Urdu Adaptation and Validation of Social Interaction Anxiety Scale: A Confirmatory Factor Analysis.

The Social Interaction Anxiety Scale (SIAS) is a globally used scale for clinical diagnostic purposes for social anxiety disorder (SAD). This article investigates the psychometric properties of the SIAS, followed by its adaptation and validation in Urdu. The study consisted of two phases. The initial phase involved the translation of the scale, and the second phase was of a cross-sectional nature and consisted of evaluating factor structure and psychometric properties of the scale. For this purpose, the study enrolled a purposive sample of 573 adults aged between 18 to 45 years (mean [standard deviation (SD)] age: 23.68 [4.28] years) with a diagnosis of SAD. The sample was recruited from educational institutes, hospitals, and clinics in Lahore, Pakistan. The data was collected using a demographic form and the Urdu version of the SIAS, along with the Multidimensional Psychological Flexibility Inventory (MPFI). The analyses of the study were carried out using SPSS V27 and AMOS V24. Confirmatory factor analysis revealed a single factor structure of the Urdu version of the SIAS consisting of 16 items. The psychometric values of the scale shown were excellent, as Cronbach's alpha equaled 0.91, convergent validity r equaled 0.37 at p less than 0.01 with psychological inflexibility, and discriminant validity r equaled -0.47 at p less than 0.01 with psychological flexibility. The study concluded that the Urdu version of the SIAS was a valid and reliable measure for the assessment of social anxiety in the Pakistani population.

Adaptation and validation of the west haven-yale multidimensional pain inventory for Pakistani population.

Objective: To evaluate the adapted version of West Haven-Yale Multidimensional Pain Inventory for patients with chronic pain. METHODS: The multiphase study was conducted from January to December 2021. The factorial structure of the Urdu version of West Haven-Yale Multidimensional Pain Inventory was evaluated on a sample of adult patients aged 18- 45 years with non-specific chronic pain, taken from public and private hospitals and clinics of Lahore, Pakistan. The Urdu version was then subjected to factor analysis, while Cronbach's alpha, composite reliability, convergent and discriminant validity of the scale were also calculated. Data was analysed using SPSS 24. RESULTS: Of the 306 subjects, 204(66.7%) were females and 102(33.3%) were men. The overall mean age was 30.94+/-8.44 years. There were 166(54.2%) subjects who were married, and 137(44.8%) reported experiencing pain daily. The confirmatory factor analysis showed a 45-item structure for 12 sub-scales as the best fit. The statistics for the final model were observed as minimum discrepancy function by degrees of freedom divided was 1.69, root mean square error of approximation was 0.05, and standardised root mean square residual was 0.06. Comparative fit index value was 0.91 and Tucker-Lewis coefficient was 0.90. Cronbach's alpha reliability ranged between 0.68 and 0.89 for the subscales, while for the total scale, it was 0.72. Conclusion: The Urdu version of West Haven-Yale Multidimensional Pain Inventory was found to be a reliable and valid tool for chronic pain assessment for patients in Pakistan.

Relationship beliefs, attachment styles and depression among infertile women.

The stigma of infertility in Pakistan has been conceded as a stressful clinical condition, significantly affecting women's over all wellbeing and spousal relationships. The present study aimed to investigate the connection between relationship beliefs, attachment styles and depression among infertile women. Ex post facto research design was employed. A total sample of 80 infertile women (40 primary and 40 secondary infertility) with age range of 25-45 years participated in the study through purposive sampling from two infertility centers of Lahore city. Data was collected using demographic information form, relationship belief inventory (RBI), attachment style questionnaire (ASQ) and depression scale of symptom checklist-revised (SCL-R). Result indicates that beliefs of disagreement is destructive (DID), mindreading is expected (MIE) and anxious attachment style were positively correlated with depression. Mindreading is expected' and anxious attachment' style emerged as the predictors of depression. However, no significant differences were found between both groups of primary and secondary infertile women. Considering, the dysfunctional relationship beliefs and negative attachment style with spouse as significant correlate and predictor of depression in infertile women. It is suggested to devise intervention focused on alleviating psychological issues related to infertility.

Randomized control trial of a culturally adapted behavioral activation therapy for Muslim patients with depression in Pakistan.

BACKGROUND: Behavioral activation therapy (BA) is as effective as cognitive behavior therapy (CBT) in treating depression and can be delivered by practitioners with much less psychological training, making it particularly suitable for low resource settings. BA that is culturally adapted for Muslims (BA-M) is a culturally adapted form of BA that has been found acceptable and feasible for Muslims with depression in the United Kingdom and Turkey; however, this is the first time that its efficacy has been determined through a definitive randomized controlled trial. AIM: To compare the effectiveness of BA-M with CBT for Muslim patients with depression in Pakistan. METHODS: One hundred and eight patients were randomized 1:1 to treatment arms in a parallel-group randomized controlled trial in hospital or community sites in Lahore, Pakistan. Recruitment followed self-referral or referrals from clinicians, consultants or relevant professionals at each site. Four measures were recorded by blinded assessors: The patient health questionnaire-9 (PHQ-9); the BA for depression scale short form (BADS-SF); symptom checklist-revised and the World Health Organization Quality-of-Life Brief Scale. All measures were recorded at baseline and post treatment; PHQ-9 and BADS-SF were also recorded at each session and at three month follow up. The primary analysis was to regress the PHQ-9 score after therapy upon the PHQ-9 score before therapy (baseline) and the type of therapy given, that is, analysis of covariance. In addition, analysis using PHQ-9 scores collected at each therapy session was employed in a 2-level regression model. RESULTS: Patients in the BA-M arm experienced greater improvement in PHQ-9 score of 1.95 units compared to the CBT arm after adjusting for baseline values (P = 0.006) The key reason behind this improvement was that patients were retained in therapy longer under BA-M, in which patients were retained for an average 0.75 sessions more than CBT patients (P = 0.013). Patients also showed significant differences on physical (P < 0.001), psychological (P = 0.004) and social (P = 0.047) domains of Quality of Life (QoL) at post treatment level, indicating an increased QoL in the BA-M group as compared to the treatment as usual group. Some baseline differences were noted in both groups for BA scores and two domains of QoL scale: Physical and environment, which might have influenced the results, though the BA-M group showed more improvement at completion of therapy. CONCLUSION: Results proved the efficacy of BA-M in reducing symptoms for depressed patients in Pakistan, indicating BA-M is a promising treatment modality for depression in future, particularly in low resource settings.

Integrated Moving on After Breast Cancer and Culturally Adapted Cognitive Behavior Therapy intervention for depression and anxiety among Pakistani women with breast cancer: Protocol of a randomized controlled trial.

Objective: The diagnosis and treatment of breast cancer is associated with significant distress that has huge impact on survivors' quality of life. The objective of this study is to assess the effectiveness of an integrated intervention "Moving on After Breast Cancer (ABC) Plus culturally adapted Cognitive Behavior Therapy" (Moving on ABC Plus). Method: This is a randomized controlled trial that aims to recruit 354 breast cancer survivors from the inpatient and outpatient oncology departments in public and private hospitals in Karachi, Hyderabad, Lahore, Multan, and Rawalpindi in Pakistan. Patients scoring 10 or above on either the Patient Health Questionnaire-9 and/or the Generalized Anxiety Disorder scale (GAD-7) will be recruited. Baseline assessments will include Functional Assessment of Cancer Therapy-Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale. Participants randomized into intervention arm, Moving on ABC Plus, will receive 12 individual therapy sessions over 4 months. Follow-up will be completed at 4- and 6-month post-randomization, using all baseline instruments along with the Client Satisfaction Questionnaire (CSQ-8). We will also explore the participants', their family members', and the therapists' experiences of the trial and intervention. Results: We will be assessing the effectiveness of intervention in reducing depression and anxiety in breast cancer survivors as a primary outcome of the trial. The secondary outcomes will include effectiveness of intervention in terms of reduction in intrusive thoughts and improvement in health-related quality of life, self-esteem, and perceived social support. Conclusion: The results of the study will inform the design of a future larger randomized control trial with long-term follow-up.

The Link between Chronic Pain and Depression in Low Income Country, Pakistan.

OBJECTIVE: To examine the relationship of subjective and physiological variables of pain in relation to depression among patients with chronic pain. METHODS: The cross-sectional study was conducted at the Centre for Clinical Psychology in Lahore, Pakistan, from January to June 2016, and comprised patients with organic, identifiable chronic pain presenting at various government, semi-government and private hospitals. Data was collected using a personal history questionnaire, West Haven-Yale Multidimensional Pain Inventory and the depression subscale of the Symptom Checklist Revised. Data was analysed using SPSS 20. RESULTS: There were 186 subjects with a mean age of 46.92±13.92 years. All variables related to chronic pain had significant relationship with depressive symptoms (p<0.05). CONCLUSIONS: The relationship between chronic pain and depressive symptoms was found to be significant, and females were at a higher risk than males.

Weight stigma and disordered eating behaviors in Pakistani overweight adolescents: the mediating role of body esteem.

PURPOSE: Weight stigma has been described as social devaluation of people on the basis of their weight and it is associated with negative consequences. The present study was designed to investigate weight stigma and its relationship with disordered eating behaviors in overweight adolescents. One of the main objectives of this study is to investigate the mediating role of body esteem between weight stigma and disordered eating behaviors in overweight adolescent girls. METHODS: Through cross-sectional research design and purposive sampling technique, a sample of 200 overweight adolescent girls was recruited from Lahore, Pakistan. Participants were asked to fill self-report measures related to weight stigma, body esteem, and disordered eating behaviors. RESULTS: SPSS and AMOS were used to analyze the data. Pearson product moment correlation showed that experiences of weight stigma were negatively related to body esteem and positively related to disordered eating behaviors in overweight adolescent girls. Furthermore, structural equation modeling (SEM) showed that body esteem was significantly mediating the relationship between weight stigma and disordered eating behaviors in adolescent girls. CONCLUSION: It is concluded that weight stigma and body esteem play a significant role in the development and maintenance of disordered eating behaviors in overweight adolescents. Awareness/educational programs could be designed to empower adolescent girls in combating negative consequences of weight stigma. Furthermore, specific programs could be designed at college or university level to boost one's body esteem and reduce disordered eating behaviors. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Social support, self-efficacy, cognitive coping and psychological distress in infertile women.

PURPOSE: The aims of this research were to investigate the relationship of social support, self-efficacy and cognitive coping with psychological distress, as well as, to determine the mediating role of self-efficacy and cognitive coping between social support and psychological distress in infertile women of Pakistan. METHODS: This cross-sectional study was conducted to recruit 158 infertile women from six hospitals of Lahore, Pakistan. A demographic questionnaire, multidimensional scale of perceived social support, infertility self-efficacy scale, coping strategies questionnaire and depression anxiety stress scale were used to assess the study variables. RESULTS: The results found that significant other, family and friends support was negatively associated with depression, anxiety and stress, however, no relationship was found between friends support and anxiety. Self-efficacy and active-practical coping had negative, whereas, avoidance-focused coping had positive relationship with depression, anxiety and stress. Active-distractive coping was negatively and religious-focused coping was positively associated with depression. Mediation analyses revealed that self-efficacy mediated the effect of social support on depression, anxiety and stress, but no mediation was found between friends support and anxiety. Moreover, avoidance-focused coping mediated the link between social support and depression, as well as, between significant other support and anxiety. CONCLUSION: Social support, self-efficacy, active-practical coping and active-distractive coping had significant negative associations with psychological distress. Hence, structured programs should be developed to enhance societal acceptance and to reduce the negative attitude of people towards infertility.

Caregiver Burden, Quality of Life and Vulnerability Towards Psychopathology in Caregivers of Patients with Dementia/Alzheimer's Disease.

OBJECTIVE: To identify caregivers' burden, evaluate quality of life in them; and predict anxiety and depression in caregivers of patients with Alzheimer's disease (AD). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Neurology and Psychiatry Department of Lahore General Hospital (LGH), from January to December, 2013. METHODOLOGY: A purposive sample of 60 caregivers, who had been taking care of patients with AD for more than one year, were recruited from the study centre. The Zarit Burden Interview was used to assess caregiver burden. The brief version of World Health Organization Quality of Life Scale to assess quality of life and anxiety and depression subscales of symptom checklist-revised were administered to assess caregivers' vulnerability towards psychopathology. RESULTS: There were 6 males and 54 females caregivers with mean age of 37.60 ±14.87 years. The burden of caregiving had negative relationship (-0.57; -0.50; -0.48; and -0.50, respectively) with physical, psychological, social, and environmental domains of quality of life. Neither caregiver burden nor quality of life predicted for anxiety and depression in the caregivers. CONCLUSION: Caregiver burden may impair quality of life of caregivers but results imply the need to identify the interpersonal and intrapersonal characteristics of caregivers that buffered the adverse effects of caregiver burden and impaired the quality of life on psychological wellbeing of the patients with AD.

Preliminary evaluation of culturally adapted CBT for psychosis (CA-CBTp): findings from developing culturally-sensitive CBT project (DCCP).

BACKGROUND: Cognitive Behaviour Therapy for Psychosis (CBTp) has a strong evidence base and is practised widely in the Western World. Psycho-social interventions, on the other hand, including Cognitive Behaviour Therapy (CBT) are hardly used in the low and middle income countries for psychosis. It has been suggested that adaptations in content, format and delivery are needed before CBT can be used outside the Western cultures. We describe preliminary evaluation of Culturally Adapted Cognitive Behaviour Therapy for Psychosis (CaCBTp) in in-patient settings in Lahore, Pakistan. AIMS: We aimed to evaluate the efficacy of culturally adapted CBT for psychosis (CaCBTp) in Pakistan in a pilot project. METHOD: In a randomized controlled trial we tested CaCBTp against treatment as usual (TAU) in in-patient settings in Pakistan. Those diagnosed with schizophrenia according to the DSM-IV-TR, and who fulfilled the inclusion criteria, were recruited into the study. Patients (n = 42) were randomized into two equal groups, i.e. CaCBTp and TAU. Assessments were carried out both at the baseline and then at the end of the therapy by raters blind to the groupings. Psychopathology was measured using PANSS (Positive and Negative Syndrome Scale of Schizophrenia), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. RESULTS: Patients receiving CaCBTp showed statistically significant improvement on measures of positive symptoms (p = .000), negative symptoms (p = .000), overall psychotic symptoms (p = .000), hallucinations (p = .000), delusions (p = .000) and insight (p = .000) at the end of the therapy. CONCLUSIONS: The CaCBTp was effective in reducing symptoms of psychosis and in improving insight in in-inpatient settings in Pakistan.

Religiosity and Subjective Well-Being amongst Institutionalized Elderly in Pakistan.

BACKGROUND: In Pakistan, the issue of institutionalized elderly is a neglected area and little is known about their subjective conditions. The present study was conducted in 2012 which examined the relationship between religiosity and subjective well being amongst institutionalized elderly people. METHODS: Data was collected from 100 adults above the age of 60 years in Lahore,Pakistan, through purposive sampling strategy. Religiosity was measured through Religiosity Index, while Trait Well Being Inventory was used to assess subjective well being. RESULTS: Pearson product moment correlation coefficient and regression analysis were used for the analysis of the data, which revealed that religiosity has a significant positive relationship with life satisfaction. However, no association was found between religiosity and mood level. Moreover, regression analysis indicated that religiosity positively predicted life satisfaction among elderly. CONCLUSION: The current research would create awareness and urge the policy makers to look into this social issue and provide better long term care to the residents of old homes.