Muhammad Riaz Bhatti

The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression Scale

The translation of the Hospital Anxiety and Depression Scale (HADS) into Urdu was undertaken by the authors in committee. After examining initial drafts by 6 independent translators, an agreed Urdu text was given to 6 back‐translators, and subsequently modified further. The evaluation of the new translation was performed in 3 stages: evaluation of linguistic equivalence of items in a bilingual population; evaluation of conceptual equivalence by examining item‐subscale correlations; and evaluation of scale equivalence by 2‐way classification of high and low scorers. Satisfactory results at each stage suggest that the Urdu version is a reliable and valid translation of the HADS for use in Pakistan.

A survey of Autism knowledge and attitudes among the healthcare professionals in Lahore, Pakistan

BackgroundThe diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness campaigns.MethodsPhysicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians (psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed. Demographic information regarding the participants of the survey was also gathered.ResultsTwo hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study. Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups, differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with Physicians (P-value <0.001). Significant misunderstandings of some of the salient features of autism were present in both professional groups.ConclusionResults suggests that current professionals in the field have an unbalanced understanding of autism due to presence of several misconceptions regarding many of the salient features of autism including developmental, cognitive and emotional features. The study has clinical implications and calls for continued education for healthcare professionals across disciplines with regards to Autism in Pakistan.

Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: A case-control study☆

OBJECTIVE To explore association between medically unexplained symptoms in children in Pakistan with emotional difficulties and functional impairments. METHODS We conducted a matched three-group case-control study of 186 children aged 8-16 years in Lahore, Pakistan. Cases were 62 children with chronic somatic symptoms for which no organic cause was identified after investigations. Two control groups of 62 children with chronic medical paediatric conditions, and 62 healthy children were identified. Cases and controls were matched for gender, age, and school class. Somatisation was measured with the Childrens Somatisation Inventory (CSI-24) while anxiety and depression were measured with the Spencer Childrens Anxiety Scale and the Short Mood and Feelings Questionnaire respectively. All questionnaires were translated into Urdu. RESULTS Mean age was 11.7 years (SD=2.1). Cases scored significantly higher on somatisation (CSI-24), anxiety and depression than both control groups. Paediatric controls scored significantly higher than healthy controls on all three measures. Two hierarchical linear regression models were used to explore if somatisation predicted depression and anxiety while controlling for several confounders. Somatisation (higher CSI-24 scores) independently and significantly predicted higher anxiety (β=.37, p=.0001) and depression (β=.41, p=.0001) scores. CONCLUSION This is the first study to show an association between medically unexplained symptoms and anxiety and depression in Pakistani children. This highlights the importance of screening for emotional difficulties in children presenting with unexplained somatic symptoms in this region.

ANXIETY AND DEPRESSION SYMPTOMS IN PATIENTS WITH DENGUE FEVER AND THEIR CORRELATION WITH SYMPTOM SEVERITY

Objective: To study the prevalence of anxiety and depression symptoms in patients with Dengue and to examine their correlation with symptom severity. Methods: In this cross sectional study, 531 consecutive patients who met the World Health Organization criteria for Dengue fever admitted to Mayo Hospital, Lahore between September and November 2011 were administered the Hospital Anxiety and Depression Scale (HADS). In addition to the HADS, the severity of their symptoms, like headache, myalgias/ arthralgias, fever, and retro/periorbital pain, was assessed on a 3-point scale (mild, moderate, and severe). Results: About 60% of the patients in our study met the criteria for anxiety and 62.2% of the patients met criteria for depression. Severity of fever, headache, myalgias and arthralgias, and retro/periorbital pain was positively correlated with both anxiety (Correlation coefficients: 0.148, 0.247, 0.184, 0.184 respectively and P < 0.01 for all) and depression scores (Correlation coefficients: 0.098, 0.154, 0.131, 0.125 respectively and P value < 0.01 for all). The strongest correlation was found between severity of headache and scores for both anxiety and depression. Both mean anxiety and depression scores were significantly higher in patients with platelet count below median (30,000/mm3) than in patients with platelet count above median (9.1 ± 4.7 vs 8.2 ± 4.7, P < 0.03, and 9.5 ± 4.5 vs 8.5 ± 4.5, P < 0.01, respectively). Conclusion: A majority of patients with Dengue have anxiety and depression symptoms. Psychiatric evaluation should be done in all Dengue patients so timely treatment can be initiated.