GENDER RESEARCH IN PAKISTAN: A SCOPING REVIEW

Researchers focusing on gender issues usually concentrate on how people perceive and interpret gender, understand or construct sex and gender etc. Much needs to be explored and understood in relation to research and concepts of gender studies. The present study “Gender Research in Pakistan: A Scoping Review” was carried out with the purpose of mapping literature on gender research in Pakistan, further exploring how gender concepts like social construction of roles, power relationships, division of labor/resources are understood and constructed by researchers in social science research. Also the review intended to provide grounds for critiquing how researchers problematize and integrate gender concepts in their phenomenon of interest and while doing so what research methods are applied by them. The paper will share the importance of gender sensitive research and the results of the scoping review carried out. It shall also attempt to document methodological gaps in the retrieved literature, concluding with some recommendations for way forward

GENDER RESEARCH IN PAKISTAN: A SCOPING REVIEW

Researchers focusing on gender issues usually concentrate on how people perceive and interpret gender, understand or construct sex and gender etc. Much needs to be explored and understood in relation to research and concepts of gender studies. The present study “Gender Research in Pakistan: A Scoping Review” was carried out with the purpose of mapping literature on gender research in Pakistan, further exploring how gender concepts like social construction of roles, power relationships, division of labor/resources are understood and constructed by researchers in social science research. Also the review intended to provide grounds for critiquing how researchers problematize and integrate gender concepts in their phenomenon of interest and while doing so what research methods are applied by them. The paper will share the importance of gender sensitive research and the results of the scoping review carried out. It shall also attempt to document methodological gaps in the retrieved literature, concluding with some recommendations for way forward

Intimate partner violence in urban Pakistan: prevalence, frequency, and risk factors

Tazeen S Ali1,2, Nargis Asad3, Ingrid Mogren4, Gunilla Krantz51School of Nursing, Aga Khan University, Karachi, Pakistan; 2Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, Stockholm, Sweden; 3Department of Psychiatry, Aga Khan University, Karachi, Pakistan; 4Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå, Sweden; 5Department of Public Health and Community Medicine/Social Medicine, The Sahlgrenska Academy at University of Gothenburg, Göteborg, SwedenBackground: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors.Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25–60 years.Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 and 57.6%, respectively; the corresponding figures for sexual violence were 53.4% and 54.5%, and for psychological abuse were 81.8% and 83.6%. Violent incidents were mostly reported to have occurred on more than three occasions during the lifetime. Risk factors for physical violence related mainly to the husband, his low educational attainment, unskilled worker status, and five or more family members living in one household. For sexual violence, the risk factors were the respondent’s low educational attainment, low socioeconomic status of the family, and five or more family members in one household. For psychological violence, the risk factors were the husband being an unskilled worker and low socioeconomic status of the family.Conclusion: Repeated violence perpetrated by a husband towards his wife is an extremely common phenomenon in Karachi, Pakistan. Indifference to this type of violence against women stems from the attitude that IPV is a private matter, usually considered a justifiable response to misbehavior on the part of the wife. These findings point to serious violations of women’s rights and require the immediate attention of health professionals and policymakers.Keywords: intimate partner violence, domestic violence, Pakistan, gender inequality, prevalence, frequency, risk factor

Applying community participatory methods to meet women\u27s mental health needs in Karachi, Pakistan

Poor mental health is a global epidemic with women affected more often compared to men. Compromised mental health jeopardizes women\u27s health and functioning and also the health and wellbeing of their children. To promote women\u27s mental health, principles of community participatory methods were used to design and implement a mental health program, which was predicated on empirical research, sensitive to community culture and needs, and delivered by Lady Health Workers in an urban slum area of Karachi, Pakistan. The sequential steps of community participation, program development, implementation and strategies for sustainability are described

Psychological distress and its associated factors among informal care givers of disabled young adults with traumatic brain injuries

Objective: To measure the psychological distress among the informal caregivers of disabled young adults with traumatic brain injuries (TBI) and to identify its associated factors.Methods: An analytical cross sectional study was conducted with 76 informal caregivers of young adults (19 - 50 years) with TBI, using admission records of one of the tertiary care hospitals in Karachi, Pakistan from 2015 to 2016. Data were collected using a structured questionnaire comprising a general demographic questionnaire and the General Health Questionnaire- 28. The effect of the predictors on the psychological distress was determined by applying multiple linear regression analysis.Results: The mean score of the psychological distress was found to be 23.5±14.28. The findings indicated that anxiety and insomnia, and social dysfunction were the most affected domains of psychological distress; whereas, depression was the least affected. Factors including the management of finances, number of children, patient\u27s gender, and patient\u27s level of disability and lack of socialization were positively associated with the level of distress. As reported by participants, religious beliefs served as a coping mechanism for most of them.Conclusions: The study showed a high level of distress among informal caregivers of young adults with TBI. For recognizing the psychological effects of TBI in patients and their informal caregivers, it is important to initiate and ensure the provision of psychological support to the patients and their families

Integration of mental health into primary healthcare: Perceptions of stakeholders in Pakistan

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC).Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan.Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out.Results: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services.Conclusions: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan

Post-traumatic stress disorder and its predictors in emergency medical service personnel: A cross-sectional study from Karachi, Pakistan

Background: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.Methods: Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were assessed. Linear regression was used on the IES-R to identify predictors of post-traumatic stress symptoms.Results: The mean score of the IES-R was 23.9 ± 12.1. EMS personnel with a dysfunctional coping style (β = 0.67 CI 0.39 – 0.95), anxiety, and depression (β = 0.64 CI 0.52 – 0.75) were more likely to have increased severity of post-traumatic stress symptoms. Age was found to have an inverse relationship with stress symptoms (β = −0.17 CI 0.33 – -0.023), indicating the susceptibility of younger EMS personnel to stress.Conclusion: The EMS personnel in this setting were found to have a moderate level of post-traumatic stress symptoms. The significant predictors of post-traumatic stress symptoms in this EMS population were age, coping style, and levels of anxiety and depression. These predicting factors can be a potential avenue for interventions to improve the mental health of these frontline workers

Psychosocial factors of deliberate self-harm in Afghanistan: A hospital based, matched case-control study

Background: Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide.Aims: We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan.Methods: A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics of the participants, history of domestic violence, drug abuse and details about the act of deliberate self-harm, including the methods used. To assess depression and anxiety, we used the WHO self-reporting questionnaire (SRQ-20). Matched odds ratios with 95% confidence interval using conditional logistic regression were used to determine statistically significant associations between psychosocial factors and deliberate self-harm.Results: Family conflicts, domestic violence, interpersonal arguments and living in extended families were found to be significantly associated with deliberate self-harm.Conclusions: In Afghanistan, deliberate self-harm appears to be predominately related to interpersonal problems and family conflicts. About two-thirds of females and more than half of males scored positive for depression, yet none were receiving treatment for this. These findings have important policy implications for mental health and suicide prevention programmes in the country

Association of depression and life satisfaction with low resilience among married women of Karachi, Pakistan

Background: The concept of resilience is very crucial in promoting positive psychological well-being. However, this construct was never looked among married women of Karachi, Pakistan. Therefore, this study aimed to assess the prevalence and the associated risk factors of resilience in Pakistan. Methods: It was a cross-sectional survey, using the Wagnild Resilience Scale (RS) to assess resilience, Beck Depression Inventory II (BDI-II) for measuring depression and Trait Wellbeing Inventory for determining Life Satisfaction. Systematic sampling was employed to enroll 636 participants of aged 20 to 40 years living in two urban squatter settlements of Karachi, Pakistan. Prevalence ratio was computed with their 95% confidence interval. Results: A total of 636 married women participated in the study. The average age of females with low resilience was 29.8 (5.7) whereas the mean age of females with high resilience was 31.1 (5.7). Around 90% of all the participants could speak in Urdu. The prevalence of low resilience among women was 21.9%. Moreover, the prevalence of depression among low resilience group was 43.9% whereas the mean life satisfaction score among females with low resilience was lower than females with high resilience. The females who had low resilience were younger and had no formal/informal education as compared to their counterparts. After controlling for other variables, the prevalence of low resilience was 1.78 times more among depressed females as compared to the non-depressed with a 95% CI: (1.27-2.51). Moreover with every one unit increase in the life satisfaction scores, the prevalence of low resilience decreased 9%. Furthermore, age and informal schooling were also found to be significantly associated with resilience. Conclusion: Depression and life satisfaction are the potential modifiable risk factors for resilience and hence we can improve resilience through interventions that may focus on reducing depression and improving satisfaction towards life. Our study also recommends that health care professionals should be educated about these modifiable risk factors to bring about a change in the society and reduce the mental health illness by promoting constructive adaptation

Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan

Background: In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors.Methods: An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients.Results: Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; - 2.757, - 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value\u3c 0.001); however, QoL for the social domain was not significantly different in both the groups. On multivariable linear regression resilience and depression among males had a significant association with QoL, after adjusting for the covariates educational status, monthly income, and number of friends. Similar association was observed among females after adjusting for the covariate monthly income only.Conclusion: Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems