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Rapid Responses: Rapid Responses published:
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We Need More Help
- Dr.Ali H Rasheed (2 April 2004)
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Anxiety and Depressive Illness in Pakistan
- Shakeel Suleman (5 April 2004)
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Mental morbidity in Pakistan: epidemic or false alarm?
- Atif Rahman, Waquas Waheed, Nusrat Husain, and Fareed Minhas (9 April 2004)
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Dr.Ali H Rasheed, Psychiatrist MOH-PTSD team
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I would like to offer my sincere feelings towards the authors of this article, but that would evoke a response that psychiatric morbidity is getting higher and higher in our societies. I am an Iraqi psychiatrist, and what my country have been through during the last decades is much worse than any other country in the world. In Iraq we have less than 100 psychiatrists serving a population of more than 24 million, and serious disruption in the health infra structure. The future of mental health programs, in such a traumatised nation, looks gloomy without the help of the international agencies. This is an occasion, I believe, to ask for more help and understanding of the needs of mental health services in the developing world. We need combined efforts in order to help them. Competing interests: None declared |
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Shakeel Suleman, Information Manager Birmingham, UK, B2 4DY
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This is an extremely useful contribution to a subject that is rarely ever discussed in Pakistan. It would be very difficult to assess the true extent of depression in Pakistan simply because in many cases it is not even diagnosed or is misdiagnosed. In some rural areas mental distress is interpreted as possession by evil spirits, requiring a spiritual cure. The paper is right to identify the causal factors as socio-economic conditions as well as family relations. Family can be the source of problems, but very often it can also be a pillar of support in the absence of any other help. Socio-economic factors, though a source of worry for most Pakistanis, can also trigger depression. Factors include the absence of a regular income and providing for a large family, worries about building a house, arranging and financing marriages for children. One factor underlying all these is insufficient attention to family planning- another issue rarely discussed in rural areas. Competing interests: None declared |
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Atif Rahman, Senior Research Fellow University Dept. of Child Psychiatry, Royal Manchester Children's Hospital, Manchester M27 4HA, Waquas Waheed, Nusrat Husain, and Fareed Minhas
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One in three people in Pakistan are anxious or depressed. (1) Such alarmingly high figures raise many questions. Are these findings artefacts? Do they represent clinical depression or social distress, and therefore, are the investigators medicalising the normal human condition of unhappiness? Or, is this a true epidemic of mental morbidity? We strongly agree with the authors that these figures should be treated with caution because of methodological issues. Psychiatric disorders are intrinsically difficult to define because they are based on clusters of symptoms rather than discrete entities. In the absence of emic instruments, diagnostic criteria used must be rigorously translated and culturally adapted. The interview style and setting may influence the response of research-naïve subjects. Absence of reliable demographic data may make it is difficult to say if samples are representative. The two- stage study design used commonly in surveys may be misleading if inappropriate weighting procedures and statistical software are used (2). In the absence of impaired functioning as a diagnostic criterion, discrimination between clinical depression and normal distress may be difficult. Furthermore, cross-sectional studies provide only limited epidemiological information. In spite of these methodological issues in the studies reviewed, Mirza and Jenkins flag up an area that should be of extreme concern to policy makers in south Asia. The socio-economic cost of mental disorder is high – more longitudinal and intervention studies are urgently required. 1. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ 2004; 328: 794-7. 2. Dunn G, Pickles A, Tansella M, Vazquez-Barquero JL. Two-phase epidemiological surveys in psychiatric research. Br J Psychiatry 1999; 174:95-100. Competing interests: None declared |
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