Sociodemographic Characteristics and Patterns of Suicide in Pakistan: An Analysis of Current Trends.

Suicide is a global phenomenon with about 79% of suicides occurring in low and middle-income countries. This study investigated current trends, demographics, and characteristics of completed suicides based on reports from leading Pakistani Newspapers. This study performed a qualitative analysis of completed suicides in Pakistan's four newspapers from January 1st, 2019, through December 31st, 2020. Data about socio-demographic characteristics, methods of suicide, possible motives, and associated features were analyzed. 2295 suicides were reported in Pakistan during 2019 and 2020. About 61.87% were completed by men, and 38.12% by women. The most suicides occurred in individuals ages < 30 years. The predominant method of suicide in this group was ingestion of poisonous substances. The most commonly reported reasons for suicide were domestic conflicts, financial problems, and failure in love/marriage. By providing insight into characteristics of suicide, this study highlights the need for effective suicide prevention policies and programs to tackle rising rates of suicide in Pakistan.

Pattern of Adolescent Suicides in Pakistan: A content analysis of Newspaper reports of two years.

Background and Objective: Suicide is a serious, yet preventable global mental health problem for people of all ages and countries. It is the third leading cause of death in 15-19-year-olds. There is paucity of systematic studies and official statistics on child & adolescent suicides in Pakistan. In the absence of other means, newspaper coverage of adolescent suicides may serve as a useful source to understand the phenomena. Our objective was to report pattern of suicide deaths in children and adolescents across Pakistan and to determine the predominant methods of suicide precipitating events and associated factors. Methods: This study used content analysis to analyze newspaper reports of adolescent suicide in four leading newspapers of Pakistan from January 1st, 2019, through December 31st, 2020. Search yielded 289 child and adolescent (ages<18) suicide reports. Data about various sociodemographic characteristics, methods of suicide, possible motives, and associated features (e.g., any suicide notes) was extracted and analyzed. Results: Total 289 suicides in children and adolescents in Pakistan were reported in selected newspapers during two years among both genders (51.5 % boys and 48.5% girls) with high incidence in late adolescence (66%). The predominant method of suicide in this group was ingestion of poisonous substances (50%) followed by hanging (35%) and use of firearms (7%). The behavior usually takes place within or near the adolescent's home environment. The act was often attributed to domestic conflicts including arguments with parents of the deceased and relationship problems. Conclusion: To develop effective suicide prevention strategies for a population, it must be studied within its own socio-cultural context. Study results emphasize adolescent suicide being a reality in Pakistan. There is urgent need for further culture specific research in this area in the country.

Assessing the quality of media reporting of suicide deaths in Pakistan against international guidelines.

BACKGROUND: In Pakistan, there is lack of official suicide data due to associated stigma and socio-cultural factors. Although, suicide incidents are regularly reported in newspapers there are no official suicide reporting guidelines. AIMS: The aim was to study the quality of suicide reporting in Pakistani newspapers and compare it to international media guidelines. METHOD: Newspaper reports on suicide deaths were searched in four Pakistani national newspapers from 1st January 2019 to 31st December 2020. Data was extracted using templates based on World Health Organization and Reporting on Suicide media guidelines. RESULTS: There were total 2,295 suicides reported in 2 years. The word 'suicide' was mentioned in title of 2,113 (92.06%) reports. In 70.37% news articles, motive for suicide was reduced to a single factor. Method was mentioned in 95.6% suicides. Pictures accompanied 103 (4.4%) news reports. Only 13 (0.57%) the news stories recognized the link between substance abuse and suicide. None of the reports provided education to public about suicide or mentioned resources to seek help. CONCLUSIONS: The articles reporting on suicide deaths were regularly featured in Pakistani newspapers with strikingly low level of adherence to suicide reporting guidelines.

A study to evaluate the impact of COVID-19 on Lifestyle of Medical students.

Background: Stressful situations are often linked with poor health and lifestyle behaviors (e.g., unhealthy diet, limited physical activity, poor sleep quality etc.). Subsequent to the nationwide lockdown in Pakistan due to COVID-19 pandemic, medical students experienced substantial lifestyle changes along with academic stresses. The goal of this study was to measure the impact that the COVID-19 lockdown had on lifestyle like sleep, physical activity and nutrition, substance abuse, dealing with finances, spirituality and family life, with respect to a sample of Pakistani medical students. Methods: This cross- sectional online study involving 1100 medical students (68.7% females) from five medical colleges in Pakistan, used self-administered questionnaire to evaluate the impact of pandemic related restrictions on lifestyle of medical students in Pakistan from August- September 2020. Parameters such as physical activity, sleep, nutrition, smoking and substance abuse, family life, finances, internet use and spirituality were studied. Results: Fifty-nine percent of medical students reported a significant effect of lockdown on their physical activity. Only 5.8% people clearly followed or adhered to a routine during the pandemic. About 54.6% students have found that physical activity and exercise significantly reduced their anxiety. More than half of respondents reported increase in screen time, weight gain and poor sleep with 3.1% of students stating an increased use of sleeping pills to fall asleep Another 18.3% students had an increased worry regarding COVID19 based on the information they received on internet. No significant increase in substance uses and alcohol use or family conflicts among students post pandemic was noted. Conclusion: Our findings underscore that COVID-19 pandemic has led to undesired changes in health and lifestyle habits of medical students, which may, to some extent, be responsible for higher negative impact. Hence it is important for medical colleges to start awareness campaigns to tackle challenges for medical students physical and emotional well-being.

Impact of the COVID-19 Pandemic on Adult Mental Health.

The outbreak of the Novel Coronavirus (COVID-19) in December 2019 has progressed to the status of a global pandemic, with countries across the seven continents adversely affected and the number of human cases exceeding two million. With no available vaccine, the treatment is primarily symptomatic for those affected and preventative for those at risk. Most countries have taken action to curtail the spread of COVID-19 through measures such as lockdowns, social distancing and voluntary self-isolation. Whilst necessary, such measures and the disease itself, may have an adverse impact on mental health. In view of research from previous pandemic crises, it is known that such situations are likely to increase stress levels and have negative psychiatric effects. The impact is likely to be felt by the general public, sufferers of COVID-19, their families and friends, persons with pre-existing mental health conditions and healthcare workers.

Assessment of Psycho-Education of Carers Questionnaire: APEC-U" translation and cross cultural adaptation of an Urdu Version.

BACKGROUND AND OBJECTIVE: Psycho-education of carers is a part of good mental health practice. Our objective was to translate and validate the English questionnaire "Assessment of Psycho-Education of Carers" (APEC) into Urdu (APEC-U), for use in Pakistan. METHODS: Following development and validation of APEC, it was translated into Urdu after consultation with experts and translators. After pretesting, one hundred and twenty bilingual male 67(55.8%) and female 53(44.2%) primary carers, who could understand both Urdu and English, and were carers for more than three months, were asked to fill in the self reporting Urdu questionnaire at the Fatima Memorial Hospital Psychiatry Out-Patient Department. The data were collected over a period of three months from September, 2018 to November, 2018. MAIN OUTCOME MEASURES: Responses were analyzed for internal consistency, reliability, Intraclass correlation coefficients and kappa statistics. RESULTS: APEC-U was understandable and capable of assessing psycho-education in Urdu. High internal consistency was demonstrated on the full scale as 0.859. Degree of agreement (<0.001) between the Urdu and the originally developed English version was evaluated by Cohen's Kappa, and a high degree of agreement was demonstrated. CONCLUSION: The Urdu questionnaire can adequately assess psycho-education of carers in psychiatric settings.

Development and validation of assessment of psycho-education of carers questionnaire: An early experience.

BACKGROUND AND OBJECTIVE: Psycho-education is an intervention integrating psychotherapeutic and educational strategies. Whilst carer psycho-education is known to aid in psychiatric disorders, at present there is no known tool to assess the degree to which this is routinely provided by mental health professionals. Our objective was to develop and validate a tool, in English, which assesses psycho-education of carers of psychiatric patients in Pakistan. METHODS: A questionnaire was generated in English. It was pretested on twenty male and female carers and was refined to attain a more reliable version. Sixty bilingual male and female primary carers, who were fluent in English, and had been in a care-giving role for more than three months were requested to complete the developed Questionnaire for the Assessment of Psycho-Education of Carers (APEC) at Fatima Memorial Hospital Psychiatry Out-patient department within a period of four months from December, 2017 to April, 2018. Carers were identified via patients presenting to a psychiatric OPD. Responses were analyzed for reliability and test retest consistency using Cronbach's alpha analysis, Intraclass correlation coefficients, factor analysis and Paired t-test. RESULTS: APEC was found to be easily understandable and capable of adequately assessing aspects of psycho-education. A high degree of internal consistency was demonstrated on cronbach's alpha analysis. Cronbach's α coefficient for various domains was sufficiently high ranging from0.76 to 0.960. Similarly, domains of (APEC) were highly correlated. Test-retest reliability was assessed by computing the correlation between Visits 1 and 2 scores. CONCLUSION: The developed questionnaire can adequately assess psycho-education of primary carers in mental health settings.

Medical Students' Stress, Psychological Morbidity, and Coping Strategies: a Cross-Sectional Study from Pakistan.

OBJECTIVE: The authors studied the prevalence of psychological morbidity, sources and severity of stresses, as well as coping strategies in Pakistani medical students. METHODS: Medical students in Lahore, Pakistan, completed a cross-sectional, self-administered questionnaire in 2013 on the sources and severity of various stressors. The General Health Questionnaire-12 (GHQ-12) and Brief COPE assessed the psychological morbidity and coping strategies. RESULTS: Out of 1500 students, 527 responded to the survey. The prevalence of psychological morbidity was 23.3%; 52.3% respondents showed evidence of distress. By logistic regression analysis, GHQ-12 caseness was associated with being male and occurrence of health-related stressors. The most common stressors were related to academic concerns. Coping strategies showed variation by GHQ-caseness. CONCLUSION: The significant psychological morbidity and distress warrants establishing support systems to support students and bringing about evidence-based changes to teaching and evaluation systems. Adequate counseling facilities should be made available and students encouraged to seek help.

Student's perceptions of educational environment across multiple undergraduate medical institutions in Pakistan using DREEM inventory.

OBJECTIVE: To objectively assess whether the medical education environment across Pakistan was at an acceptable standard and to determine factors influencing its perception. METHODS: The cross-sectional study was conducted from August to November 2012 at six undergraduate medical institutions across Pakistan. The Dundee Ready Education Environment Measure (DREEM) inventory having five subscales of perceptions of learning, teachers, atmosphere, academic self-perceptions and social self-perceptions was administered anonymously to all the consenting medical students. Data was analysed using SPSS 17. RESULT: Of the 3045 questionnaires distributed, 2084(68.4%) were returned duly filled. Of all the respondents, 1311(63%) were females. Overall mean score found positive was 105.0±25.8 (Max: 200). Corresponding scores in the subscales were: student's perception of learning 25.1±7.2 (Max: 48); social self-perception 15.4±3.9 (Max: 28); academic self-perception l7.2±6.5 (Max: 32); perception of teachers being in need of some re-training 22.5±7.1 (Max: 44); and perception of atmosphere as having many issues needing a change 24.8±7.0 (Max: 48). Female students and pre-clinical year students perceived environment as more positive than male students (108.6±23.0 vs. 98.8±28.9 [p<0.001]) and students belonging to clinical years (108.0±24.0 vs. 03.3±26.5 [p<0.001]). CONCLUSION: Highest score was found in the domain of student's social self-perceptions and lowest in the domain of student's perception of teachers. Results can be used as a basis for planning and executing remedial measures needed to improve undergraduate medical education environment in Pakistan.

Reliability of the ICD-10 International Personality Disorder Examination (Urdu Translation): A preliminary study.

OBJECTIVE: To test the reliability and applicability of Urdu translation of the International personality disorder examination (IPDE) in a psychiatric outpatient population in Pakistan. METHODS: This study was conducted at the outpatient department of Fatima Memorial Hospital Lahore from April 2012 to March 2013. Patients considered to have a personality disorder by a psychiatrist were initially screened by the IPDE screening questionnaire. Those who scored positive on screening were evaluated in a detailed interview using IPDE. Two interviewers conducted the interviews simultaneously, to ensure inter-rater reliability. For translation, permission was taken from World Health Organization. Linguistic equivalence was assessed through back- translation and conceptual equivalence through opinion of mental health experts. The final Urdu draft was obtained after incorporating modifications suggested by experts following a feasibility study. The analysis was carried out using SPSS v.20. RESULTS: Out of 30 enrolled patients, 25(83.3%) were females. The mean age of the sample was 28.5+6.08 years. Majority of patients had more than one personality disorder. Most prevalent personality disorder was emotionally unstable borderline type with a phi correlation of 0.831, followed by emotionally unstable impulsive type and anankastic personality disorder with phi correlations of 0.930 and 0.867, respectively, for definite cases. Correlation coefficient for dimensional scores between the two raters was 0.392 for paranoid personality disorder, 0.842 for anankastic and around 0.9 for the rest of the personality disorders, each. CONCLUSION: Urdu translation of IPDE is a reliable tool to screen and diagnose personality disorders in population of Pakistan.

Educating tomorrow's doctors: A cross sectional survey of emotional intelligence and empathy in medical students of Lahore.

OBJECTIVE: Medical education in Pakistan traditionally emphasizes physician's biomedical knowledge with less emphasis on interpersonal skills and ability to relate to the patients. This study explored the emotional intelligence & empathy of undergraduate medical students and investigated its relationship with various factors to act as baseline for future work in this area. METHODOLOGY: The Schutte Emotional Intelligence scale and Davis' Interpersonal Reactivity Index in addition to socio demographic questionnaire were administered to first year and final year medical undergraduates of two medical Institutions in Lahore, Pakistan. Data was analyzed by using SPSS 17 version. RESULTS: The overall mean scores for medical students both on emotional intelligence and empathy is significantly lower than that found in previous literature, highlighting that medical students do not appear to fare better than average people in EQ. Women showed statistically significant higher scores on Appraisal of emotions , Regulation of emotions, Empathic concern Scale & Personal distress scale. Comparison of EI & IRI of students according to medical college year did not show any statistical significance. CONCLUSION: Current medical curriculum and training in Pakistan does not appear to increase EI abilities which are building blocks that may allow students and residents to develop competence. Medical educators in Pakistan should look for ways to incorporate emotional intelligence in medical curriculum which will ultimately contribute towards patient centered practice, patient satisfaction as well as effective communication skills.

Anxiety and Depression among Parents of Children with Intellectual Disability in Pakistan.

BACKGROUND: Studies have shown an association between parental distress and caretaking of children with developmental cognitive delays. There is little data in developing countries, such as Pakistan, concerning the impact of raising children with intellectual disability upon the quality of parent functioning and risk for psychopathology. OBJECTIVE: To assess the level of psychopathology i.e. anxiety, depression and both anxiety and depression together among parents of children with intellectual disability (ID). METHODS: This was a cross-sectional study conducted at a tertiary care hospital in Pakistan. The study was approved by the Institutional Research Committee. Participants were 198 parents (99 fathers/99 mothers) of 100 children with the diagnosis of ID. Informed consents were obtained. The parents were assessed for anxiety and depression using DSM IV criteria. RESULTS: Significantly high proportion of mothers (89%) had anxiety, depression, or both anxiety and depression together as compared to fathers (77%) (p-value <0.05). Among mothers, 35% met criteria for anxiety, 40% for depression and 13% for both anxiety and depression. Among fathers 42% had anxiety, 31% depression and 3% both anxiety and depression. There was a significant association between gender of parent and individual psychiatric diagnosis of anxiety, depression and anxiety and depression together (p-value <0.05). A significant association was also found between mother's anxiety, depression or both and degree of ID of their children (p-value <0.05). CONCLUSIONS: 1) Significantly high proportion of parents of children with ID has psychiatric diagnosis of anxiety, depression or both; 2) the psychiatric diagnosis of anxiety, depression and anxiety and depression together is associated with gender of parent; and, 3) the diagnosis of anxiety, depression or both in mothers was associated with severity of ID in their children.

CONTEXTE: Des études ont montré une association entre la détresse parentale et la garde d'enfants souffrant de retards de développement cognitif. Dans les pays en développement, comme le Pakistan, il existe peu de données au sujet des répercussions d'élever des enfants souffrant de déficience intellectuelle sur la qualité du fonctionnement des parents et le risque de psychopathologie. OBJECTIF: Évaluer le niveau de psychopathologie, c.-à-d., l'anxiété, la dépression et l'anxiété et la dépression à la fois chez les parents d'enfants souffrant de déficience intellectuelle (DI). MÉTHODES: Cette étude intersectorielle a été menée à un hôpital de soins tertiaires du Pakistan. Elle a été approuvée par le comité de recherche institutionnelle. Les participants étaient 198 parents (99 pères/99 mères) de 100 enfants ayant reçu un diagnostic de DI. Des consentements éclairés ont été obtenus. Les critères de l'anxiété et de la dépression du DSM-IV ont servi à évaluer ces troubles chez les parents. RÉSULTATS: Une proportion significativement élevée des mères (89%) souffrait d'anxiété, de dépression ou d'anxiété et de dépression à la fois comparé aux pères (77%) (valeur p < 0,05). Chez les mères, 35 % satisfaisaient aux critères de l'anxiété, 40%, à ceux de la dépression et 13% à ceux de l'anxiété et de la dépression à la fois. Chez les pères, 42% souffraient d'anxiété, 31%, de dépression et 3% d'anxiété et de dépression à la fois. Il y avait une association significative entre le sexe des parents et le diagnostic psychiatrique individuel d'anxiété, de dépression, et d'anxiété et de dépression à la fois (valeur p < 0,05). Une autre association significative a été observée entre l'anxiété, la dépression ou les deux chez la mère et le degré de DI de leurs enfants (valeur p < 0,05). CONCLUSIONS: 1) Une proportion significativement élevée des parents d'enfants souffrant de DI a un diagnostic psychiatrique d'anxiété, de dépression, ou des deux à la fois; 2) le diagnostic psychiatrique d'anxiété, de dépression, ou des deux à la fois est associé au sexe du parent; et 3) le diagnostic d'anxiété, de dépression, ou des deux à la fois chez les mères était associé à la gravité de la DI de leurs enfants.

Perceptions of and attitudes to alcohol use among Pakistani medical students.

Studies worldwide have reported alarming rates of alcohol misuse among medical students (Webb et al, 1996; Kuo et al, 2002; Akvadar et al, 2004). These reports are surprising as well as of extreme concern, as medical professionals are supposedly more educated on the harmful effects of excessive alcohol consumption. The majority of studies exploring the knowledge and attitudes of medical students regarding alcohol have been from the USA and the UK, with only few from lower-income countries and the Islamic world (Kumar & Basu, 2000; Akvadar et al, 2004).

Pattern of benzodiazepine use in psychiatric outpatients in Pakistan: a cross-sectional survey.

BACKGROUND: Benzodiazepines (BDZ) are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. In countries like Pakistan where laws against unlicensed sale of BDZ are not implemented vigorously the risk of misuse of and dependence on these drugs is even higher. Previous studies have shown that BDZ prevalence among patients/visitors to general outpatient clinics in Pakistan may be as high as 30%. However, no research has been carried out on the prevalence of BDZ use in psychiatric patients in Pakistan. METHODS: We carried out a cross-sectional survey over 3 months in psychiatry outpatient clinics of two tertiary care hospitals in Karachi and Lahore. Besides basic socio-demographic data the participants were asked if they were taking a BDZ at present and if yes, the frequency, route and dosage of the drug, who had initiated the drug and why it had been prescribed. We used chi-square test and t-test to find out which socio-demographic or clinical factors were associated with an increased risk of BDZ use. We used Logistic Regression to find out which variable(s) best predicted the increased likelihood of BDZ use. RESULTS: Out of a total of 419 participants 187 (45%) of the participants had been currently using at least one BDZ. Seventy-three percent of the users had been using the drug for 4 weeks or longer and 87% were taking it every day. In 90% of cases the BDZ had been initiated by a doctor, who was a psychiatrist in 70% of the cases. Female gender, increasing age, living in Lahore, and having seen a psychiatrist before, were associated with an increased likelihood of using BDZ. CONCLUSION: The study shows how high BDZ use is in psychiatric outpatients in Pakistan. Most of the users were taking it for a duration and with a frequency which puts them at risk of becoming dependent on BDZ. In most of the cases it had been initiated by a doctor. Both patients and doctors need to be made aware of the risk of dependence associated with the use of BDZ.