Effect of COVID-19 lockdown on health of women in Pakistan - Socioeconomic perspective.

Objectives: This study investigates the dimensions of women's experiences during the COVID-19 lockdown in Pakistan, considering their historical vulnerability to natural disasters. Methods: A cross-sectional study was conducted in Pakistan from May to September 2020 at Services institute of medical Sciences, Lahore. An online survey collected socio-demographic data, household responsibilities, and access to medical services using a self-designed questionnaire. Women aged 18 years and above (n=1307) were included through convenience sampling. Data analysis utilized SPSS 20.0. Results: Of the surveyed women, 10 (14.9%) experienced improved health outcomes, while 39 (58.27%) faced poor health outcomes. Proper access to medical services was reported by 29 (43.3%) participants, while 38 (57.1%) had no access. Two women (3.0%) conceived during the lockdown. 45 (67.2%) women lived in nuclear families, and 21 (31.3%) in joint family systems. Additionally, 46 (68.7%) women were significantly burdened with household chores, while 21 (31.3%) had a normal routine. Among COVID-19-positive respondents, 70% reported weight gain from increased screen time and sedentary lifestyle. Difficulties in managing children's online classes were reported by 34.6% of participants. Moreover, 84% had a monthly income below one hundred thousand PKR. Among women aged 23-28 years, 30.9% had adverse effect on their husband's income, and 4.7% experienced unemployment. Unfortunately, 16% of respondents lost a relative due to COVID-19. Even with access to health facilities. Conclusion: The COVID-19 lockdown in Pakistan led to adverse socioeconomic and health outcomes for women. These findings highlight the measures needed to address women's challenges amid pandemic impact.

Addressing the elephant in the room: understanding functional neurological symptom disorder through the lens of culture and religion.

Owing to the dearth of scholarly works to understand the presence of Functional Neurological Symptom Disorder (FNSD) among mental health patients in Pakistan, this study sought to understand how cultural and religious conflicts are implicated in the aetiology of FNSD. The study recruited 22 participants, comprising five men and 17 women. The participants were recruited from the Department of Psychiatry at Services Hospital, Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Thematic Analysis. The two main themes identified in this study were cultural and religious values and beliefs about romantic relationships. Within the cultural and religious values theme, subthemes of self-perception, a conviction in religious beliefs, and sexual suppression were identified. Furthermore, the subthemes of beliefs about romantic relationships were family's approval, engagement against wishes, and fear of exposure. The two main themes are interconnected: beliefs about romantic relationships were interpreted and experienced through the perspective of religion and culture. To summarize, this study concluded that stressors related to culture and religion are significant contributing factors in the development of FNSD. This study has important implications for mental health professionals, as awareness around the interplay of cultural as well as religious beliefs and FNSD will enable them to devise effective and holistic therapeutic intervention.

Family Conflicts Are Bitter Splits That Hurt: A Qualitative Inquiry Toward Understanding the Impact of Family Issues in Functional Neurological Symptom Disorder.

Functional Neurological Symptom Disorder (FNSD) or Conversion Disorder, is a fairly common diagnosis among mental health patients in Pakistan. Despite its prevalence there's a dearth of research on the phenomenon, particularly on the experience of FNSD. The study was conducted with the aim to ascertain the lived experiences of individuals with Functional Neurological Symptom Disorder (FNSD) around stressful situations in their families in Pakistan. For this purpose, a total sample of 10 participants (Women = 8; Men = 2) were recruited from the psychiatry department of a tertiary care hospital in Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Interpretative Phenomenological Analysis (IPA). The two main themes revealed in the analyses were quarrels and unexpressed emotions. The sub-themes of quarrels included quarrels with family members, quarrels within family, parental/marital discord, and quarrels with extended family members. The subthemes for unexpressed emotions were hurt, anger, sadness, and jealousy. In conclusion, this study revealed that in Pakistan, stressors related to family serve as significant contributing factors in the development of FNSD.

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.

"We are the soul, pearl and beauty of Hindu Kush Mountains": exploring resilience and psychological wellbeing of Kalasha, an ethnic and religious minority group in Pakistan.

The Kalasha are a marginalized ethnic and religious minority group in northern Pakistan. The Kalasha minority is known for their divergent polytheistic beliefs, and represents the outliers of the collectively monotheistic Muslim population of Pakistan. This study aimed to explore the psychological resilience beliefs and lived experiences of the Kalasha and to identify cultural protective factors and indigenous beliefs that help them maintain psychological wellbeing and resilience. Seven semi-structured interviews and two focus-group discussions were conducted. The total sample consisted of 6 women and 8 men, aged 20-58 years (Mage = 36.29, SD = 12.58). The Interpretative Phenomenological Analysis qualitative method was chosen. Study findings identified that factors contributing to the wellbeing, happiness and resilience enhancement beliefs of Kalasha included five main themes, all influenced by their unique spirituality: contentment, pride in social identity, tolerance, gender collaboration and gratitude. The study also revealed the Kalasha's perception of their marginalization related to challenges and threats. The Kalasha emphasized bringing these resilience enhancement beliefs into practice, as a mean to buffer against challenges. In conclusion, this study revealed Kalasha's wellbeing and resilience enhancement factors, which they believed in and practiced as an element of their indigenous culture and religion.

Comparison of spiritual well-being and coping strategies of patients with generalized anxiety disorder and with minor general medical conditions.

The purpose of the present study was to compare the spiritual well-being and coping strategies of patients with generalized anxiety disorder (GAD) and those with general medical conditions (GMC). The sample was comprised of 40 participants with GAD fulfilling the diagnostic criteria of DSM IV-TR and 50 participants with GMC. The descriptive statistics, correlation analysis and independent sample t test were used for data analysis. The results revealed the significant negative correlation of spiritual wellness with GAD symptoms and positive correlation between spiritual wellness, active practical and religious-focused coping strategies. The independent sample t test showed that spiritual wellness of participants with GMC was higher than participants with GAD. Moreover, out of 13 dimensions of spiritual wellness inventory, the scores of participants with minor general medical conditions in the dimensions of conception of divinity, present centeredness, hope, forgiveness, conscientiousness and spiritual freedom remained significantly higher than those with GAD. The participants with GMC used more active practical coping strategies and religious-focused coping strategies than participants with GAD. There was no difference between two groups of participants in using active distracting coping strategies, while avoidance-focused coping strategies were used by participants with GAD more than those with GMC.

Perception of mental health in Pakistani nomads: an interpretative phenomenological analyses.

The study was conducted to explore the mental health issues of Pakistani nomads and to uncover their concept, ideation, and perception about mental health and illnesses. It was an exploratory study situated in the qualitative paradigm. The research strategy used was Interpretative Phenomenological Analysis (IPA), as the study was planned to explore the lived experiences of nomads regarding mental health and coping strategies and how they interpret those experiences. For data collection, focus group discussions (FGDs) were conducted. Seven participants were included in the FGDs, and two FGDs were conducted composed of both genders. The responses were recorded, and data were transcribed and analysed using IPA. Data verification procedures of peer review, which help to clarify researcher bias and rich thick description, were used. The major themes were lack of resources and myriad unfulfilled needs, specifically the basic needs (food, shelter, and drinking and bathing water). Moreover, a strong desire to fulfil the secondary needs of enjoyment and having luxuries was also reflected. A list of recommendations was forwarded for policy making of this marginalized community and to create awareness regarding mental health.