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Background: Schools have a major role in promoting children's physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers' knowledge and beliefs about psychological problems influence the way they deal with their students' mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization's Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore. Methods: Teachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention. Results: Compared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher's self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months. Conclusion: This study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools. Trail Registration: ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background & Objective: Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan's first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years' period since the inception of the unit. Methods: Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients' scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed. Results: Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3 ±2.3. Mean duration of admission was 15.60 ±6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fiftynine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge. Conclusion: Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries. [ABSTRACT FROM AUTHOR]

Background and Objectives: Stigma around COVID-19 is a major barrier in global efforts to control the COVID 19 pandemic. Limited data is available regarding stigma faced by COVID-19 patients in low- and middle-income countries (LMIC). The aim of the current study was to explore the stigma experienced by hospitalized patients with COVID-19 illness in Lahore, Pakistan. Methods: Following Institutional Review Board approval and informed consent, patients were assessed using modified HIV short form stigma scale and open-ended questions. Questions focused on experiences, feelings, and opinions as to how patients feel and how they were treated prior to and during the hospitalization. Data analysis for quantitative data was performed using SPSS-20, while qualitative responses were interpreted by content analysis method. Results: One hundred and fourteen patients were interviewed (Mean age 38.8 years + 15.3) with 53.5% being males. Widespread experience of stigma was reported by patients particularly for concerns about public attitudes (7.43 + 1.43) & disclosure (6.89 + 1.45). Main themes which emerged from the qualitative responses were social stigma and rejection, humiliating behaviour of others, breach of confidentiality, loss of trust/respect, and impact of COVID-19 diagnosis on their business. Conclusions: Existence of significant stigma among COVID-19 patients isolated in a tertiary care hospital in a LMIC highlights the need for culturally sensitive strategies to address it. [ABSTRACT FROM AUTHOR]

Objective: To assess psychological impact of COVID-19 pandemic among healthcare workers (HCWs) in a University Teaching Hospital, the main referral center for COVID-19 in Lahore Pakistan, by quantifying symptoms of acute stress disorder, depression, anxiety, insomnia and to explore their potential risk factors. Study Design: Descriptive Analytical study. Place and Duration of the Study: King Edward Medical University from March 30th-April 15th 2020. Methods: Following Institutional Review Board approval and informed consent, Demographic form, Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, and the stress reactions questionnaire were used for data collection. Descriptive statistics were computed. Binary logistic regression was done to determine potential risk factors for mental health outcomes. Results: Three hundred and thirty-seven healthcare workers participated with 79% physicians and 20% were nurses and paramedical staff. The prevalence of anxiety, depressive symptoms, acute stress disorder and insomnia was 36.2%, 30%, 27.9% &1.5% respectively. Women, frontline HCWs and junior staff had more anxiety, depression and insomnia symptoms with physicians reporting more acute stress symptoms compared to nurses. Binary logistic regression showed that being a junior staff member and a frontline worker appeared to be an independent risk factors for depression and anxiety (but not insomnia). Conclusion: High psychological distress among healthcare workers during COVID-19 reported in Pakistan. Failure to provide adequate psychosocial support can significantly impair their functioning and compromise patient care. [ABSTRACT FROM AUTHOR]

Objectives To determine the efficacy of brief Culturally adapted CBT (CaCBT) for depression when added to Treatment As usual (TAU)—delivered by trained therapists using a manual compared with alone TAU. Methods This was an assessor-blinded, randomised controlled clinical trial. Particpants with a diagnosis of depression, attending psychiatry departments of three teaching hospitals in Lahore, Pakistan, were included in the study. We screened a total of 280 patients and randomly allocated 137 of them to CaCBT plus Treatment As Usual (TAU) [Treatment group] or to TAU alone [Control group]. Assessments were completed at baseline, at 3 months and at 9 months after baseline. Reduction in depression score (Hospital Anxiety and Depression-Depression Subscale) at 3 months was primary outcome measure. The secondary outcome measures included anxiety scores (Hospital Anxiety and Depression-Anxiety Subscale), somatic symptoms (Bradford Somatic Inventory), disability (Brief Disability Questionnaire) and satisfaction with the treatment. Findings A total of 69 participants were randomised to Treatment group and 68 to Control group. Participants in Treatment group showed statistically significant improvement in depression ( p =0.000), anxiety ( p =0.000), somatic symptoms ( p =0.005) and disability ( p =0.000). This effect was sustained at 9 months after baseline (Except for disability). Participants in Treatment group also reported higher satisfaction with treatment compared with those in Control group. Conclusion Brief CaCBT can be effective in improving depressive symptoms, when compared with treatment as usual. This is the first report of a trial of Culturally adapted CBT from South Asia and further studies are needed to generalise these findings. [ABSTRACT FROM AUTHOR]

Background: Adverse psychological effects have been associated with COVID-19-related disease containment measures, but little is known about the psychiatric symptoms and distress., Aims: This study aimed to explore and understand the psychiatric symptoms and distress in suspected or confirmed COVID-19 patients isolated and quarantined in hospital., Methods: A mixed methods study was conducted in the COVID-19 units of Mayo Hospital, Lahore, Pakistan; 114 out of 160 adult patients were assessed by telephone using validated scales (Stress Reactions and Adjustment Disorder Checklist, 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale and Insomnia Severity Index) and a few open-ended questions about expectations and anticipated areas of need during hospitalization, including experiences with isolation., Results: The prevalence of adjustment disorder, acute stress disorder, anxiety, depressive symptoms and insomnia was 67.5%, 3.5%, 16.7%, 18.4%, and 29.8% respectively. One male patient tried to commit suicide during the study period. Fear, anger, low mood, anxiety and sleep disturbances were the most notable psychological consequences in qualitative the responses. Inadequate communication, poor ward facilities, concerns about the health of family members and financial problems were the most commonly identified factors leading to distress., Conclusion: Our results show alarmingly high levels of stress-related symptoms - insomnia, depression and anxiety - among COVID-19 confirmed or suspected hospitalized patients. There is a need to incorporate psychological services in the acute phase of illness for prompt recognition and management of psychiatric problems., (Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: The teacher's role in school mental health initiatives cannot be overemphasized. Despite global evidence of educational interventions in improving teachers' knowledge and attitudes regarding mental health, this area remains under researched in Pakistan. This paper presents a study protocol of a pilot randomized controlled trial to examine the effectiveness of a teacher training intervention for improving mental health literacy and self-efficacy among school teachers in urban Lahore, Pakistan., Methods: The randomized controlled trial will follow the CONSORT guidelines. Participants will be allocated to the Intervention group (receiving the World Health Organization, Eastern Mediterranean Region (WHO-EMRO) School Mental Health Manual-based intervention in three 6-h, face-to-face sessions) or a waitlist control group (not receiving training during the study period). Participants will be teachers of private schools with similar broad demographic characteristics in an inner city area of Lahore. The primary outcome measures for the trial is teachers' mental health literacy. It will be assessed by using the previously applied (during WHO training of Master Trainers) self-administered questionnaire in both groups pre and post training and at 3 months' follow-up. Secondary outcomes include: for teachers: Teachers' self-efficacy (assessed by the Teachers' Sense of Self Efficacy Scale (TSES) short form.); for students (11-16 years): socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire (assessed at baseline and 3 months post intervention); for schools: the WHO School Psychosocial Profile Questionnaire (baseline and 3 months post intervention)., Discussion: Given the high prevalence of child mental health problems, stigma and lack of services, it is important to consider alternate avenues for promoting positive mental health among youth. This pilot study should establish the effectiveness of the WHO-EMRO School Mental Health Manual-based Intervention improving teacher's mental health literacy and helping them to learn practical steps that can be implemented at low cost in school settings. It will also provide information regarding intervention implementation and sustainability., Trial Registration: ClinicalTrials.gov, ID: NCT02937714 . Registered on 18 October 2016.

Background: Currently clinicians and researchers in Pakistan have to use translated western instruments to screen for anxiety and depressive disorders. This study investigated the local idioms of emotional distress in Pakistan to develop a culturally valid and easy-to-use instrument to screen for common mental disorders in general clinical settings., Methods: A systematic survey was conducted of psychiatric case notes of patients attending clinics in Peshawar and Lahore, diagnosed with anxiety or depressive disorders, to identify the range of common idioms of psychological distress. A pilot version of the questionnaire was refined and validated among a composite sample of 330 patients in inpatient, outpatient and rural community settings. ICD-10 Diagnostic Criteria for Research were used to define cases and patients' relatives acted as normal controls., Results: The pilot version of the questionnaire was reduced to 42 items based on odds ratios between cases and controls. Anxiety symptoms were generally reported by depressed patients, but not vice versa. Finally 30 items were selected, in two sub-scales. This final version achieved sensitivity, specificity, and positive and negative predicted values of over 90% when comparing cases and controls., Limitations: This questionnaire was based on what patients tell doctors and may not capture the entire repertoire of local idioms of distress. The validation study was conducted only in an Urdu/Punjabi speaking population, in Lahore and surrounding areas., Conclusions: The Pakistan Anxiety and Depression Questionnaire consists of an anxiety/depression scale and a depression scale, each of 15 items. It demonstrates excellent validity as screening instrument for anxiety and depressive disorders in clinical settings in Pakistan.

Objective: To study the characteristics of the epileptics and the risk factors contributing to the development of epilepsy., Design: Descriptive study., Place and Duration of Study: Epilepsy Clinic at Ahbab Hospital, Lahore, from June 2002 to August 2002., Subjects and Methods: Data was collected from 158 subjects, 89 males and 69 females, suffering from epilepsy. The information about socio-demographic characteristics and family history of illness, perinatal morbidity, birth place and mother s age at the time of delivery was obtained using a pre-tested questionnaire. Data was analyzed on SPSS version 10., Results: Majority of the subjects were single (77.84%), 1st born among their siblings (25.95%), belonged to low social class (50.63%), and unemployed (25.31%). The major risk factors were family history of illness (23.52%) and positive medical problem around birth (12.66%). The presence of family history of illness, positive medical problem around birth and advanced maternal age at birth were associated with early onset of epilepsy. Vulnerability for the epilepsy also increases among hospital deliveries., Conclusion: Although the present study has identified various risk factors, yet the results need to be further confirmed through case-control studies.