Amna Khalid

The association of marital relationship and perceived social support with mental health of women in Pakistan

BackgroundMarital circumstances have been indicated to be a salient risk factor for disproportionately high prevalence of depression and anxiety among Pakistani women. Although social support is a known buffer of psychological distress, there is no clear evidence as to how different aspects of marital relations interact and associate with depression and anxiety in the lives of Pakistani married women and the role of social supports in the context of their marriage.MethodsTwo hundred seventy seven married women were recruited from Rawalpindi district of Pakistan using a door knocking approach to psychometrically evaluate five scales for use in the Pakistani context. A confirmatory factor analysis approach was used to investigate the underlying factor structure of Couple satisfaction Index (CSI-4), Locke-Wallace Marital Adjustment Test (LWMAT), Relationship Dynamic Scale (RDS), Multidimensional Scale for Perceived Social Support (MSPSS) and the Hospital Anxiety and Depression Scale (HADS). The interplay of the constructs underlying the three aspects of marital relations, and the role of social support on the mental health of married Pakistani women were examined using the Structural Equation Model.ResultsThe factor structures of MSPSS, CSI-4, LWMAT, RDS and HADS were similar to the findings reported in the developed and developing countries. Perceived higher social support reduces the likelihood of depression and anxiety by enhancing positive relationship as reflected by a low score on the relationship dynamics scale which decreases CMD symptoms. Moreover, perceived higher social support is positively associated with marital adjustment directly and indirectly through relationship dynamics which is associated with the reduced risk of depression through the increased level of reported marital satisfaction. Nuclear family structure, low level of education and higher socio-economic status were significantly associated with increased risk of mental illness among married women.ConclusionFindings of this study support the importance of considering elements of marital relationship: satisfaction, adjustment and negative interactions which can be prioritized to increase the efficiency of marital interventions. It also highlights the role of social support in the context of marital relationships among Pakistani women. Furthermore, the study presents the etiological models of depression and anxiety with reference to the above.

A pilot study examining the awareness, attitude, and burden of informal caregivers of patients with dementia.

Pakistan is 1 of 5 countries with the highest projected increase in prevalence of dementia in the Asia Pacific region (Access Economic, 2006), where there is a lack of structured support network for caregivers in general and for dementia caregivers in specific. The caregivers and other related individuals predominantly rely on traditional familial support for caregiving. This approach places immense burdens on the familial caregivers (Shaji, 2009). In Pakistan, there is paucity of research evidence on care of patients with dementia and the needs of caregivers dealing with such patients. This study explores awareness among caregivers, their attitudes toward family members suffering from dementia, and their experience of burden. In-depth interviews were conducted with 12 caregivers of patients diagnosed with dementia in Rawalpindi/Islamabad, Pakistan. There was a considerable lack of awareness about dementia as an illness among the caregivers. They reported a conflict between emotional and religious commitments to nurture older adult relatives and their experience of psychological, physical, and economic burden, resulting in occasional episodes of carelessness and violence toward them. The study indicated that women, particularly those who were employed outside of the home, reported higher levels of stress. It is suggested that support from extended family in all forms was perceived as a concrete form of stress relief by the primary caregiver. The findings of this study indicate that the social and financial burden of dementia on families of caregivers in Pakistan may be exacerbated if they do not have support. This indicates a need for multipronged intervention from both government and nongovernment organizations, as well as the community, to develop programs for caregivers that are nested within the cultural context of filial piety in Pakistan. These strategies should also be gender sensitive, giving priority to more at-risk groups.

Social Support, Marital Adjustment, and Psychological Distress Among Women With Primary Infertility in Pakistan

This study aimed to identify prevalence rates of psychological distress among Pakistani women seeking help for primary infertility. The associations of social support, marital adjustment, and sociodemographic factors with psychological distress were also examined. A total of 177 women with primary infertility were interviewed from one hospital in Islamabad using a Self-Reporting Questionnaire, the Multidimensional Scale of Perceived Social Support, and the Locke-Wallace Marital Adjustment Test. The data were collected between November 2012 and March 2013. The prevalence of psychological distress was 37.3 percent. The results of the logistic regression suggested that marital adjustment and social support were significantly negatively associated with psychological distress in this sample. These associations were not confounded by any of the demographic variables controlled in the multivariable regression models. The role of perceived social support and adjustment in marriage among women experiencing primary infertility are important factors in understanding their psychological distress. The results of this small-scale effort highlight the need for social and familial awareness to help tackle the psychological distress related to infertility. Future research needs to focus on the way the experience of infertility is conditioned by social structural realities. New ways need to be developed to better take into account the process and nature of the infertility experience.

A pilot study of depression among older people in Rawalpindi, Pakistan

BackgroundDepression is common among elderly in developed countries and it is more pronounced in institutional settings. In Pakistan there is a lack of empirical data on depression among this segment of the population particularly with reference to their living arrangements.The objectives of the present study are to report the magnitude of depression among elderly having two different residential arrangements and to examine the association of depression and its established demographic factors.FindingsData were collected from 141 respondents. 108 were community residents (m = 57 and f = 51) and 33 were living in the care homes (m = 29 and f = 4).Prevalence of depression as assessed by Geriatric Depression Scale (GDS) among community and Care Homes (CHs) participants was 31.5 percent and 60.6 percent, respectively.On Centre of Epidemiological Studies Depression Scale (CES-D), 42.6 percent of the community and 69.7 percent of the CH respondents were deemed depressed. Before adjusting for any other potential risk factors the odds of being depressed was significantly increased if the study participants were living in CH, relatively older, female, not currently married, had low educational level, had lower Mini Mental State Examination (MMSE) scores, and reported lower perceived emotional and practical support. In a partially adjusted logistic regression model an increased risk of depression was not confounded by any of the above mentioned risk factors.However, the risk associated was not significant when it was adjusted for social support.ConclusionsThe findings of the current study are consistent with previous research and throws light on the dire need for interventions to address mental health needs of Pakistani elderly.Implications for improving the mental health status of elderly are also presented.

Parental bonding and adolescents’ depressive and anxious symptoms in Pakistan

INTRODUCTION A quantitative cross sectional study was carried out to investigate the role of parental bonding in relation to depressive and anxious symptoms among secondary school adolescents in Pakistan. The study also aimed to investigate the construct validity of the parental bonding inventory in the cultural context of Pakistan. METHODS The sample consisted of 1124 adolescents recruited from eight secondary schools in Rawalpindi, Pakistan. Urdu translated versions of Parental Bonding Instrument (Qadir et al., 2005) and Hospital Anxiety and Depression Scales (Mumford et al., 1991) were administered in classroom settings. Confirmatory factor analysis (CFA) and Structural Equation Modeling (SEM) were used to analyze the data. RESULTS Results from the CFA of the Urdu version of the Parental Bonding Instrument supported a modified version of the three factor model proposed by Kendler (1996) consisting of warmth, protectiveness and authoritarianism. Based on SEM, we found a significant relationship between low parental warmth and depression symptoms among adolescents, whereas maternal protectiveness was a significant predictor for anxiety. Parental authoritarianism was not a significant predictor for depression or anxiety. DISCUSSION Findings of this study indicate that parental bonding is a central construct within a developmental framework in the cultural context of Pakistan, and is important when considering long-term psychosocial functioning of individuals. It should be explored further in clinical populations of Pakistani adolescents to ascertain significance of these constructs for interventions.

Factor Structure of the Urdu Version of the Spence Children's Anxiety Scale in Pakistan

ABSTRACT Spence Childrens Anxiety Scale (SCAS) is one of the most commonly used self-report questionnaires to measure symptoms of anxiety disorders in adolescents. Despite its common use, studies that examine the psychometric properties of SCAS in Pakistan is lacking. Therefore, the purpose of this study was to examine the psychometric properties of the Urdu translated version of the SCAS among adolescents in Pakistan. A total of 1277 students (708 boys and 569 girls), aged 13 to17 years, who had been recruited from 13 schools in Rawalpindi, Pakistan participated in the study. The mean overall anxiety score was significantly higher in girls than males on all the SCAS subscales except for obsessive compulsive disorder. The internal consistency of the Urdu SCAS was good. Confirmatory factor analyses supported six separate factor structures. Results of the study are discussed with reference to the sociocultural milieu of Pakistan and culture sensitive conceptualization of anxiety and its subtypes.