Demographic factors, social problems and material amenities as predictors of psychological distress: a cross-sectional study in Karachi, Pakistan.

PURPOSE: Previous research has shown high prevalence rates for stress and psychiatric morbidity in rural areas of Pakistan, but prevalence findings from urban areas vary widely (between 18 and 70%). Many of these studies have focused on special populations and may not be representative of the general population in urban settings. The purpose of the present study was to ascertain prevalence and predictors of psychological distress in a representative sample of community dwelling adults from mid-low to low-income urban areas of Karachi, Pakistan. METHOD: A cross-sectional survey was undertaken utilizing probability-based sampling from five mid-low to low-income communities of Karachi. Measures included the twelve-item Urdu version of general health questionnaire (GHQ-12), a demographic questionnaire, and questions about financial, health-related and family problems and about access to services and material amenities owned. RESULTS: Seventeen per cent of respondents (N = 1,188) were positive for psychological distress. More females were distressed than males and migrant groups had higher prevalence of distress as compared with natives of the city. Although other studies have shown low education or income to be associated with emotional distress and non-psychotic psychiatric morbidity, our study suggested that having limited income or education may make one more vulnerable to social problems that in turn may be associated with greater distress. An access to services and material amenities had a small but significant association with decreased distress. CONCLUSION: The overall national prevalence rates may not reveal the influence of gender, region (rural v. urban) and migration on psychological distress. Further research is needed to address mental health of migrant groups in urban centers of Pakistan.

The effect of spirituality and religious attendance on the relationship between psychological distress and negative life events.

PURPOSE: The aim of this study was to assess the effect of religious attendance and spirituality on the relationship between negative life events and psychological distress. METHODS: This was a cross-sectional study of 1,071 community dwelling adults from East Baltimore, Maryland who participated in the fourth (2004-2005) wave of the Baltimore Epidemiologic Catchment Area study. The 20-item General Health Questionnaire (GHQ-20) was used to measure psychological distress. Multiple regression models were used to assess the association between negative life events and distress as well as to measure the effect of religious attendance and spirituality on the association between psychological distress and negative events while adjusting for demographic variables, past distress and social support from friends and relatives. RESULTS: In pooled analysis, negative events were significant predictors of distress, b = 1.00, ß = 0.072, p < 0.05. Religious attendance and spirituality did not affect or modify the association between negative events and distress. However, religious attendance was inversely associated with distress with higher frequency of attendance associated with lower distress after controlling for demographic and social support factors, b = -2.10, ß = -.110, p < 0.01 for attending 1-3 times a month; b = -2.39, ß = -0.156, p < 0.01 for attending weekly; and b = -3.13, ß = -0.160, p < 0.001 for attending more than once per week. In stratified analysis, negative events were associated with distress for those who were low on spirituality, b = 1.23, ß = 0.092, p < .05, but not for those who were high on spirituality; the association between religious attendance and decreased distress was true only for those scoring high in spirituality. Social support accounted for some of the inverse association between religious and distress. CONCLUSION: Religious attendance and spirituality may play a role in how people experience and deal with difficult life situations.

Prevalence of insomnia and use of sleep medicines in urban communities of Karachi, Pakistan.

OBJECTIVE: To assess the prevalence of insomnia, its associated factors and the use of sleep medicines. METHODS: The cross-sectional survey of 1488 adults from five urban and semi urban communities of Karachi, Pakistan, was conducted from August 2007 to July 2008. All face-to-face interviews were conducted in Urdu and data was entirely based on self-reported information by the respondents. Data was analysed using STATA 10.1. RESULTS: Of the total, 466 (31.3%) respondents reported insomnia out of which 141 (30.2%) reported using sleep medicines. These medicines were most frequently prescribed by some family physician (114/141; 80.8%). The odds of having insomnia were three times as likely if someone scored positive for psychological distress (OR 3.09; CI 2.30 -4.15) and two times as likely if he/she was troubled by health related issues (OR = 2.40; CI 1.84 - 3.13) or had been exposed to adverse events (OR = 2.02; CI 1.18 - 3.45). Those who experienced financial problems were 59% more likely to report sleep problems (OR = 1.59; CI 1.20 - 2.12). Gender, age, income or occupational status were not found to be associated with insomnia, but married persons tended to enjoy better sleep. CONCLUSION: Every third respondent reported insomnia and one-third of these were taking a sleeping pill prescribed by a family physician. Married people enjoyed better sleep. Gender, age or income was not associated with sleep difficulties.

A United Nations General Assembly Special Session for mental, neurological, and substance use disorders: the time has come.

Mental, neurological, and substance use (MNS) disorders are leading causes of the global burden of disease and profoundly impact the social and economic well-being of individuals and communities. The majority of people affected by MNS disorders globally do not have access to evidence-based interventions and many experience discrimination and abuses of their human rights. A United Nations General Assembly Special Session (UNGASS) is needed to focus global attention on MNS disorders as a core development issue requiring commitments to improve access to care, promote human rights, and strengthen the evidence on effective prevention and treatment.