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IntroductionReligion and spirituality (R/S) serve as sources of meaning-making and coping for many individuals and families. While research on the relationship between R/S and mental health has been ongoing, their role in pediatric mental health is poorly understood. The objective of this study is to assess research trends and predominant themes of R/S in child and adolescent psychiatric research in articles published in the Journal of the American Association of Child and Adolescent Psychiatry (JAACAP). This provides a rough measure of the relative importance of these topics to academic psychiatrists and researchers in the field and identifies gaps for future research.MethodsAll research and review articles published in JAACAP between 2000-2023 with a focus on R/S themes were retrieved, screened, and appraised for content and extent of focus on R/S (major, minor, incidental). Included articles were assessed for R/S variables and predominant themes.ResultsThirty-two (32) research articles published between 2000-2023 contained sufficient R/S content for inclusion in our study. Only 4 articles had R/S as their major focus. Our analysis suggested a decline in publications with R/S content over the last 24 years. The R/S variables and measurement tools were heterogenous, with religious attendance and religious affiliation being the most frequently measured variables. The predominant themes include the relationships between R/S and psychopathology, suicide, utilization of services, conceptualization of illness, trauma, identity, and coping.DiscussionDespite the significance attributed to R/S by many youths and families and the increasing academic interest in the intersection between R/S and health, a significant gap exists in our understanding of R/S vis-à-vis child and adolescent mental health. This gap may be further compounded by the limited attention offered to R/S factors and variables in academic psychiatric activities. JAACAP, a global leading academic platform, may advance this discourse by inviting and encouraging publications addressing R/S variables. This may inform diagnostic, preventive, and interventive clinical work with children and their families.

Abstract Objective Pregnancy is a complex phenomenon accompanied by biological, physiological and psychosocial changes for a mother. It is also regarded as a stressful life event where a woman’s role, identity and interpersonal relationships are restructured. The present study from Pakistan explores the association of sleep quality and poor sleeping habits with prenatal stress using Pittsburgh Sleep quality Index. Results There were a total of 516 women (mean age = 29.82 years), with more than half reporting poor sleep quality. Ethnically, a majority (395, 76.6%) were natives of the Punjab province while rest were non-natives. A high percentage of respondents reported poor subjective sleep quality (22.1%), sleep latency (44.1%), habitual sleep efficiency (27.5%), sleep disturbance (30.1%), use of medications (7.1%) and daytime dysfunction (29.5%). According to logistic regression analysis, respondents with poor sleep quality were 2.24 (95% CI = 1.55–3.22, P

Lead (Pb) is a highly toxic contaminant that is ubiquitously present in the ecosystem and poses severe environmental issues, including hazards to soil-plant systems. This review focuses on the uptake, accumulation, and translocation of Pb metallic ions and their toxicological effects on plant morpho-physiological and biochemical attributes. We highlight that the uptake of Pb metal is controlled by cation exchange capacity, pH, size of soil particles, root nature, and other physio-chemical limitations. Pb toxicity obstructs seed germination, root/shoot length, plant growth, and final crop-yield. Pb disrupts the nutrient uptake through roots, alters plasma membrane permeability, and disturbs chloroplast ultrastructure that triggers changes in respiration as well as transpiration activities, creates the reactive oxygen species (ROS), and activates some enzymatic and non-enzymatic antioxidants. Pb also impairs photosynthesis, disrupts water balance and mineral nutrients, changes hormonal status, and alters membrane structure and permeability. This review provides consolidated information concentrating on the current studies associated with Pb-induced oxidative stress and toxic conditions in various plants, highlighting the roles of different antioxidants in plants mitigating Pb-stress. Additionally, we discussed detoxification and tolerance responses in plants by regulating different gene expressions, protein, and glutathione metabolisms to resist Pb-induced phytotoxicity. Overall, various approaches to tackle Pb toxicity have been addressed; the phytoremediation techniques and biochar amendments are economical and eco-friendly remedies for improving Pb-contaminated soils.

Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = −0.59; 95% confidence interval (CI) −0.95 to −0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = −1.43, 95% CI −2.22 to −0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings.

Cognitive behavioral therapies (CBT) have been demonstrated efficacious in treating perinatal depression (PND). This has been demonstrated in several meta-analyses of randomized controlled trials and quasi-experimental studies. However, there is a need for up-to-date meta-analytical evidence providing reliable estimates for CBT’s effectiveness in treating and preventing PND. Furthermore, with the world moving toward precision medicine, approaches require a critical synthesis of psychotherapies, especially to unpack their mechanisms of action and to understand what approaches work best for whom. Therefore, the present systematic review and meta-regression analyses aim to answer these research questions.

Abstract Objectives Restless Legs Syndrome (RLS) is commonly known to cause morbidity in patients on hemodialysis, making them prone to chronic mental health illnesses such as depression and anxiety, and also adversely impact quality of life. In this study, we examined the association of quality of life, anxiety, and depression with restless leg syndrome in the hemodialysis patients at Karachi Institute of Kidney Diseases. Results About 26.7% of the participants reported RLS among the sample size Presence of RLS was not associated with quality of life, depression, and anxiety. However, p-values

Abstract Objective Antenatal stress is highly prevalent globally and is associated with adverse physical and psychiatric morbidities and adverse neonatal outcomes. However, the burden of antenatal stress and its psychosocial predicators have not been explored in context of the Pakistani sociocultural environment. The present study explores the prevalence of antenatal stress and its association with gender of offspring, socioeconomic background, cultural beliefs, and access to healthcare in the province of Punjab, Pakistan. Results There was a total of 516 pregnant women. Antenatal stress was measured by the Perceived Stress Scale (PSS). The mean score of the respondents on the Perceived Stress Scale was 7.55 (3.43). A total of 218 (42.2%) respondents reported higher stress levels. Logistic regression analysis (backward method) yielded a significant model predicting high stress levels. According to it, low family income, unplanned pregnancy, increasing number of children, less autonomy in decision making, marital problems, harassment, desire to have a male offspring, and the history of birth complications, attended by midwives were associated with high stress levels.

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization.Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted.Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7–20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1–14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9–16.6%), substance use (4.0%, 95% CI: 3.1–5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6–4.9%), phobic disorders (1.8%, 95% CI: 1.1–2.8%), panic disorders (1.1%, 95% CI: 0.6–2.2%), bipolar disorders (0.7%, 95% CI: 0.3–1.6%), and psychosis (0.5%, 95% CI: 0.3–0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9–27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8–9.6%); GAD: current prevalence 10.3% (95% CI: 6.1–17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4–8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied.Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR.Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

Abstract Objectives We examined the association of bullying experiences with depressive symptoms and psychosocial functioning among children and adolescents in rural Pakistan. A total of 452 school-going children in Nawabshah, Pakistan were conveniently interviewed to assess rates of bullying experiences and severity of depressive symptoms. Depressive symptoms were assessed using the Patient Health Questionnaire for Adolescents. Results Experience of victimization was reported by 130 (28.8%) and perpetration by (146, 32.3%). A total of 162 (35.80%) reported mild depressive symptoms, 88 (19.50%) moderate, 33 (7.30%) moderately severe and 19 (4.20%) severe depressive symptoms. Age was not associated with patterns of bullying other than pure bully perpetration (.12, P = .024). Both victims and perpetrators of bullying experienced adverse emotional and social consequences. Bully-perpetrators exhibited the greater severity of depressive symptoms due to distress in psychosocial functioning.

South Asian countries report the highest prevalence of common mental disorders (CMDs) globally. This systematic review and meta-analysis report the pooled prevalence of CMDs among the South Asian countries. Database searches were conducted in eight electronic databases. Titles, abstracts, full-text screening, and extraction of data on the event rate of 17 indicators of CMDs were performed by two independent reviewers. A total of 160 studies were included and data analysis was done using the Comprehensive Meta-analysis Software (v.3). A prevalence of depressive symptoms was 26.4% among 173,449 participants, alcohol abuse was 12.9% (n = 107,893); anxiety 25.8% (n = 70,058); tobacco smoking 18.6% (n = 84,965); PTSD 17.2% (n = 42,298); mixed anxiety and depression 28.4% (n = 11,102); suicidal behaviors 6.4% (n = 25,043); misuse of opiates 0.8% (n = 37,304); tobacco chewing 21.0% (n = 10,586); use of cannabis 3% (n = 10,977); GAD 2.9% (n = 70,058); bipolar disorder 0.6% (n = 7,197); IV drug abuse 2.5% (n = 15,049); panic disorder 0.01% (n = 28,087); stimulant use 0.9% (n = 1,414); OCD 1.6% (n = 8,784) and phobic disorders 1.8% (n = 27,754). This study reported a high prevalence of CMDs in South Asian countries; necessitating further research on psychiatric epidemiology in those contexts. It informs the need for effective policymaking and implementation of culturally appropriate multilevel interventions.

Background: Bullying and peer victimization among adolescents are growing public health concerns that affect victims’ emotional well-being, and their social and academic functioning. Despite concerns about this public health epidemic in low- and middle-income countries, most prevalence, policy and intervention studies have been conducted in developed countries and economies.Methods: This cross-sectional study was conducted between September 2016 and July 2017 at seven public and private schools located in five districts in Pakistan: Lodhran, Rahim Yar Khan, Bahawalpur, Faisalabad, Multan, Thatta, and Nawabshah. A total of 2,315 schoolchildren were surveyed with a specially designed instrument in Urdu with items about demographics and bullying behavior, together with a strengths and difficulties questionnaire.Results: Mean age of the respondents was 14.63 (2.87) years. More than half of the respondents were males (n = 1301, 56.2%), and a majority reported that their mothers were housewives (n = 2,100, 90.7%). A total of 615 (26.6%) respondents reported being bullied at school, and 415 (17.9%) reported being bullied away from school. Perpetration of bullying was reported by 430 (18.6%) participants at school and 376 (16.3%) away from school. Being bullied in the past was strongly associated with becoming a perpetrator of bullying in the future. Internalizing symptoms were significantly associated with male gender, older age, being a victim of bullying, and employment status of the respondent’s mother. Externalizing symptoms were significantly associated with male gender, older age, being a victim and perpetrator of bullying, and mother’s employment status.Conclusion: Bullying perpetrators have a greater tendency to exhibit externalizing symptoms, whereas victims develop both externalizing and internalizing psychopathologies.

Abstract Objective The clusters of participants with a homogeneous psychological make-up can be identified using sophisticated machine learning techniques such as the two-step clustering algorithm. It can also help us to identify the synergistic and additive effects of a range of psychometric variables. The identification of synergistic effect of this clustering of defense mechanism has significant practical implications as they share a certain variance. This study aims to identify the clusters of ego defenses and their relationship with academic performance and mental health outcome in medical students. Results The high achievers scored higher on mature and neurotic defense styles and lower on immature than their counter parts. A higher proportion of medical students in high achievers group had normal scores on depressive symptoms than low achievers. While a majority among low achievers suffered from severe anxiety levels than high achievers group. High achievers scored higher on sublimation, humor, anticipation, suppression, pseudo-altruism, idealization, reaction formation, autistic fantasy, denial, and rationalization.

Abstract Objective Previous research indicates that attitudes to pregnancy and motherhood are influenced by social values, culture and religion. This study explores the relationship between social support and unwanted pregnancy among Pakistani women. This cross-sectional study was conducted at four teaching hospitals in Lahore in 2014. Results A total of 500 pregnant women who visited the hospitals’ obstetrics and gynecology departments were asked to respond to a questionnaire consisting of respondents’ characteristics and the Social Provisions Scale (SPS). Logistic regression analyzed the predictors of unplanned pregnancy. Unwanted pregnancies were more likely to occur among pregnant women from rural areas, with low scores on the SPS ‘reassurance of worth’ sub-scale, no history of contraceptive use, and who already had at least one son than those with no sons.

Abstract Purpose In a novel approach, certain organic wastes byproducts of agro industries were assessed for their ability to support maize growth and Zn bioavailability in maize grain. Methods In a field experiment, maize (Zea mays) was supplemented with farm yard manure (FYM), press mud (PM), fisheries manure (FM), and slaughter house waste (SHW) in combination with Zn soil application (ZnS) and Zn foliar spray (ZnF) with recommended doses of N:P:K (140:100:60 kg ha−1), respectively. Besides assessing the maize growth, grain, and straw yield, Zn bioavailability in maize grain was also studied. Results Organic materials combined with ZnS and ZnF significantly increased the maize yield and Zn bioavailability. PM + ZnS increased the grain yield by 69.71%, while FM + ZnF and FYM + ZnF increased the grain Zn concentration by 86.37 and 86.16%, respectively. Moreover, grain Zn content was greatly influenced by PM + ZnS and PM + ZnF resulted an average increase by 160%. Phytate concentration and phytae:Zn molar ratio in grain were decreased by 30.34 and 66.92%, respectively by FYM + ZnF. Estimated Zn bioavailability ranged from 0.92 to 2.04 mg Zn/300 g in maize grain, and was maximum by PM and FYM combined with ZnF. Conclusion Organic manures influence the nutrient uptake from soil, increase the product quality, and act as a good organic fertilizer. The current study revealed that organic manures can enhance crop growth and Zn uptake in grain in sustainable manner. It would be an eco-friendly approach by utilizing organic wastes annually generated by agro industries.

Gender disparity has been documented in advanced doctoral degrees, research, and academic positions, and therefore, it can logically be deduced that the gender disparity would be found in journals' editorial boards. In this study, we sought to determine the gender distribution in editorial boards of psychiatry journals worldwide. We also studied the academic achievements of editorial board members by comparing professional background, education level, and research productivity indices. We analyzed the gender of editorial members of 119 psychiatry journals from Clarivate Analytics' Journal Citation Reports. Our data included 8423 editorial board members from which we randomly selected 10% editorial board members to represent the full sample for further analyses. Overall, women represented 30.4% of editorial board and approximately 30% in each category: (1) Editor-in-chief/deputies, (2) Associate/section editors, (3) Editorial board*, and (4) Advisory board. The majority (65%) of men were M.D. psychiatrists, and women (58%) were Ph.D. psychologists. Women in editorial leadership positions (Category 1 & 2) were correlated with fewer women in editorial or advisory boards. Women had half the mean number of publications than men while serving journals with approximately the same mean impact factor. Our study results show that, besides gender disparity, gender bias does not exist in the psychiatry journal editorial boards. Given the implication of the editorial board position on science, academic advancement, and networking, this disparity remains detrimental to achieving equity, diversity, and inclusion in academic psychiatry. Keywords: Female, Gender disparity, Editorial board, Psychiatry

INTRODUCTION:In recent years, several non-specialist mediated interventions have been developed and tested to address problematic symptoms associated with autism. These can be implemented with a fraction of cost required for specialist delivered interventions. This review represents a robust evidence of clinical effectiveness of these interventions in improving the social, motor and communication deficits among children with autism. METHODS:An electronic search was conducted in eight academic databases from their inception to 31st December 2018. A total of 31 randomized controlled trials were published post-2010 while only 2 were published prior to it. Outcomes pertaining to communication, social skills and caregiver-child relationship were meta-analyzed when reported in > 2 studies. RESULTS:A significant improvement was noted in child distress (SMD = 0.55), communication (SMD = 0.23), expressive language (SMD = 0.47), joint engagement (SMD = 0.63), motor skills (SMD = 0.25), parental distress (SMD = 0.33) parental self-efficacy (SMD = 0.42) parent-child relationship (SMD = 0.67) repetitive behaviors (SMD = 0.33), self-regulation (SMD = 0.54), social skills (SMD = 0.53) symptom severity (SMD = 0.44) and visual reception (SMD = 0.29). CONCLUSION:Non-specialist mediated interventions for autism spectrum disorder demonstrate effectiveness across a range of outcomes for children with autism and their caregivers.

Abstract Objective This data set was compiled to assess mental well-being, dietary pattern and physical health parameters of health care professionals in Pakistan. Data description The Warwick-Edinburgh mental well-being scale was first evaluated for the Pakistani population then used, along with other measures like body mass index, exercise and dietary habits to assess health and wellbeing of health care providers. The importance of the data lies in the fact that no previous records or data exists in our knowledge that used a subjective index to assess wellbeing in Pakistani population. Furthermore, this data may be used as part of a global analysis to find differences in well-being and health habits of health care providers in developing countries as opposed to developed countries.

Introduction: The present study explores the association of adverse childhood experiences with impulsivity and functional identity among Pakistani adults. Methods: In this cross-sectional study, 260 Pakistani medical students aged 18 and above were approached. A consent form, a questionnaire on sociodemographic characteristics, and an English versions of the Adverse Childhood Experiences (ACE) scale, Functions of Identity scale (FIS) and Barratt’s Impulsiveness Scale (BIS-11) was employed in this study. All data were analyzed in SPSS v. 20. Results: A total of 122 (52.6%) of respondents had experienced at least one adverse childhood experience. Verbal, physical, sexual adverse events and poor support and affection from family were the most reported adverse events. ACE scores yielded a significantly positive association with cognitive stability, perseverance and motor impulsivity on the Barrat’s impulsivity scale. Whereas, it yielded negative association with structure and harmony subscales of the functional identity as well as cognitive complexity subscale of the impulsivity scale. Conclusions: A high proportion of Pakistani medical students reported adverse childhood experiences, which lead to impulsive behaviors and poor functional identities.

Background: The field of child and adolescent psychiatry lags behind adult psychiatry significantly. In recent years, it has witnessed a significant increase in the publication of journals and articles. This study provides a detailed bibliometric analysis of articles published from 1980 to 2016, in the top seven journals of child and adolescent psychiatry. Methods: Using the Web of Science core collection, we selected 9,719 research papers published in seven psychiatric journals from 1980 to 2016. We utilized the Web of Science Analytics tool and Network Analysis Interface for Literature Studies (NAILS) Project scripts to delineate the general trends of publication in these journals. Then, co-citation analysis and hierarchical cluster analysis was performed using CiteSpace to map important papers, landmark theories and foci of research in child and adolescent psychiatry. Results: The field of child and adolescent psychiatry has experienced an increasing trend in research, which was reflected in the results of this study. Hierarchical cluster analysis revealed that the research foci in psychiatry were primarily studies related to the design of psychometric instruments, checklists, taxonomy, attention deficit hyperactivity disorder (ADHD), depression, PTSD, social phobia, and psychopharmacology. Moreover, several landmark studies, including the validation of a child behavior checklist, Ainsworth's empirical evidence of Bowlby's attachment theory, and adult outcomes of childhood dysregulation were published. This study also reports rapid expansion and innovation in research areas in the field of child and adolescent psychiatry from 1980-2016. Conclusions: Rapid expansion and innovation in research areas in the field of child and adolescent psychiatry has been observed, from 1980 to 2016.

Background: Bibliometrics is a form of quantitative analysis that employs peer-reviewed research, journal articles and citation counts to examine the content of current literature on a particular topic. The authors aim to identify the major academic disciplines that dominate the landscape of published materials and research endeavors on the topic of refugees. Methods: Using the Web of Science, a database of most-cited articles was created by a team with expertise in bibliometrics. Results: Citations ranged between 1,493 and 105; averaging 203 citations per article. The publications spanned the years from 1973 to 2010. The year 2004 had the highest number of publications. All articles were published by 45 journals. In total, 294 investigators authored these articles. Psychiatry, psychology and public health constituted the top three fields of affiliation, with the most investigated feature being the mental health of refugees. Single investigators authored a quarter of all articles. Conclusion: This bibliometric evaluation allowed a multi-dimensional outlook on the conditions of refugee populations across the globe, through collation of relevant peer-reviewed research journal articles. This specialized form of assessment has resulted in a multi-disciplinary compendium of publications on the subject.

Introduction: The present study explores the association of adverse childhood experiences with impulsivity and functional identity among Pakistani adults. Methods: In this cross-sectional study, 260 Pakistani medical students aged 18 and above were approached. A consent form, a questionnaire on sociodemographic characteristics, and an English versions of the Adverse Childhood Experiences (ACE) scale, Functions of Identity scale (FIS) and Barratt’s Impulsiveness Scale (BIS-11) was employed in this study. All data were analyzed in SPSS v. 20. Results: A total of 122 (52.6%) of respondents had experienced at least one adverse childhood experience. According to linear regression analysis, ACE scores were significantly associated with increasing age, increasing order in birth, lower scores on functional identity structure and non-planning impulsivity, and higher scores on future (functional identity) and motor impulsivity. Conclusions: A high proportion of Pakistani medical students reported adverse childhood experiences, which lead to impulsive behaviors and poor functional identities.

Background: The field of child and adolescent psychiatry lags behind adult psychiatry significantly. In recent years, it has witnessed a significant increase in the publication of journals and articles. This study provides a detailed bibliometric analysis of articles published from 1980 to 2016, in the top seven journals of child and adolescent psychiatry. Methods: Using the Web of Science core collection, we selected 9,719 research papers published in seven psychiatric journals from 1980 to 2016. We utilized the Web of Science Analytics tool and Network Analysis Interface for Literature Studies (NAILS) Project scripts to delineate the general trends of publication in these journals. Then, co-citation analysis and hierarchical cluster analysis was performed using CiteSpace to map important papers, landmark theories and foci of research in child and adolescent psychiatry. Results: The field of child and adolescent psychiatry has experienced an increasing trend in research, which was reflected in the results of this study. Hierarchical cluster analysis revealed that the research foci in psychiatry were primarily studies related to the design of psychometric instruments, checklists, taxonomy, attention deficit hyperactivity disorder (ADHD), depression, PTSD, social phobia, and psychopharmacology. Moreover, several landmark studies, including the validation of a child behavior checklist, Ainsworth's empirical evidence of Bowlby's attachment theory, and adult outcomes of childhood dysregulation were published. This study also reports rapid expansion and innovation in research areas in the field of child and adolescent psychiatry from 1980-2016. Conclusions: Rapid expansion and innovation in research areas in the field of child and adolescent psychiatry has been observed, from 1980 to 2016.