Psychosocial predictors of health-related quality of life of South Asians with acute coronary syndrome

Introduction: South-Asians are the largest ethnic minority group in the UK. Depression and coronary heart disease (CHD) are common in this group. The importance of depression in South Asians has not attracted significant research interest, to date; yet there is evidence that it is associated with the development of CHD, and when it develops after CHD leads to poor prognosis. Objective: This study aims to investigate the effects of depression on quality of life of the South Asians under secondary care, by reviewing previous literature and performing a prospective research. The hypothesis was that, after controlling for demographic, psychological and medical variables depression would be associated with impaired HRQoL in South Asians 6 months after acute coronary syndrome (ACS). Methods: Demographic, psychological and medical data were collected. Participants completed the Hospital Anxiety and Depression Scale (HADS), Short-Form 36 (SF-36) and ENRICHD Social Support Instrument (ESSI) in the first phase. In the 2nd phase the Structured Clinical Interview for DSM-IV (SCID) was performed to validate the HADS. The PCS (SF-36) and HADS were completed at follow up. Results: Of the 250 enrolled patients 202 completed follow up. A HADS score of ≥ 17 was identified as the best cut off point. The prevalence of depression was 30%. Baseline depression, lack of education and retirement were predictors of poor QoL (p<0.05). Moreover, diabetes mellitus, respiratory and haematological disorders were associated (p< 0.05) with QoL; however after adjustment depression was the only significant predictor of poor HRQoL. Conclusions: This study suggests that depression is common in South Asians following ACS and it is associated with poor HRQoL. Further developments in the liaison psychiatry and increasing mental health knowledge of the cardiologists may help the earlier identification and subsequent treatment of depression to improve the prognosis of CHD patients.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study.

BACKGROUND: Perinatal depression is a public health problem in low and middle income countries. Although effective psychosocial interventions exist, a major limitation to their scale up is the scarcity of mental health professionals. The aim of this study was to explore the facilitators and barriers to the acceptability of peer volunteers (PVs)-volunteer lay women from the community with shared socio-demographic and life experiences with the target population-as delivery agents of a psychosocial intervention for perinatal depression in a rural area of Pakistan. METHODS: This qualitative study was embedded in the pilot phase of a larger peer-delivered mental health programme. Forty nine participants were included: depressed mothers (n = 21), PVs (n = 8), primary health care staff (n = 5), husbands (n = 5) and mothers-in-law (n = 10). Data were collected through in-depth interviews and focus groups and analysed using the Framework Analysis approach. RESULTS: The PVs were accepted as delivery agents by all key stakeholders. Facilitators included the PVs' personal attributes such as being local, trustworthy, empathetic, and having similar experiences of motherhood. The perceived usefulness and cultural appropriateness of the intervention and linkages with the primary health care (PHC) system was vital to their legitimacy and credibility. The PVs' motivation was important, and factors influencing this were: appropriate selection; effective training and supervision; community endorsement of their role, and appropriate incentivisation. Barriers included women's lack of autonomy, certain cultural beliefs, stigma associated with depression, lack of some mothers' engagement and resistance from some families. CONCLUSION: PVs are a potential human resource for the delivery of a psychosocial intervention for perinatal depression in this rural area of Pakistan. The use of such delivery agents could be considered for other under-resourced settings globally

Prevention of: self harm in British South Asian women: study protocol of an exploratory RCT of culturally adapted manual assisted Problem Solving Training (C- MAP)

<p>Abstract</p> <p>Background</p> <p>Suicide is a major public health problem worldwide. In the UK suicide is the second most common cause of death in people aged 15-24 years. Self harm is one of the commonest reasons for medical admission in the UK. In the year following a suicide attempt the risk of a repeat attempt or death by suicide may be up to 100 times greater than in people who have never attempted suicide.</p> <p>Research evidence shows increased risk of suicide and attempted suicide among British South Asian women. There are concerns about the current service provision and its appropriateness for this community due to the low numbers that get involved with the services. Both problem solving and interpersonal forms of psychotherapy are beneficial in the treatment of patients who self harm and could potentially be helpful in this ethnic group.</p> <p>The paper describes the trial protocol of adapting and evaluating a culturally appropriate psychological treatment for the adult British South Asian women who self harm.</p> <p>Methods</p> <p>We plan to test a culturally adapted Problem Solving Therapy (C- MAP) in British South Asian women who self harm. Eight sessions of problem solving each lasting approximately 50 minutes will be delivered over 3 months. The intervention will be assessed using a prospective rater blind randomized controlled design comparing with treatment as usual (TAU). Outcome assessments will be carried out at 3 and 6 months. A sub group of the participants will be invited for qualitative interviews.</p> <p>Discussion</p> <p>This study will test the feasibility and acceptability of the C- MAP in British South Asian women. We will be informed on whether a culturally adapted brief psychological intervention compared with treatment as usual for self-harm results in decreased hopelessness and suicidal ideation. This will also enable us to collect necessary information on recruitment, effect size, the optimal delivery method and acceptability of the intervention in preparation for a definitive RCT using repetition of self harm and cost effectiveness as primary outcome measures.</p> <p>Trial Registration</p> <p>Current Controlled Trials 08/H1013/6</p

Is equipoise a useful concept to justify randomised controlled trials in the cultural context of Pakistan? A survey of clinicians in relation to a trial of talking therapy for young people who self-harm

Background: Clinical equipoise, also defined as the uncertainty principle, is considered essential when recruiting subjects to a clinical trial. However, equipoise is threatened when clinicians are influenced by their own preferences. Little research has investigated equipoise in the context of trial recruitment. Methods: This cross-sectional survey sought clinicians’ views (operationalised as 11 statements relating to treatments offered in a trial of a psychological intervention for young people) about equipoise and individual treatment preferences in the context of moral justification for recruiting young people at risk of self-harm or suicide to a randomised controlled trial (RCT) to evaluate the Youth Culturally Adapted Manual Assisted Psychological Intervention (Y-CMAP) in Pakistan. We compared the views of clinicians involved in Y-CMAP RCT recruitment to those of a sample of clinicians not involved in trial recruitment but treating similar patients, comparing their sociodemographic characteristics and the proportions of those in each group agreeing with each statement. Results: There was a response rate of 96% (75/78). Findings showed that, during trial recruitment and before the RCT results were known, the majority of all responding clinicians (73.3%) considered Y-CMAP to be an effective treatment for young people at risk of self-harm or suicide. Although there was an acknowledgement of individual preferences for the intervention, there was near consensus (90%) on the need to conduct an RCT for reaching an evidence-based decision. However, there were no significant differences in the proportion of recruiting clinicians reporting a treatment preference for Y-CMAP than non-recruiting clinicians (31 (88.6%) versus 36 (90%), p = 0.566). A significantly higher proportion of non-recruiting clinicians (87.5%) as compared to (48.5%) in the trial (p = 0.000) stated that there may be other treatments that may be equally good for the patients, seemingly undermining a preference for the intervention. Those reporting a treatment preference also acknowledged that there was nothing on which this preference was based, however confident they felt about them, thus accepting clinical equipoise as ethical justification for conducting the RCT. There was a significant group difference in views that treatment overall is better as a result of young patients’ participation in the Y-CMAP trial (p = 0.015) (i.e. more clinicians not involved in the trial agreed with this statement). Similarly, more clinicians not involved in the trial agreed on the perceived availability of other treatment options that were good for young people at risk of self-harm (p < 0.05). Conclusions: The paper highlights that clinicians in Pakistan accept the notion of clinical equipoise as an ethical justification for patient participation in RCTs. The need for conducting RCTs to generate evidence base and to reduce bias was considered important by the clinical community

Psychological distress among patients of an orthopaedic outpatient clinic: a study from a low-income country

<p>Abstract</p> <p>Background</p> <p>Depression is common among general trauma patients and is associated with a poor outcome. We evaluated the relationship of psychological distress to physical injury, musculoskeletal complaints, and social factors in a low-income country.</p> <p>Methods</p> <p>We administered the Self-Rating Questionnaire (SRQ), the Oslo social support questionnaire, and the Brief Disability Questionnaire (BDQ).</p> <p>Results</p> <p>An SRQ score of 9 or more, which indicates probable depressive disorder, occurred in 45.6% of men and 76.1% of women. A high SRQ score was associated with female sex, little or no education, low income and little social support. Even after these were controlled for there was a significantly higher SRQ score in patients with arthritis, backache/prolapsed disc, major fracture and other bone pathology.</p> <p>Conclusions</p> <p>Depressive disorder appears to be very common in orthopaedic outpatients in Pakistan; both social circumstances and nature of bone pathology are associated with such depression.</p

mHealth based interventions for the assessment and treatment of psychotic disorders: a systematic review

The relative burden of mental health disorders is increasing globally, in terms of prevalence and disability. There is limited data available to guide treatment choices for clinicians in low resourced settings, with mHealth technologies being a potentially beneficial avenue to bridging the large mental health treatment gap globally. The aim of the review was to search the literature systematically for studies of mHealth interventions for psychosis globally, and to examine whether mHealth for psychosis has been investigated. A systematic literature search was completed in Embase, Medline, PsychINFO and Evidence Based Medicine Reviews databases from inception to May 2016. Only studies with a randomised controlled trial design that investigated an mHealth intervention for psychosis were included. A total of 5690 records were identified with 7 studies meeting the inclusion criteria. The majority of included studies, were conducted across Europe and the United Sates with one being conducted in China. The 7 included studies examined different parameters, such as Experiential Sampling Methodology (ESM), medication adherence, cognitive impairment, social functioning and suicidal ideation in veterans with schizophrenia. Considering the increasing access to mobile devices globally, mHealth may potentially increase access to appropriate mental health care. The results of this review show promise in bridging the global mental health treatment gap, by enabling individuals to receive treatment via their mobile phones, particularly for those individuals who live in remote or rural areas, areas of high deprivation and for those from low resourced settings