Perceived Stress among Students in Medical/Dental and Allied Health Universities in Pakistan due to COVID-19 Pandemic

  Objective: Aim of the study was to explore the perceived stress in students at various medical and dental universities across Pakistan during the COVID 19 pandemic, using a validated scale.Materials and Methods: The study took place at the Institute of Psychiatry (IOP) Rawalpindi Medical University (RMU). Results: About 400 medical students participated countrywide. The final analysis was conducted on 333 participants who completed the survey form. Study participants comprised 69.1% female and 30.9% male students. About 74.5% of the participants represented Punjab province, 1.2% were from Sindh, another 1.2% belonged to Baluchistan, 2.4% were from KPK, and 1.5% were from AJK while 19.2% of them resided in Islamabad. The majority of participants were enrolled in MBBS (78.4%) while the rest were from BDS (3%), Allied Health Sciences (12.9%), Clinical Psychology (3.6%), and Pharm D (2.1%).The mean perceived stress score was 21.34, SD=4.90 suggesting high perceived stress levels. Approximately 4.5% of students perceived low levels of stress, 80.2% perceived moderate stress, whereas 15.3% scored high on the perceived stress scale. Male students had statistically significant (p=0.38) lower stress levels (M=19.99, SD=5.91) as compared to females (M= 21.95, SD= 4.26). Conclusions: Perceived stress level in medical students was alarmingly high and requires urgent intervention by the Medical and Dental Universities for immediate action and policy guidance for early identification and effective management. This can be achieved by delivering targeted e-workshops and evidence-based e-trainings for stress management like psychological first aid and mindfulness techniques

Improving psychosocial distress for young adolescents in rural schools of Pakistan: study protocol of a cluster randomised controlled trial.

Introduction Emotional problems are leading contributors to health burden among adolescents worldwide. There is an urgent need for evidence-based psychological interventions for young people. This study aims to evaluate the effectiveness of a school-based, group psychological intervention, Early Adolescent Skills for Emotions (EASE) developed by the WHO to improve psychosocial distress in Pakistani adolescents. Method and analysis A two-arm, single-blinded, cluster randomised controlled trial, with a wait-list control arm is being conducted in school settings of rural Pakistan. Forty eligible public-school clusters have been randomised (stratified by gender) on a 1:1 allocation ratio into intervention (n=20) and control arm (n=20). Following informed consent, 564 adolescents with psychosocial distress (Youth-reported Paediatric Symptoms Checklist, cut-off ≥28) from 40 schools have been enrolled into the trial (14±3 average cluster size) between 2 November 2021 and 30th November 2021. Participants in the intervention arm will receive EASE in 7-weekly adolescents and 3-biweekly caregivers group sessions in schools. The adolescent sessions involve the components of psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention. Caregivers will receive training to learn and implement active listening; spending quality time and using praise as a strategy to help their children. The primary outcome is reduction in psychosocial distress at 3 months postintervention. Secondary outcomes include symptoms of depression and anxiety, caregiver–adolescent relationship and caregivers’ well-being. Outcomes will be assessed at baseline, immediate 1 week and 3-months postintervention. Qualitative process evaluation will explore barriers and facilitators to programme implementation in low-resource school settings. Ethics Ethics approval has been obtained from Central Ethics Committee of University of Liverpool, UK, Ethics Review Committee of WHO Geneva and from the Institutional Review Board of Human Development Research Foundation (HDRF), Pakistan. Dissemination The findings of the study will be disseminated by WHO and through peer-reviewed publications

A randomised double-blind placebo-controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at risk Mental States: The NAYAB study.

BackgroundInflammatory mechanisms are thought to contribute to the onset of psychosis in persons with an at-risk mental state (ARMS). We investigated whether the anti-inflammatory properties of minocycline and omega-3 polyunsaturated fatty acids (omega-3), alone or synergistically, would prevent transition to psychosis in ARMS in a randomised, double-blind, placebo-controlled trial in Pakistan.Methods10,173 help-seeking individuals aged 16-35 years were screened using the Prodromal Questionaire-16. Individuals scoring 6 and over were interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to confirm ARMS. Participants (n = 326) were randomised to minocycline, omega-3, combined minocycline and omega-3 or to double placebo for 6 months. The primary outcome was transition to psychosis at 12 months.FindingsForty-five (13.8 %) participants transitioned to psychosis. The risk of transition was greater in those randomised to omega-3 alone or in combination with minocycline (17.3.%), compared to 10.4 % in those not exposed to omega-3; a risk-ratio (RR) of 1.67, 95 % CI [0.95, 2.92] p = 0.07. The RR for transitions on minocycline vs. no minocycline was 0.86, 95 % CI [0.50, 1.49] p > 0.10. In participants who did not become psychotic, CAARMS and depression symptom scores were reduced at six and twelve months (mean CAARMS difference = 1.43; 95 % CI [0.33, 1.76] p InterpretationIn keeping with other studies, omega-3 appears to have beneficial effects on ARMS and mood symptom severity but it increased transition to psychosis, which may reflect metabolic or developmental consequences of chronic poor nutrition in the population. Transition to psychosis was too rare to reveal a preventative effect of minocycline but minocycline did not improve symptom severity. ARMS symptom severity and transition to psychosis appear to have distinct pathogeneses which are differentially modulated by omega-3 supplementation.FundingThe study was funded by the Stanley Research Medical Institute

Youth Culturally adapted Manual Assisted Problem Solving Training (YCMAP) in Pakistani adolescent with a history of self-harm: protocol for multicentre clinical and cost-effectiveness randomised controlled trial

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

Assessment of parent/ caretaker satisfaction with child and adolescent mental health services in a tertiary care setting

BACKGROUND: Assessment of parent/caretaker satisfaction with child and adolescent mental health services in a tertiary care setting METHODS: In this descriptive cross sectional study, 130 parents/caretakers of children aged ≤ 16 years were administered Parent/Caretaker Satisfaction Questionnaire which is a 20-item, 4-point Likert type scale, after their second visit/consultation with Child Psychiatric OPD via non-probability consecutive sampling directly as well as telephonically during six months period. Demographic variables were collected via Proforma. The data was analyzed using SPSS v 16.0. p- value <0.05 was considered significant. RESULTS: 73.1% (n=95) were very satisfied (satisfaction level>60), 24.6 %(n=32) were satisfied (satisfaction between 21-60) and only 2.3%(n=3) were unsatisfied (satisfaction ≤20). No significant association was found between demographic variables and level of satisfaction. CONCLUSION: Our study revealed a high level of parent/caretaker satisfaction with Child and Adolescent mental health services in a tertiary care setting. No significant association was found between socio-demographic variables and parent/caretakers’ satisfaction. KEY WORDS: Patient satisfaction, Quality of health care, Child Psychiatry, Mental health service

Magnitude of Neurocognitive Impairment and Severity of Depression in Geriatric Population

Background and Objective: &nbsp;With the increasing life expectancy of the populations and rising prevalence of depressive and neurocognitive disorders, there is a need to address the association between the two in terms of magnitude of the neurocognitive disorders and the severity of depression. The current study addresses this issue and aims to observe the association between the two. Methods: &nbsp;This cross-sectional descriptive study was conducted from September 2014 to March 2015 at the Institute of Psychiatry at Benazir Bhutto Hospital, Rawalpindi, Pakistan where consecutive patients aged &ge; 65 years were screened for depression using Geriatric Depression Scale (GDS). Neurocognitive impairment was assessed using Mini Mental State Examination (MMSE). -square test was used to compute the association between depression severity and neurocognitive deficit. Results: &nbsp;There was approximately equal gender distribution with a mean age of 63.6 &plusmn; 9.68 years. Eighty six percent of the study population was found to be suffering from clinical depression while seventy percent had neurocognitive deficit. The severity of depression came out to be directly proportional to the magnitude of the neurocognitive disorder (P = 0.000) with 68.8% of the patients with severe depression having moderate to severe neurocognitive deficit. Conclusions: &nbsp;Depression is associated with significant neurocognitive impairment in elderly in the local population; higher the severity of depression more the magnitude of cognitive impairment.</p

Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT)

Background: Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization’s Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. Methods: A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. Results: The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. Conclusions: The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents