannot be ruled out.

Prevalence of and factors associated with anxiety and depression among women in a lower middle class semi-urban community of Karachi, Pakistan.

OBJECTIVE: To study the prevalence of, and factors associated with anxiety and depression among women. DESIGN: A cross sectional survey. SETTING: A lower middle class semi-urban community of Karachi, Pakistan. PARTICIPANTS: A total of 1218 women between the ages of 18-50 years. METHODOLOGY: Systematically every third household was identified from which a woman was randomly selected. The Aga Khan University Anxiety and Depression Scale and a socio-demographic questionnaire were administered verbally by trained interviewers for assessing the prevalence of, and associated factors for anxiety and depression. RESULTS: A prevalence of 30% was found. Increasing age, lack of education and verbal abuse were the associated factors found to have an independent relationship. CONCLUSION: Providing education and reducing domestic abuse could lead to decrease in the prevalence of anxiety and depression in women.

Effect of a tumour-produced lipid-mobilizing factor on protein synthesis and degradation.

Treatment of murine myoblasts, myotubes and tumour cells with a tumour-produced lipid mobilizing factor (LMF), caused a concentration-dependent stimulation of protein synthesis, within a 24 h period. There was no effect on cell number or [(3)H] thymidine incorporation, but a similar concentration-dependent stimulation of 2-deoxyglucose uptake. LMF produced an increase in intracellular cyclic AMP levels, which was linearly (r(2)= 0.973) related to the increase in protein synthesis. The effect of LMF was attenuated by the adenylate cyclase inhibitor MDL(12330A), and was additive with the stimulation produced by forskolin. Both propranolol (10 microM) and the specific beta(3)-adrenergic receptor antagonist SR 59230A (10(-5)M), significantly reduced the stimulation of protein synthesis induced by LMF. Protein synthesis was also increased by 69% (P = 0.006) in soleus muscles of mice administered LMF, while there was a 26% decrease in protein degradation (P = 0.03). While LMF had no effect on the lysosomal enzymes, cathepsins B and L, there was a decrease in proteasome activity, as determined both by the 'chymotrypsin-like' enzyme activity, as well as expression of proteasome alpha-type subunits, determined by Western blotting. These results show that in addition to its lipid-mobilizing activity LMF also increases protein accumulation in skeletal muscle both by an increase in protein synthesis and a decrease in protein catabolism.

Syndrome X and family practitioners.

BACKGROUND: Increased incidence of hypertension, non-insulin dependent diabetes (NIDDM) and coronary heart disease often cluster in the same individuals and there have been speculations that a common mechanism may be responsible for all of these pathological conditions. This risk factor constellation, which is associated with an enhanced risk for cardiovascular disease, is sometimes referred to as the "Insulin Resistance Syndrome", "Syndrome X", or the "Metabolic Syndrome". AIM: To find out the prevalence of Syndrome X in the population of patients coming to a preventive health check clinic at a tertiary care teaching hospital in a megacity of the developing world. METHODS: A total of 270 patients, above the age of 40 years, who attended preventive health check clinics of 2 Family Physicians at the Aga Khan University from January 1996 to July 1997 were selected. Patients below 40 years were excluded from the study. RESULTS: The prevalence of Syndrome X, defined as association of obesity, NIDDM, hypertension, raised LDL and raised triglycerides is 2.6% in patients above 40 years, who were screened in this study. CONCLUSION: The significant prevalence of Syndrome X is alarming and we need to strengthen our existing educational programs for prevention of obesity, increased physical activity and better control of hypertension. When drugs are selected for pharmacological treatment, priority should be given to those, which improve the insulin sensitivity index or are at least neutral in this respect.

Development of an indigenous screening instrument in Pakistan: the Aga Khan University Anxiety and Depression Scale.

The use of translations of instruments for detecting anxiety and depression continues to be debated. An indigenous screening instrument has been developed in Urdu for anxiety-depression syndromes at the Aga Khan University. It has been developed from the complaints of 150 anxious and depressed patients presenting to a non-speciality clinic and has been validated in 53 patients in a psychiatry clinic. The questionnaire has 25 items, 13 psychlogical and 12 somatic. At a score of 20 it has a sensitivity of 66%, a specificity of 79%, a positive predictive value of 83 and a negative predictive value of 60. In comparison with available instruments in Urdu, comprising of either psychological or somatic items, this scale includes both, which increases its reliability for use as a screening instrument by Community Health Workers in a primary health care setting, in epidemiologic work in Pakistan and in transcultural psychiatric research.