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.

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.

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.

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.

The hidden crisis: COVID-19 and impact on mental health of medical students in Pakistan

Background

Medical students have faced an enormous disruption to their lives due to the COVID-19 pandemic. The study aimed to assess the impact of COVID-19 on medical student’s psychological well-being in Pakistan. Following ethical approval, an online survey developed in collaboration with World Psychiatric Association (WPA) was distributed among medical students of 5 Medical colleges in the Punjab province of Pakistan between August and September 2020. Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Risk Assessment Suicidality Scale (RASS) were used to assess psychological well-being. Data was analyzed using SPSS 26.0.

Results

Eleven hundred medical students responded, 756 (69%) being females. More than 2/3rd admitted that their emotional state got worse in relation to appearance of anxiety, insecurity, and sadness, compared to before the outbreak of COVID-19. Prevalence of anxiety and depressive symptoms were 48.6% and 48.1%, respectively. Female medical students, pre-clinical students, and those with a previous psychiatric history reported experiencing more anxiety and depression symptoms (P value < 0.001). One in five medical students thought that it would be better if they were dead, and 8% admitted to often think of committing suicide during the past 2 weeks. RASS and subscales (intention, life, and history) scores were higher in females and students with previous psychiatric problems.

Conclusion

Our findings underscore that the impact of COVID-19 on medical students has been significant; hence, it is crucial for medical colleges to employ strategies to maintain the student’s well-being with safeguards like reassurance, support, and confidential student-centered psychiatric services. The use of virtual platforms (websites, email) to educate and screen students by staff members can create a positive impact. The limitations of this study include cross-sectional design, the possibility of selective participation being web-based survey, response bias, and the possibility of reluctance of students to report mental health problems due to stigma.

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.

Depression in Rheumatoid Arthritis and its relation to disease activity

Objectives:

To determine the level of depression in Rheumatoid Arthritis and its relationship with severity of Rheumatoid Arthritis.

Methods:

This cross sectional analytical study was conducted from March 2014 to May 2014.

Total 102 cases of Rheumatoid Arthritis (RA) diagnosed as per ACR (American College of Rheumatology) 1987 criteria were enrolled from Rheumatology Department, Fatima Memorial Hospital. Severity of Rheumatoid Arthritis was assessed by Health Assessment Questionnaire (HAQ) and disease activity score (DAS - 28) while severity of depression was measured by Beck Depression Inventory (BDI) scale II questionnaire. The relationship between depression and disease activity (severity) of Rheumatoid Arthritis was assessed by calculating correlation coefficient between depression, disease activity score (DAS 28) of Rheumatoid Arthritis and health assessment questionnaire (HAQ).

Results:

Out of 102 patients, 77(75.5%) were females and 25(24.5%) males. The mean age of patients was 43.5± 11.9 years and the mean duration of disease was 7.8 ± 5.5 years.71.5% of Rheumatoid Arthritis patients were found to have some degree of depression and this was directly related to the severity of disease. Moderate and severe depression were present in 23 (22.5%) and 19(18.6%) patients respectively.

Conclusion:

In this study, almost three-fourths of Rheumatoid Arthritis patients were found to have depression. There was a strong association between Rheumatoid Arthritis disease activity and the level of depression. So it is imperative for clinicians treating Rheumatoid Arthritis patients to screen them for co morbid depression and manage it accordingly.

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.

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.

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.

Antenatal depression and its predictors in Lahore, Pakistan

Mental health is an important but neglected component of reproductive health. This study aimed to determine the prevalence and risk factors for antenatal depression among women attending for antenatal care at an urban tertiary care hospital in Lahore, Pakistan. In a cross-sectional study, structured questionnaires were filled and screening for depression was done using the Edinburgh postnatal depression scale (EPDS). Out of 506 antenatal attendees 126 (24.9%) had no depression (EPDS scores<10), 53 (10.5%) scored 10-12 and 327 (64.6%) had EPDS scores>12. Depression scores (>or=10) were more common in mothers aged<20 years (93.7%) than those aged>35 years (55.0%). Fear of childbirth and separation from husband were identified as significant risk factors for development of antenatal depression, while family history of psychiatric illness was significant protective factor. Domestic violence, drug abuse, lack of support, previous miscarriage and personal history of previous psychiatric illness were not found to be significant risk factors.

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).

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).

Bullying of junior doctors in Pakistan: a cross-sectional survey

INTRODUCTION

The aim of this study was to determine the prevalence of workplace bullying among junior doctors in Pakistan, identify the types and sources of bullying behaviours and investigate the perceived barriers to making complaints against bullying.

METHODS

We conducted a cross-sectional survey of junior doctors using convenience sampling in three tertiary care hospitals in two provinces of Pakistan. Demographic details and information about the different types of bullying behaviours experienced by junior doctors in the 12 months preceding the study were collected using a previously validated list of 20 such behaviours. Respondents were also asked to indicate the sources of bullying, any complaints made and if not, the reasons behind it. The data was analysed using the Statistical Package for the Social Sciences.

RESULTS

A total of 654 doctors participated in the study. 417 (63.8 percent) of them reported experiencing one or more type of bullying in the past 12 months. 436 (66.7 percent) doctors had witnessed the bullying of others. The most common source of bullying was consultants (51.6 percent). 306 (73.4 percent) respondents did not make a complaint against the bullying.

CONCLUSION

Bullying is faced by a fairly large proportion of junior doctors in Pakistan. The most frequent perpetrators of this bullying are consultants. Major changes are required at the national, organisational and individual levels in Pakistan to tackle the bullying problem and prevent its adverse consequences in an already vulnerable healthcare delivery system.