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BACKGROUND: Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. METHODS: This was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016). RESULTS: We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (- 3.6 (- 4.9, - 2.4)), depression (- 7.1 (- 8.7, - 5.4)), hopelessness (- 2.6 (- 3.4, - 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention. CONCLUSIONS: Suicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration.
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Terapia Cognitivo-Comportamental , Comportamento Autodestrutivo , Suicídio , Humanos , Adulto , Qualidade de Vida , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Ideação SuicidaRESUMO
BACKGROUND: Eating disorders (EDs) are serious mental health conditions that affect a person physically and psychologically. In the past, EDs were only recognized as a cultural phenomenon/societal by-product of the West. However, research evidence marks its presence in non-western countries also, including South Asia. This study aims to evaluate the feasibility and acceptability of a manualized psychological intervention called Getting Better Bite by Bite (GBBB) in individuals who screened positive on measures of EDs in Pakistan. METHODS: The proposed study is a feasibility randomized controlled trial (fRCT). The study will be conducted at five sites across Pakistan: Karachi, Hyderabad, Lahore, Rawalpindi, and Multan to recruit a total of 80 participants. Eligible participants will be randomized to either (1) the intervention group; in which they will receive one-to-one sessions of GBBB along with routine care or (2) the routine care group; in which they will only have access to the routine care. We have received ethics approval by the National Bioethics Committee. The study is registered at clinicaltrials.gov (NCT05724394). The study team has received permission from recruitment centers: hospitals (i.e. the psychiatry department of public and private hospitals based in these cities), fitness centers (i.e., gyms), educational institutes (i.e., colleges and universities), and community settings (i.e. community health clinics). Self-referrals from General Practitioners and community settings will be accepted. The intervention manual has been translated into Urdu and a multidisciplinary team including service users has culturally adapted the content of intervention for local context. DISCUSSION: This study will provide evidence on feasibility and acceptability of a culturally adapted intervention for individuals who screen positive on measures of EDs. The findings of this study will inform a fully powered Randomized Controlled Trial of the proposed intervention. TRIAL REGISTRATION: The study is registered on clinicaltrials.gov (NCT05724394). Protocol version (1.0. 1st June 2022).
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BACKGROUND: Covid 19 was declared as a public health emergency by the World Health Organisation (WHO) due to its rapid spread and catastrophic effects on health. It affected around 119 M people with mortality rate of 0.27% worldwide, including South-Asians. This review aims to understand the risk perceptions, cultural religious beliefs and the coping mechanisms of South Asians during the Covid 19 pandemic. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search engines were used: Medline, Cochrane Library, PsycINFO, CINAHL, and Web of Science. Included studies investigated perceptions and opinions of individuals on knowledge, risk and protective factors, native faith based practices, and attitudes towards the COVID-19 pandemic. RESULTS: The database search produced 282 articles to screen. The final narrative synthesis included five studies comprising of 13,476 participants from Pakistan, India, Nepal, and Bangladesh. Ten studies, comprising 7,893 participants, were eligible and included for meta-analysis. The overall pooled prevalence with maximum heterogeneity for correct knowledge of symptoms, hand washing or use of sanitizers, face masking use of herbal or traditional remedies and physical distancing or avoidance of contact was reported through meta-analysis. CONCLUSION: The review brings forth a useful comparison of individual and cultural differences in KAP, risk perceptions and coping strategies. This review highlights the need for and importance of tailored information dissemination, culturally sensitive risk communication, targeted educational interventions, community engagement and empowerment, policy, and infrastructure improvements, as well as continued research and data collection. By addressing these implications, efforts to mitigate the impact of COVID-19 can be more effective and equitable across diverse populations. PROSPERO REGISTRATION: CRD42021246475.
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Adaptação Psicológica , COVID-19 , Humanos , COVID-19/psicologia , COVID-19/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , SARS-CoV-2 , ReligiãoRESUMO
BACKGROUND: Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries. AIMS: To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan. METHOD: This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed. RESULTS: Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals. CONCLUSIONS: Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.
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Public feelings and reactions associated with finance are gaining significant importance as they help individuals, public health, financial and non-financial institutions, and the government understand mental health, the impact of policies, and counter-response. Every individual sentiment linked with a financial text can be categorized, whether it is a headline or the detailed content published in a newspaper. The Guardian newspaper is considered one of the most famous and the biggest websites for digital media on the internet. Moreover, it can be one of the vital platforms for tracking the public's mental health and feelings via sentimental analysis of news headlines and detailed content related to finance. One of the key purposes of this study is the public's mental health tracking via the sentimental analysis of financial text news primarily published on digital media to identify the overall mental health of the public and the impact of national or international financial policies. A dataset was collected using The Guardian application programming interface and processed using the support vector machine, AdaBoost, and single layer convolutional neural network. Among all identified techniques, the single layer convolutional neural network with a classification accuracy of 0.939 is considered the best during the training and testing phases as it produced efficient performance and effective results compared to other techniques, such as support vector machine and AdaBoost with associated classification accuracies 0.677 and 0.761, respectively. The findings of this research would also benefit public health, as well as financial and non-financial institutions.
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Internet , Saúde Mental , Humanos , Aprendizado de Máquina , Redes Neurais de Computação , Máquina de Vetores de SuporteRESUMO
INTRODUCTION: Suicide is a global health concern. Sociocultural factors have an impact on self-harm and suicide rates. In Pakistan, both self-harm and suicide are considered as criminal offence's and are condemned on both religious and social grounds. The proposed intervention 'Youth Culturally Adapted Manual Assisted Problem Solving Training (YCMAP)' is based on principles of problem-solving and cognitive-behavioural therapy. YCMAP is a brief, culturally relevant, scalable intervention that can be implemented in routine clinical practice if found to be effective. METHOD AND ANALYSIS: A multicentre rater blind randomised controlled trial to evaluate the clinical and cost-effectiveness of YCMAP including a sample of 652 participants, aged 12-18 years, presenting to general physicians/clinicians, emergency room after self harm or self referrals. We will test the effectiveness of 8-10 individual sessions of YCMAP delivered over 3 months compared with treatment as usual. Primary outcome measure is repetition of self-harm at 12 months. The seconday outcomes include reduction in suicidal ideation, hopelessness and distress and improvement in health related quality of life. Assessments will be completed at baseline, 3, 6, 9 and 12 months postrandomisation. The nested qualitative component will explore perceptions about management of self-harm and suicide prevention among adolescents and investigate participants' experiences with YCMAP. The study will be guided by the theory of change approach to ensure that the whole trial is centred around needs of the end beneficiaries as key stakeholders in the process. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Ethics Committee of University of Manchester, the National Bioethics Committee in Pakistan. The findings of this study will be disseminated through community workshops, social media, conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04131179.
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Qualidade de Vida , Comportamento Autodestrutivo , Adolescente , Análise Custo-Benefício , Humanos , Estudos Multicêntricos como Assunto , Paquistão , Resolução de Problemas , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Autodestrutivo/prevenção & controleRESUMO
BACKGROUND: Associations between childhood trauma, personality, and Major Depressive Disorder (MDD) have been well established in studies conducted in high-income countries. However, there are limited studies on these associations in low and middle-income countries (LMICs), where MDD is highly prevalent. We assessed the relationships between childhood trauma, personality, and MDD in women in Karachi, Pakistan. METHOD: In this cross-sectional study of 455 female patients attending general medical outpatient clinics, a diagnosis of MDD was confirmed using the Structured Clinical Interview for DSM-IV (SCID); retrospective reports of childhood trauma were collected using the childhood trauma questionnaire (CTQ); and Big Five personality traits were assessed using the NEO Personality Inventory Revised (NEO PI-R). Other measures included the Life Events Questionnaire (LEQ) and the Multidimensional Scale of Perceived Social Support (MSPSS). Factors independently associated with MDD were determined using logistic regression analyses. RESULTS: Of the 455 women recruited between August 1, 2011 and July 31, 2013, 242 (53%) had a diagnosis of MDD. Women with MDD were significantly more likely to be separated, had more stressful life events and higher CTQ scores. Higher perceived social support, conscientiousness and extraversion were independently associated with significantly reduced odds of MDD. There were no significant associations between CTQ scores and any of the NEO PI-R subscales. LIMITATIONS: Ratings of childhood trauma were based on retrospective recall. CONCLUSION: MDD and a history of childhood trauma were highly prevalent in Pakistani women attending general medical clinics. Interventions to prevent childhood trauma and promote social support in women may improve public mental health in LMICs like Pakistan.
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Transtorno Depressivo Maior , Países em Desenvolvimento , Instituições de Assistência Ambulatorial , Estudos Transversais , Depressão , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Paquistão , Personalidade , Estudos Retrospectivos , Apoio SocialRESUMO
Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of Science and ProQuest) was undertaken to identify studies measuring shame, guilt and self-harm (including suicidal and non-suicidal behaviour). Meta-analysis was undertaken where papers focused on the same subtype of shame or guilt and shared a common outcome. Thirty studies were identified for inclusion. Most forms of shame were associated with non-suicidal self-injury (NSSI), but research was sparse concerning suicidal behaviour. Fewer studies examined guilt and findings were more varied. Methodological issues included a paucity of longitudinal designs and lack of justification for sample sizes. Results of this review support the link between shame and self-harm, particularly NSSI. The direction of this relationship is yet to be established. Clinically, consideration should be given to the role of shame amongst individuals who present with NSSI. This review was pre-registered on PROSPERO (CRD42017056165).