Challenges of having a child with thalassemia in Pakistan: A phenomenological study.

BACKGROUND: Thalassemia is a persistent hemolytic disease and has debilitating effects on patients and their parents. Parents of these children experience pain and suffer from additional emotional strain as they provide daily and lifetime care and are mostly concerned about the health and future of their children. AIM: The study aimed to understand the experiences of parents of children with thalassemia related to their family, financial, social, treatment, and psychological issues in Pakistan. METHODS: This descriptive phenomenological study recruited 21 parents of children with thalassemia through purposive sampling until data saturation was achieved. Analysis of transcribed interviews was performed through Colaizzi's method and themes and subthemes revolving around diagnosis, challenges, and treatment issues were extracted. FINDINGS: A total of 21 Pakistani parents participated in this study. Most of the participants were females (n = 16, 76.19%), housewives/stay-at-home moms (n = 13 (61.90%), and were uneducated (n = 6, 28.57%). Regarding genetic traits, only three (14.28%) parents declared that they had genetic traits of thalassemia. The findings of our study revealed that thalassemia is enormously influenced by psychosocial and economic problems because of this disease in their families. CONCLUSION: Our findings indicated that parents of these children face multi-faceted challenges, such as physical, socio-emotional, financial, and familial. These findings may lead to an adequate understanding of their individual needs and efficient utilization of supportive and care programs. PRACTICE IMPLICATIONS: An understanding of such experiences, involving those distinctive to Pakistani culture, is especially vital to inform the care of these children and enhance their quality of life.

Psychological assessment of atopic dermatitis in Asia: a systematic review.

Atopic dermatitis (AD) is a frequently occurring skin disorder in Asia that substantially impacts the social, financial, and psychological lives of individuals. However, there is uncertainty regarding the psychological instruments for this domain. Hence, this review systematically assessed the existing measurement instruments used, developed, and/or validated for the measurement of psychological outcomes in Asian adult patients with AD as well as the scope of those assessment tools (e.g. validity and reliability). Electronic searches were performed using six databases (inception to February 2020) to identify studies. Thematic analysis of 44 included studies revealed that the commonly employed tools to assess the quality of life were the Dermatology Life Quality Index followed by the Skindex-16 questionnaire, the European Quality of Life-5 Dimensions, and the Quality of Life Hand Eczema Questionnaire. Similarly, the Patient Health Questionnaire, Self-rating depression scale (SDS), and Hospital Anxiety and Depression Scale were frequently employed to assess depressive symptoms. Additionally, symptoms of anxiety were frequently assessed through Interaction Anxiousness Scale and the Spielberger State-Trait Anxiety Inventory. Although a variety of psychological assessment measures have been used in research, data on their reliability and validity is limited. Also, information on the cultural applicability of these instruments is scantier. More research is needed to ascertain the suitability of tools for use in clinical practice.

Mental health literacy: A systematic review of knowledge and beliefs about mental disorders in Malaysia.

BACKGROUND: Mental health problems in Malaysia are on a rise. This study aimed at performing a systematic review of mental health literacy (MHL) in Malaysia. METHODS: Medline, Embase, ERIC/Proquest, ScienceDirect, Pubmed, PsycINFO, CINAHL, Scopus, EBM Reviews - Cochrane Central Register of Controlled Trials, Ovid Emcare and reference lists of included studies were searched in February 2020. Studies that evaluated at least one of the main components of MHL, including (1) knowledge related to mental health issues, and (2) stigma, were included irrespective of study design. As secondary findings, the review also synthesized results related to facilitators and barriers to seeking mental health services. Depending on the research design, the quality of each study was assessed through checklists. RESULTS: Forty six studies published between 1995 to 2019 were included. Most studies used cross-sectional designs to investigate MHL. Findings indicate that most Malaysians have stigmatizing attitudes towards mental health problems. Participants in the included studies endorsed multifactorial explanations of mental health issues with a dominance of supernatural and religious aetiologies. Likewise, the commonest barrier was considering sources other than professional sources of mental-health services. Presence of adequate knowledge and considering providers as competent facilitated help-seeking. Additionally, there was considerable heterogeneity in studies and a lack of standardized measures assessing MHL. CONCLUSIONS: There is an increase in studies on MHL in Malaysia. A few of these studies, based on experimental design, have shown positive effects. Researchers, practitioners, and policymakers should develop standardized measures and interventional studies based on all the components of MHL.

Validity and Reliability of the Urdu Version of the McLean Screening Instrument for Borderline Personality Disorder.

Introduction: Although the translation and the validation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) are performed in various languages and samples, no study has established the validity and reliability of the Urdu version of MSI-BPD in individuals with cardiac problems. Materials and Methods: The Urdu version of the MSI-BPD was prepared through the standard back-translation method. The translation and adaption were completed in four steps: forward translation, adaption and translation, back translation and committee approach, and cross-language validation. The sample, selected through the purposive sampling method, comprised of 150 adults with cardiac problems (men = 75 and women = 75), with an age range of 23-78 years (M = 55, SD = 10.6). The Cronbach alpha reliability and factorial validity of the MSI-BPD were assessed through confirmatory factor analysis (CFA) and Pearson correlation analyses. Internal consistency and test-retest reliability (at 2 weeks' interval) were used to evaluate the reliability. Statistical analyses were performed, using SPSS (version 22) and Structural Equation Modeling (SEM) software. Results: Preliminary analysis revealed that the overall instrument had good internal consistency (Urdu MSI-BPD α = 0.79; English MSI-BPD α = 0.77) as well as test-retest correlation coefficients for 15 days (r = 0.94). Conclusions: Findings suggested that the MSI-BPD, with important limitations, can be used as an effective preliminary screening tool to measure BPD in Urdu-speaking adults with cardiac problems. Further validations should be conducted to make the translated version of the MSI-BPD an appropriate tool to screen BPD in hospitals and mental health care settings.

Acceptance and commitment therapy for individuals having attention deficit hyperactivity disorder (ADHD): A scoping review.

OBJECTIVES: Acceptance and commitment therapy (ACT) has accumulated increasing evidence-base for a broad range of mental health issues. Considering that ACT encourages broad and flexible patterns of behaviour and neutralizes the pervasive psychological processes proposed to be caused by most individuals' distress, such a modality may be effective for ADHD. This review aimed to give a synthesis of the studies, so far, focusing on the usefulness of ACT approaches among individuals having ADHD. DESIGN/METHODS: This scoping review searched studies exploring the effectiveness of ACT approaches for individuals with ADHD across eight electronic databases (Medline, Embase, PsycInfo, ScienceDirect, PubMed, Emcare, Scopus, and Google Scholar). This review was based on a total of two quasi-experimental and four experimental studies. RESULTS: A thematic analysis was suggested based on the PRISMA guidelines. Overall, the review presented preliminary evidence demonstrating the use of ACT among individuals with ADHD. It was found that the ACT was used to treat a variety of behavioural and psychosocial outcomes, which included reducing ADHD symptoms (e.g., impulsivity, inattention, inflexibility, etc.) and other sequelae related to the ADHD diagnosis such as poor quality of life, academic procrastination, depression and anxiety symptoms, and psychological maladjustment. CONCLUSIONS: This review revealed that ACT was a flexible approach that could be adapted to deliver both targeted treatment of ADHD symptomatology and more general psychosocial issues. It could also be delivered in group or individual formats. Nevertheless, although the findings of the present scoping review indicate promising results, more research is needed.

Adapting cognitive-behavioral therapy for a Malaysian muslim.

Background: Over the years, cognitive-behavioural therapy (CBT) has gained momentum because of its robust evidence in the treatment of several disorders. However, there is an issue of religious and cultural appropriateness as CBT principles are based on Western conceptualization. This single-case study (N = 1) implements a culturally and religiously adapted CBT on a 34-year-old male with panic disorder with agoraphobia in Malaysia. The client had symptoms comprising various episodes of sudden onset of breathlessness, accelerated heart rate, and fear of dying for the last 14 years. The CBT was culturally and religiously adapted based on (1) A CBT manual in Bahasa Malaysia that was previously modified and adjusted according to the norms of the Malaysian society and (2) General guidelines in "Religious-Cultural Psychotherapy in the Management of Anxiety Patients" by Razali et al in 2002. The present modified CBT had 3 assessments formulation sessions and 12 intervention sessions. Methods: The first 6 sessions were based on the behaviour component of CBT (ie, a relaxation technique using Islamic prayer, reciting verses from the Holy Quran, slow breathing exercise, body scan, and progressive muscular relaxation). However, sessions 7 to 12 were focused on cognitive restructuring and exercises, such as identification of negative automatic thoughts, cognitive distortions, dysfunctional thought records, vertical arrow technique, and the coping statement was practised through collaborative empiricism, while implementing Islamic and cultural elements. The focus of termination sessions was on interoceptive exposure, cognitive rehearsal, and in vivo situational exposure. Results: Beck Anxiety Inventory (BAI) was administered at regular intervals. BAI scores revealed the effectiveness of adapting the intervention. Conclusion: Panic attacks, worry about panic attacks, and anxiety scores reduced remarkably and the client was able to go out of the house, travel independently, and pursue religious/social activities.

Investigating cognitive control and cognitive emotion regulation in Iranian depressed women with suicidal ideation or suicide attempts.

OBJECTIVE: This study compared cognitive control (working memory, interference control, perseveration) and cognitive emotion regulation among Iranian women with depression who had attempted suicide, had only suicidal ideation, and healthy controls. METHOD: Participants (N = 75) completed a clinical interview, cognitive control tasks, and the Cognitive Emotion Regulation Questionnaire. RESULTS: Those with suicidal ideation or previous attempts had poorer cognitive control and cognitive emotion regulation than controls. Furthermore, those who had attempted suicide had poorer cognitive control and reported greater use of self-blame, rumination, and catastrophizing, and less use of acceptance, than those with suicidal ideation only. There was an indirect effect of cognitive control deficits on suicidality through cognitive emotion regulation (self-blame, acceptance, rumination, catastrophizing). CONCLUSIONS: Exploring these cognitive deficits and difficulties can assist in further understanding the risk factors for suicidality and improve targeted interventions. This is of particular relevance in Iran where the need for policies and interventions targeting the prevention of suicide has been identified.

Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry.

BACKGROUND: The COVID-19 outbreak has gravely impacted the physical and psychological health of people. As the outbreak is ongoing, it is crucial to equip the emergency healthcare workers (HCWs) to be medically and psychologically prepared. OBJECTIVE: To examine the psychological impact of COVID-19 on emergency HCWs and to understand how they are dealing with COVID-19 pandemic, their stress coping strategies or protective factors, and challenges while dealing with COVID-19 patients. METHODS: Using a framework thematic analysis approach, 15 frontline emergency HCWs directly dealing with COVID-19 patients from April 2, 2020 to April 25, 2020. The semi-structured interviews were conducted face-to-face or by telephone. Data were analyzed using thematic analysis. RESULTS: Findings highlighted first major theme of stress coping, including, limiting media exposure, limited sharing of Covid-19 duty details, religious coping, just another emergency approach, altruism, and second major theme of Challenges includes, psychological response and noncompliance of public/denial by religious scholar. CONCLUSIONS: Participants practiced and recommended various coping strategies to deal with stress and anxiety emerging from COVID-19 pandemic. Media was reported to be a principal source of raising stress and anxiety among the public. Religious coping as well as their passion to serve humanity and country were the commonly employed coping strategies.

Public Perception About the Zika Virus in Working Professionals: A Qualitative Inquiry.

AIMS: The Global Outbreak Alert and Response Network recently warned that the Zika virus-containing mosquitoes are being found in Pakistan and the health sector is on high alert. It is thus significant to understand public beliefs and perceptions of the Zika virus and vaccination in the current scenario of Pakistan. METHODS: Twenty semistructured qualitative interviews were conducted and analyzed through an inductive approach to analysis. RESULTS: The findings were presented in three main categories which were coded: Reality vs. Conspiracy, Vaccination Concerns, and Public Worries. The majority believed that the Zika virus is a real problem and that authorities might be trying to hide the Zika cases in Pakistan. Moreover, they believed that health organizations are being incompetent by failing to take timely remedial measures to manage the Zika. However, 20% have an opposing view and believed that the Zika virus is a conspiracy against Pakistan from the West. CONCLUSION: Overall, most participants were concerned about the lack of treatment and preventive methods and emphasized the need to create awareness among the public. It is observed that the participants' perceptions ranged from perceiving the Zika virus as real to as a conspiracy.

Prevalence of mental health problems in women in polygamous versus monogamous marriages: a systematic review and meta-analysis.

While some studies suggest different mental health outcomes among women in polygamous versus monogamous marriages, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of marriage types (i.e., polygamous and monogamous marriages) and differences in the prevalence of mental health issues. Eleven electronic databases, along with further identified references lists, were searched. Thirteen studies met the inclusion criteria. They included 3166 participants, and 986 women were in a polygamous marriage. All studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the five symptoms to assess for the effect of marriage type. The studies indicate a significant association of marriage type with psychological symptoms. The meta-analysis indicates that women in polygamous marriage had worsened mental health as compared with women in monogamous marriages. The weighted mean differences with 95% confidence intervals were somatization 0.53, 0.44-0.63; obsession-compulsion 0.35, 0.14-0.56; interpersonal sensitivity 0.42, 0.12-0.73; depression 0.41, 0.15-0.67; anxiety 0.41, 0.15-0.68; hostility = 0.47, 0.28-0.66; phobic anxiety 0.39, 0.17-0.61; paranoid ideation 0.35, 0.24-0.47; psychoticism 0.41, 0.23, 0.59; and Global Severity Index (GSI) 0.43, 0.25-0.60. A higher self-esteem and life satisfaction among women in polygamous marriages and statistically superior family functioning among women in monogamous marriages were also found. However, there was no statistically significant difference between the marital satisfaction of women in polygamous versus monogamous marriages. Results are consistent with the existing research on the prevalence of mental health issues among women in polygamous marriages. Nonetheless, these women were found to have elevated self-esteem and life satisfaction than women in monogamous marriages. Directions for future research are indicated.

A systematic review of mental health literacy in Pakistan.

Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.

The satisfaction with life scale: Psychometric properties in Pakistani population.

Background: The construct of satisfaction with life has been studied across various cultures through the Satisfaction with Life Scale. The Satisfaction with Life Scale (SWLS) has been validated across several populations and languages. There are no published psychometric properties of its Urdu version. Hence, the aim of this study was to ascertain the psychometric properties of the Urdu version of the SWLS among the Urdu speaking population of Pakistan. Methods: The SWLS has already been translated into Urdu, and the Urdu version is available on the author's website however there is no information about its psychometric properties. To establish the psychometric properties especially the factor structure of the already translated Urdu SWLS, the SWLS-Urdu was administered to Urdu speaking population residing in Pakistan. The statistical analyses (i.e., normality through skewness and kurtosis, Kaiser-Meyer-Olkin (KMO) and Bartlett's test of sphericity, and test and re-test reliability) were conducted through SPSS version 25.0. Structure Equation Modelling via maximum likelihood method of estimation was used to perform confirmatory factor analysis on the data using AMOS 20.0. The significance level was set at p < 0.05. Results: The study was completed by recruiting 120 participants from different universities in Lahore, Pakistan. The sample was equally divided between male and female participants. The mean age of participants was 22.7(3.6) years. Test of the adequacy of the sample through Kaiser-Mayer-Olkin showed KMO=0.88 and Bartlett's test of sphericity (p<0.001). The Cronbach's alpha reliability of the scale was 0.90 and Confirmatory Factor Analysis confirmed a one-factor model as a good fit with strong statistical evidence. No factorial group variances were noticed in male and female participants. Conclusion: This study shows that Urdu SWLS has sound psychometric properties, is linguistically and culturally acceptable, and equally useful in assessing satisfaction with life in the Urdu speaking population.

Prevalence of and Factors Contributing to Glue Sniffing in the South Asian Association for Regional Cooperation (SAARC) Region: A Scoping Review and Meta-analysis.

Background: Although glue sniffing has been linked with significant morbidity and mortality, it is still under-researched and poorly recognized issue globally. Objective: A scoping review was performed to identify the factors and outcomes related to glue sniffing in India, Pakistan, Nepal and Bangladesh. Methods: Ten databases; Medline via Ovid, Google scholar, EBSCOhost (CINAHL Plus), ProQuest Central, PsycInfo, IndMED, Ovid Embase, Scopus, PubMed, and Science Direct were searched from their inception to January 2019 for both qualitative and quantitative studies examining any aspect of glue-sniffing. Studies published only in English language were included. Prevalence of glue-sniffing in SAARC region was the primary outcome measure. Findings: Of 8951studies screened, 344 were assessed for eligibility and 31 studies were included. The majority of the studies were conducted in India (15) and Pakistan (11). Meta-analysis of proportion, using random effects model, for both primary and secondary outcomes found that the highest incidence of glue sniffing was 57% (0.57, CI 95% 0.49-0.66) in India. The overall incidence of tobacco and naswar (snuff) as was 83% (0.83, 95% CI 0.80-0.86). Conclusions: The prevalence of glue sniffing, especially among street children, is alarmingly high and presents a challenge for health and social services for countries in SAARC region. More research work is required to examine long term impact of glue sniffing on physical and mental health.

Health Literacy Studies Conducted in Australia: A Scoping Review.

Health literacy (HL) is an essential component of various literacies mentioned in the field of health and education, including cultural, technological, media and scientific literacies. It is important for motivating higher consumer engagement. We aimed to review previous studies of HL in Australia to inform future studies, extend current knowledge and further enhance HL. Using search strings, a systematic search of four databases (i.e., MEDLINE; Embase; CINAHL and Eric) was carried out. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) based search strategy led to identification of a total of N = 9696 records, that were further screened for inclusion in the review. The review findings were categorized into three major themes: (1) HL and health numeracy; (2) contrast of: knowledge deficiency, knowledge gained, problems of current health care system and (3) HL measurement methods and its domains. The findings from this scoping review show a dearth of measurement tools with sound psychometric properties for assessing HL. The findings also reveal low levels of HL in consumers which is in turn affecting health-related behaviors, utilization of health services and navigation of the health system. More recent developments have tried to integrate vital aspects, including introduction of applications to increase HL and exploring HL in Aboriginal communities.

Understanding the reminiscence bump: A systematic review.

One of the most consistently observed phenomena in autobiographical memory research is the reminiscence bump: a tendency for middle-aged and elderly people to access more personal memories from approximately 10-30 years of age. This systematic review (PROSPERO 2017:CRD42017076695) aimed to synthesize peer-reviewed literature pertaining to the reminiscence bump. The researchers conducted searches in nine databases for studies published between the date of inception of each database and the year 2017. Keywords used included: reminiscence, bump, peak, surge, blip, reminiscence effect, and reminiscence component. Sixty-eight quantitative studies, out of 523, met the inclusion criteria. The researchers implemented a thematic analytic technique for data extraction. Four main themes were generated: methods of memory activation/instruction for life scripts, types of memory/life scripts recalled, location of the reminiscence bump, and theoretical accounts for the bump. The two prevailing methods of memory activation implemented were the cuing method and important memories method. Three types of memories/life scripts were recalled: personal/autobiographical memory, memories for public events, and life script events. The findings illustrate differing temporal periods for the bump: approximately 10-30 years for memories for important events, approximately 5-30 years for memories that were induced by word cues, and 6-39 years for studies using life scripts. In explaining the bump, the narrative/identity account and cultural life script account received the most support.

Factor Structure of Urdu Version of the Flourishing Scale.

Background: A great deal of research has been carried out on the assessment of the eudaimonic perspective of psychological well-being and the hedonic perspective of subjective well-being. The Flourishing Scale (FS) has been extensively used in research and practice, as it assesses the fundamental aspects of social psychological functioning. Nevertheless, the psychometric properties of Urdu versions of eudaimonic measures, such as the FS, have not yet been ascertained. The translation and validation of the FS in the Urdu language was not available, and hence this study was planned with the aim to validate the Urdu version of the FS. Methods: We assessed the psychometric properties of the FS in a sample of adults aged 18 years and above in Pakistan (N = 130) using exploratory factor analysis based on principal component analysis with varimax rotation and confirmatory factor analysis. Results: The exploratory factor analysis confirmed the unidimensional nature of the 8-item FS. We assessed that the Urdu version of the FS showed a high internal consistency reliability (α = 0.914) with a significant intraclass correlation coefficient (ICC), p < 0.001). In our study, the Kaiser-Mayer-Olkin value was 0.915 with a chi-square test value (χ2) of 637.687, and Bartlett's test of sphericity was significant (df = 28, p < 0.001). The intraclass correlation coefficients (ICCs) at test-retest for all domains were statistically significant (p < 0.001) and showed excellent agreement for all the items. The revised confirmatory factor analysis revealed a good-fit model, but with item 8-"People respect me"-removed due to its lower factor loading. Conclusions: The findings suggest that the FS is a psychometrically sound instrument for assessing social psychological functioning among adults in Pakistan. Therefore, the validated Urdu version of the FS may be used in future studies of well-being in clinical psychology and positive psychology.

Exploring Relationship Between Spiritual Intelligence, Religiosity and Life Satisfaction Among Elderly Pakistani Muslims.

This study is an effort to explore the relationship between spiritual intelligence, religiosity and life satisfaction in elderly Pakistani Muslims. A non-probability purposive sampling technique is utilized in order to recruit a sample of 100 elderly people (n = 50 men; n = 50 = women). Standardized questionnaires were used for collecting data. Data analysis was carried out using Pearson product-moment correlation analysis and independent sample t test. Findings revealed a significant correlation between spiritual intelligence, religiosity and life satisfaction among Pakistani elderly Muslim people. Gender differences were considered while conducting the study, and findings are valid for both male and female elderly Pakistani Muslims. Some findings of this study endorse findings of some previous studies, and it adds latest insights to the existing body of knowledge on the subject.