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Dowry is a transfer of materialistic goods or money from bride’s parents to bridegroom family at the time of marriage. However, as dowry demand rises, it has a significant detrimental impact on the lives of women. This chapter discusses the history of dowry and its practices, the positive and negative impact, and policy implications. The keywords used for this search were: “Dowry AND Pakistan,” “Pakistan culture AND Violence against women,” “social aspects AND Dowry practices,” and “Intimate-partner violence AND Pakistan.” To ensure that readers would receive valid information on the subject, authors searched from reliable engines. Dowry is a common tradition, particularly in South Asian countries. It is originated from Hindu culture, but later adopted and practiced by other Islamic and European-American nations. Though it provides an opportunity for women to get their share of pre-mortem inheritance from their parent’s property. However, it may be the leading cause of violence and abuse that poses an enormous burden on the brides. Violence prevention is achievable, but it requires efforts by the government, health institutions, and civil society. This is an additional contribution by the authors to raise awareness regarding “Dowry,” which is one of the preventable predictors of violence.

Introduction This study translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) and Brain Module (QLQ-BN20) amongst patients with primary brain tumors (PBT) in Pakistan, and assessed the correlation of QoL with resilience, depression, and anxiety. Methods Translation of the EORTC QLQ-C30 and QLQ-BN20 was performed as per EORTC guidelines. A survey comprising of Urdu translations of EORTC QLQ-C30, QLQ-BN20, Wagnild and Young Resilience Scale (RS-14) and Hospital Anxiety and Depression Scale was administered to patients with PBT at a tertiary care hospital in Pakistan. Reliability (via Cronbach alpha), content validity index (CVI) scores, construct validity, and inter-scale correlations were assessed. Results Our sample consisted of 250 patients with PBT, most commonly glioma (46.8%) and meningioma (21.2%). All patients were able to understand the Urdu translations. The Cronbach alphas for the QLQ-C30 and the QLQ-BN20 were 0.860 and 0.880, respectively. The CVI scores for clarity and relevance were high for both the EORTC QLQ-C30 (0.98 and 0.96, respectively) and the QLQ-BN20 tool (0.81 and 0.95, respectively). The global QoL domain (EORTC QLQ-C30) showed significant positive correlations with resilience (r = 0.422), and significant negative correlations with depression (r = − 0.541) and anxiety (r = − 0.502). Strong inter-scale correlations were observed between physical functioning and insomnia (r = − 0.690) and role functioning and insomnia (r = − 0.641). Conclusion Our study confirms the Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 as valid clinical tools for the measurement of QoL in primary brain tumors patients within the cultural and socioeconomic context of Pakistan. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00354-6., Plain language summary Quality of life (QoL) is an important facet of well-being for patients with primary brain tumors (PBTs), as these individuals face significant distress during the course of their illness and treatment. It is important to have valid and reliable tools to accurately measure the QoL of patients with PBTs. The EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and its brain tumor-specific module EORTC QLQ-BN20 (EORTC QLQ-Brain Neoplasms 20) are exactly that. However, the use of the EORTC QLQ-C30 and QLQ-BN20 is limited in Pakistan, where the national language is Urdu, and the majority of patients are of low socioeconomic backgrounds. Since no Urdu translations of the EORTC QLQ-C30 and QLQ-BN20 exist, we aimed to translate and validate these tools to enable their applicability in Pakistan. The Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 demonstrated good validity amongst patients with PBTs. Thus, our study confirms the EORTC QLQ-C30 and QLQ-BN20 as valuable clinical tools for the measurement of QoL in primary brain tumors patients within the linguistic, cultural and socioeconomic context of Pakistan. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00354-6.

Perinatal mental health issues in women can lead to a variety of health complications for both mother and child. Building resilience can strengthen coping mechanisms for pregnant women to improve their mental health and protect themselves and their children. The study aims to develop and validate the contextual and cultural appropriateness of the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention for pregnant women in Pakistan. A three-phase approach was used to develop and validate an intervention that promotes resilience in pregnant women. Phase I comprised a needs assessment with stakeholders (pregnant women and key informants) to elicit opinions regarding module content. In Phase II, an intervention to build resilience was developed with the help of a literature review and formative assessment findings, and Phase III involved the validation of the intervention by eight mental health experts. The experts assessed the Content Validity Index (CVI) of the SM-ART intervention on a self-developed checklist. The resultant SM-ART intervention consists of six modules with strong to perfect CVI scores for each of the modules. Qualitative responses endorsed the strengths of the intervention as having innovative and engaging activities, contextual and cultural relevance, and a detailed, comprehensive facilitator guide. SM-ART was successfully developed and validated and is now ready for testing to promote the resilience of pregnant women at risk of perinatal mental illness.

Violence against women (VAW) is a major determinant in the assessment of a women's mental health. Many interventions have addressed strategies to reduce VAW, however, little information is available regarding effectiveness in the local context, particularly the role of men in women's empowerment. In Pakistan, a qualitative approach was undertaken in all four of its provinces to describe the community residents', both men and women, perceptions regarding the acceptability of a proposed life skills building (LSB) intervention involving men's engagement with regards to women's empowerment and VAW. Eighteen focus group discussions were conducted with men and women from locales within each province of Pakistan, averaging 6-10 participants per group. Fourteen key informant interviews were conducted with community stakeholders. The analysis identified three major themes: family life and male engagement, LSB training as an empowerment tool, and operationalization of the proposed LSB intervention. The proposed LSB intervention was well accepted by the participants with a strong urge to engage men in receiving the LSB training sessions. Men's engagement has been identified as an important element to facilitate women's empowerment. Participants suggested that these sessions should be held for two and a half hours per week within the community public spaces. In addition, these sessions should be based on an interactive approach. The focus of these sessions should include ideas surrounding positive relationships and economic skills building. Moreover, men's engagement will help to reduce VAW and improve the mental health of women in a patriarchal country like Pakistan.

IntroductionDespite quality of life (QoL) being recognized as an important outcome in neuro-oncology, there is a lack of research from Pakistan where sociocultural differences may influence QoL. This study aimed to measure the QoL in patients with primary brain tumors (PBTs), and assess its association with mental health outcomes, resilience, and social support.MethodsA cross-sectional survey was conducted among primary brain tumor patients. QoL was measured using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Resilience was assessed by Wagnild and Young's Resilience Scale, mental health outcomes using Hospital Anxiety and Depression Scale, and social support using the Enriched Social Support Instrument.ResultsOur study included a total of 250 patients, with median age of 42 years (range 33-54 years). The mean global QoL of the sample was 75.73 ± 14.9. On multivariable linear regression, global QoL was inversely associated with no or low income, having hypertension (-5.77), currently using a urine catheter (-15.33), having low social support (-28.16) suffering from mild (-9.88) or symptomatic (-17.59) depression, or mild anxiety (-7.11), while resilience (0.28) demonstrated a significant positive association. Conclusion The quality of life of patients with primary brain tumors in Pakistan is a function of clinical factors such as comorbid disease and use of a urinary catheter, social factors such a family income and social support, and psychological factors such as mental illness and resilience. Our findings may be of use in the development of QoL-improving interventions within the sociocultural setting of Pakistan.

BackgroundFamily presence during resuscitation (FPDR) has not been fully adopted by healthcare professionals (HCPs), especially physicians and nurses. However, the concept of FPDR is gradually gaining recognition around the world. There are no guidelines or policies in Pakistan to guide HCPs in their practice regarding FPDR. However, over time, patients' and families' rights have gained recognition and healthcare has progressed to become more patient–family centered.AimThe study aims to evaluate the impact of an educational program on knowledge, attitudes, and practices (KAP) of HCPs towards FPDR in ED, at a tertiary care setting, in Karachi, Pakistan.MethodsA quasi-experimental pretest and posttest design was used. KAP of ED nurses and physicians were assessed before (pretest), immediately after (posttest I), and at two weeks (posttest II) after the educational intervention, which includes an hour of educational training session.ResultsThe mean scores of knowledge and attitude of HCPs at all three points (pretest, posttest I, and posttest II) were found to be statistically significant (p < .001). There was a significant difference between pre- and posttest I, and posttest II (p < .001), but not between the two posttests. No significant difference was observed regarding practice scores.ConclusionThe study tested an educational intervention for FPDR, which was found to be effective in improving the HCPs' knowledge and in changing their attitude. Based on these results, FPDR-specific training, with structured FPDR guidelines using a multidisciplinary team approach are essential for the implementation of FPDR.

Objectives This study assessed resilience in brain tumor patients at a tertiary care hospital in Pakistan (a lower-middle-income country; LMIC), and explored its relationship with patients' sociodemographic factors, clinical characteristics, social support, and mental health. Methods A cross-sectional survey was conducted amongst adult (≥18 years) patients with brain tumor at the Aga Khan University Hospital, Pakistan. Resilience was assessed by Wagnild and Young's Resilience Scale,andpatients'psychosocial characteristics by the Hospital Anxiety and Depression Scale and the Enriched Social Support Instrument. Results A total of 250 patients were included (mean age:44 years; 68% males), with majority (97.6%) having high social support and only 4.4% and 2% having symptomatic depression and anxiety, respectively.On multivariable linear regression adjusted for covariates, lower resilience was associated withnot being involved in household decision-making(Adjusted Beta Coefficient: 4.58 [95% Confidence Interval:-7.59,-1.56]), not currently working (-2.80[-4.61,-0.99]), undergoing multiple neurosurgical interventions such as tumor biopsies or resections(-8.64[-13.11,-4.16]), receiving chemotherapy (-5.17[-9.51,-0.83]) or combination adjuvant therapy (-2.91[-5.14,-0.67]), low social support (-7.77[-13.73,1.81]), milddepression (-13.00[-17.00,-8.99]) or symptomatic depression (-19.79[-24.69,-14.89]), and mild anxiety (-4.24[-7.98,-0.50]). Conclusion Our study highlights the function of familial/household role and working status in mediating resilience, and demonstrates the well-known protective effect of resilience for mental health in brain tumor patients in Pakistan, a South-Asian LMIC.These findings are of clinical relevance with regards to the development of culture-specific evidence-based resilience-building interventions that may help patients with brain tumors to cope with the psychological distress of cancer. This article is protected by copyright. All rights reserved.

Background In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors. Methods An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients. Results Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; − 2.757, − 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value Conclusion Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems.

Purpose This study was undertaken to determine the effects of individualized education with support intervention on breast cancer patients’ anxiety and depression while undergoing radiation therapy (RT). Moreover, the intervention was assessed for its feasibility in the context of Pakistan. Methods A quasi-experimental design was used to conduct this study in RT department of a public hospital in Karachi. A total of 61 breast cancer patients receiving radiation as adjuvant therapy participated in the study. The experimental group (n = 31) received individualized education with support in the form of face-to-face sessions and information booklet prior to the commencement of RT. In addition, the nurse remained available for the consultation during the RT sessions and on telephone throughout the RT period. However, the control group received only information booklet. Patients' anxiety and depression were measured in both of the groups before the commencement of RT, and at the completion of RT by using the Aga Khan University Anxiety and Depression Scale (AKUADS). Results A significant reduction was found in the overall mean anxiety and depression scores of the experimental group (p = 0.000) from pre-test to post-test. The overall mean anxiety and depression scores of the control group showed no significant difference (p = 0.187). The effect size of the intervention was large (Cohen's d = 2.5). Conclusion The intervention was effective in reducing anxiety and depression among breast cancer patients receiving RT. Replication of the study on a larger scale in multiple settings on other cancer patients is recommended.

Background Recent Life Changes Questionnaire (RLCQ) developed by Richard Rahe has enabled quantification of stress by analyzing life events. The overall aim of the study was to create a reliable version of the Rahe’s RLCQ for measuring stress in individuals living in developing countries and assess its validity. This paper discusses criterion validation of the adapted RLCQ in urban communities in Pakistan. Methods This is a criterion validation study. Four urban communities of Karachi, Pakistan were selected for the study in which households were randomly chosen. Two data collectors were assigned to administer the adapted RLCQ to eligible participants after obtaining written informed consent. Following this interaction, two psychologists interviewed the same participants with a diagnostic gold standard of Mini International Neuropsychiatric Interview (MINI) which is utilized in usual practice within Pakistan to confirm the presence of stress related mental disorders such as Depression, Anxiety, Dysthymia, Suicide, Phobia, OCD, Panic Disorder, PTSD, Drug abuse and dependence, Alcohol abuse and dependence, Eating Disorders and Antisocial Personality Disorder to validate the accuracy of the adapted RLCQ. We generated the ROC curves for the adapted RLCQ with suggested cut-offs, and analyzed the sensitivity and specificity of the adapted RLCQ. Results The area under the receiver operating characteristic curve (ROC) of common mental disorders such as depression and anxiety was 0.64, where sensitivity was 66%, specificity was 56% and the corresponding cut off from the adapted RLCQ was 750. Individuals scoring ≥750 were classified as high stress and vice versa. In contrast, the area under the ROC curve for serious mental disorder and adverse outcomes such as suicide, bipolar and dysthymia was 0.75, where sensitivity was 72% and specificity was 60% at the cut off of 800 on the adapted RLCQ. Individuals scoring ≥800 were classified as high stress and vice versa. The rate of agreement between the two psychologists was 94.32% (Kappa = 0.84). Conclusion The adapted and validated RLCQ characterizes common mental disorders such as depression and anxiety with moderate accuracy and severe mental disorders such as suicide, bipolar and dysthymia with high accuracy. Trial registration Clinicaltrials.gov NCT02356263. Registered January 28, 2015. (Observational Study Only).

Background: Depression is one of the growing public health concerns among women worldwide. This is one of the most under-recognized and under-treated mental illnesses worldwide. Women of developing countries are inexplicably affecting with depression. Purpose: The purpose of study is to assess the prevalence and associative factors of depression among women of aged 20 to 40 years living in urban squatter settlements of Karachi, Pakistan. The identification of all the potential determinants will potentially help in formulating preventive strategies in order to decline the prevalence of depression among women and improve the wellbeing of women. Methods: An analytical cross-sectional survey was employed among women living in Reta Plot and Kala Board communities of Karachi, Pakistan. Beck Depression Inventory II (BDI-II) was used to measure depression. Systematic sampling was used to recruit 636 married women. Cox proportional hazard was run to compute prevalence ratios and their 95% confidence interval. Results: Our study estimated 33.3% of depression among study participants. The current study showed that age, possession of own vehicle, years of schooling and recent deaths in family were significantly associated with depression. Conclusion: This research was a bold step to address the issue of increasing rate of depression among Pakistani population. Our study results can convince policy makers to extend mental health support to women by improving accessibility of services. Recommendation: Our study recommends that the women of our society should be encouraged for attaining education. This study also recommends that at primary health care setting, every health professional should be trained to screen the depression. Moreover, the results of our study can also encourage policy makers to expand mental health support services for women.

To determine the socio-economic status of a peri-urban community.The cross-sectional study was conducted at Deh Chuhar village, Gaddap Town, Karachi from December 2015 to February 2016. The Water/Sanitation, Assets, Maternal Education and Income Index was used. All variables were given a score on the scale of 0-8. The resulting index was illustrated in the form of quintiles.: A total of 254 households were surveyed. Total population was 2117 with mean number of household members being 8±4. Mean index score was 0.39±0.14 and the median score was 0.375. Percentile distribution of the score indicated that 152(60%) households scored below 0.40 whereas, 51 (20%) were in the highest quintile with a score above 0.50.Water/Sanitation, Assets, Maternal Education and Income index suggested poor socio-economic status of the community studied.

Background: The concept of resilience is very crucial in promoting positive psychological well-being. However, this construct was never looked among married women of Karachi, Pakistan. Therefore, this study aimed to assess the prevalence and the associated risk factors of resilience in Pakistan. Methods: It was a cross-sectional survey, using the Wagnild Resilience Scale (RS) to assess resilience, Beck Depression Inventory II (BDI-II) for measuring depression and Trait Wellbeing Inventory for determining Life Satisfaction. Systematic sampling was employed to enroll 636 participants of aged 20 to 40 years living in two urban squatter settlements of Karachi, Pakistan. Prevalence ratio was computed with their 95% confidence interval. Results: A total of 636 married women participated in the study. The average age of females with low resilience was 29.8 (5.7) whereas the mean age of females with high resilience was 31.1 (5.7). Around 90% of all the participants could speak in Urdu. The prevalence of low resilience among women was 21.9%. Moreover, the prevalence of depression among low resilience group was 43.9% whereas the mean life satisfaction score among females with low resilience was lower than females with high resilience. The females who had low resilience were younger and had no formal/informal education as compared to their counterparts. After controlling for other variables, the prevalence of low resilience was 1.78 times more among depressed females as compared to the non-depressed with a 95% CI: (1.27-2.51). Moreover with every one unit increase in the life satisfaction scores, the prevalence of low resilience decreased 9%. Furthermore, age and informal schooling were also found to be significantly associated with resilience. Conclusion: Depression and life satisfaction are the potential modifiable risk factors for resilience and hence we can improve resilience through interventions that may focus on reducing depression and improving satisfaction towards life. Our study also recommends that health care professionals should be educated about these modifiable risk factors to bring about a change in the society and reduce the mental health illness by promoting constructive adaptation.

Background Depression and peer violence are global issues impacting youth. We are presenting baseline data as part of a cluster randomized control trial underway, on adolescent depression, and associated factors among boys and girls in schools. Method Cluster randomized control trial is underway for measuring the effectiveness of school-based play intervention program of the NGO Right to Play, in a sample of 1752 grade 6 youth in 40 public schools of Hyderabad, Pakistan. Students responded to Child Depression Inventory (CDI-2), the Peer Victimization Scale (PVS), the Peer Perpetration Scale (PPS), and investigator-driven seven-item School Performance Scale. Results We report baseline assessments to examine the prevalence of depressive symptoms, and associated occurrence of peer perpetration and victimization. Boys report significantly more depressive symptoms as well as perpetration and victimization compared to girls (p ≤ .0001). Our analysis indicates that among boys, depression was found associated with greater age, food insecurity, poorer school performance and working for money, as well as being beaten at home and witnessing beating of their mother by their father or other relatives. Among girls, depression was associated with a younger age, greater food insecurity and poorer school performance. Depression was also associated with a great likelihood of engagement in peer violence, experience of punishment at home, and witnessing their father fighting with other men or beating their mother. Conclusions Engagement in violent behaviors, exposure to violent acts and poverty surfaces as detrimental to mental health in youth age groups, suggesting strong measures to address youth violence, and poverty reduction for positive mental health outcomes in school age children.

BackgroundCancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.Method and analysisA cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD of QoL and resilience will range from 16.5 to 40.8 for head and neck cancer, and 12.7 to 34.1 for brain tumour, at 5% level of significance, with 2.5 precision. QoL will be assessed by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-H&N35 and EORTC QLQ-BN20 and resilience will be evaluated by Wagnild and Young’s 14-item scale. Mean±SD will be reported for resilience and QoL scores. Unadjusted and adjusted β-coefficients, with 95% CI, will be reported by using multiple linear regression analysis. Correlation analysis will also be performed using Pearson or Spearman rank correlation coefficients. A p value of Ethics and disseminationEthical approval has been obtained from the Aga Khan University Pakistan’s Ethical Review Committee. Written informed consent will be taken from the participants by trained research assistants. A trained psychologist will provide on-spot counselling to the participants and those identified with severe depression will be referred to a psychiatrist. The study materials will be kept under lock and key and the electronic data base will be password protected and will only be accessed by the research team. The study findings will be disseminated through publications conferences and workshops and research briefs.Trial registration numberClinicaltrials.gov registry (NCT03466762).

Background Contextually relevant stressful life events are integral to the quantification of stress. None such measures have been adapted for the Pakistani population. Methods The RLCQ developed by Richard Rahe measures stress of an individual through recording the experience of life changing events. We used qualitative methodology in order to identify contextually relevant stressors in an open ended format, using serial in-depth interviews until thematic saturation of reported stressful life events was achieved. In our next phase of adaptation, our objective was to scale each item on the questionnaire, so as to weigh each of these identified events, in terms of severity of stress. This scaling exercise was performed on 200 random participants residing in the four communities of Karachi namely Kharadar, Dhorajee, Gulshan and Garden. For analysis of the scaled tool, exploratory factor analysis was used to inform structuring. Finally, to complete the process of adaption, content and face validity exercises were performed. Content validity by subject expert review and face validity was performed by translation and back translation of the adapted RLCQ. This yielded our final adapted tool. Results Stressful life events emerging from the qualitative phase of the study reflect daily life stressors arising from the unstable socio-political environment. Some such events were public harassment, robbery/theft, missed life opportunities due to nepotism, extortion and threats, being a victim of state sponsored brutality, lack of electricity, water, sanitation, fuel, destruction due to natural disasters and direct or media based exposure to suicide bombing in the city. Personal or societal based relevant stressors included male child preference, having an unmarried middle aged daughter, lack of empowerment and respect reported by females. The finally adapted RLCQ incorporated “Environmental Stress” as a new category. Conclusion The processes of qualitative methodology, in depth interview, community based scaling and face and content validity yielded an adapted RLCQ that represents contextually relevant life stress for adults residing in urban Pakistan. Trial registration Clinicaltrials.gov NCT02356263. Registered January 28, 2015. (Observational Study Only). Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1315-1) contains supplementary material, which is available to authorized users.

Background: There were no instrument exists in South Asia to assess resilience. Thus, this study assessed the validity and reliability of the Urdu version of Wagnild and Young's long and short Resilience Scales. Methods: Study was carried out in two urban squatter settlements of Karachi, Pakistan. Resilience Scales were validated against the depression, anxiety, and life satisfaction scales among 20- to 40-year-old married women. Sample size for validity and reliability were 636 and 319. Results: Moderate negative correlation with the depression and anxiety and moderate positive significant correlation with life satisfaction were found with both scales. The test-retest correlation were .54 and .49, respectively. Internal consistency were found acceptable. Concurrent validity were .729 and .813. Conclusions: Study found a valid and reliable resilience scale in Urdu language.Keywords: resilience scale; validation; Urdu language; Pakistani populationThe resilience concept is widely discussed in history by diverse disciplines, such as psychology, philosophy, and theology. It is defined as "the ability to rebound or spring back, the power of something to resume its original shape or position after compression or bending" (Dowrick, Kokanovic, Hegarty, Griffiths, & Gunn, 2008). Some have also viewed resilience as a defense mechanism, which allows people to grow in the face of adversity (Davydov, Stewart, Ritchie, & Chaudieu, 2010). Thus, improving resilience can be a significant factor in mental health treatment because it represents one's internal power, strengths, positivity, flexibility, competency, and ability to cope effectively when faced with adversity (Abiola & Udofia, 2011).Resilience is a powerful antidote to depression. Strong resilient individuals are able to handle change and adversity well. They become less depressed. Resilience has been measured in thousands of people and the results have proven that it measures individual strengths that are potentially preventive for depression (Wagnild, 2009). Hence, measuring resilience helps because when the resilience scores increase, symptoms of depression and stress decrease. Thus, it can be said that resilience protects against depression and reduces the associated psychological effects. In addition, anxiety is negatively associated with resilience. If individual's resilience score is less, they will be more likely to dwell on problems, feel overwhelmed, and ultimately adapt unhealthy coping techniques to handle stress, which will further increase their anxiety.Most studies have suggested that resilient persons tend to manifest adaptive behavior, especially in the areas of social functioning. One study found that resilience displayed high measures of consistency and correlation with life satisfaction scales in different situations (Salazar-Pousada, Arroyo, Hidalgo, Perez-Lopez, & Chedraui, 2010). Moreover, when people experiences positive emotions to meet life's challenges and opportunities, their satisfaction with life rises because learning to cope with the down times is essential to life satisfaction (Cohn, Fredrickson, Brown, Mikels, & Conway, 2009).Assessing resilience in high-risk populations, who are vulnerable to psychological and developmental problems, is very essential. Poverty is considered as one of the confirmed contributors that causes vulnerability among individuals, families, and communities. Those individuals who experience economic and employment hardships might feel discouragement and fear, and the individual might believe that life is pointless (Wagnild & Collins, 2009). Literature in this area is very scarce (Oft, 2009).Resilience is an important trait for promoting positive psychological well-being and studying this can contribute to our understanding of constructive adaptation and stress resistance. In South Asia, there is no known validated tool for measuring resilience, this limits our ability to carry out empirical research in this area and to identify people who have the capacity for resilience. …

Background Child peer violence is a global problem and seriously impacts health and education. There are few research studies available in Pakistan, or South Asia. We describe the prevalence of peer violence, associations, and pathways between socio-economic status, school performance, gender attitudes and violence at home. Methods 1752 children were recruited into a cluster randomized controlled trial conducted on 40 fairly homogeneous public schools (20 for girls and 20 for boys), in Hyderabad, Pakistan. This was ranging from 20–65 children per school. All children were interviewed with questionnaires at baseline. Results Few children had no experience of peer violence in the previous 4 weeks (21.7% of girls vs.7% of boys). Some were victims (28.6%, of girls vs. 17.9% of boys), some only perpetrated (3.3% of girls vs. 2.5%) but mostly they perpetrated and were victims (46.4%.of girls vs 72.6%. of boys). The girls’ multivariable models showed that missing the last school day due to work, witnessing her father fight a man in the last month and having more patriarchal gender attitudes were associated with both experiencing violence and perpetration, while, hunger was associated with perpetration only. For boys, missing two or more days of school in the last month, poorer school performance and more patriarchal attitudes were associated with both victimization and perpetration. Witnessing father fight, was associated with peer violence perpetration for boys. These findings are additionally confirmed with structural models. Discussion Peer violence in Pakistan is rooted in poverty and socialization of children, especially at home. A critical question is whether a school-based intervention can empower children to reduce their violence engagement in the context of poverty and social norms supportive of violence. In the political context of Pakistan, reducing all violence is essential and understanding the potential of schools as a platform for intervention is key.

Peer violence was remarkably high at baseline. Among urban public school students, 94% of 6th-grade boys and 85% of girls reported being victimized by peers in the last 4 weeks. And 85% of boys and 66% of girls reported perpetrating such violence. Boys scored worse on a number of mental health measures. A cluster RCT is underway to evaluate a well-established school-based intervention using sports and games to reduce peer violence., Background: Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health. Methods: A cluster randomized controlled design is being conducted with boys and girls in grade 6 in 40 schools in Hyderabad, Pakistan, over a period of 2 years. The Multidimensional Peer-Victimization and Peer Perpetration Scales and the Children's Depression Inventory 2 (CDI 2) are being used to measure the primary outcomes while investigator-derived scales are being used to assess domestic violence within the family. Specifics of the intervention, field logistics, ethical, and fidelity management issues employed to test the program's impact on school age youth in a volatile and politically unstable country form this report. Baseline Results: A total of 1,752 school-age youth were enrolled and interviewed at baseline. Over the preceding 4 weeks, 94% of the boys and 85% of the girls reported 1 or more occurrences of victimization, and 85% of the boys and 66% of the girls reported 1 or more acts of perpetration. Boys reported more depression compared with girls, as well as higher negative mood and self-esteem scores and more interpersonal and emotional problems. Interpretation: Globally, prevalence of youth violence perpetration and victimization is high and associated with poor physical and emotional health. Applying a randomized controlled design to evaluate a peer violence prevention program built on a firm infrastructure and that is ready for scale-up and sustainability will make an important contribution to identifying evidence-informed interventions that can reduce youth victimization and perpetration.