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Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:794
  1. Ilyas Mirza (ilyasmirza{at}, specialist registrar in adult psychiatry1,
  2. Rachel Jenkins, visiting professor and director2
  1. 1Royal London Hospital (St Clement's), London E3 4LL
  2. 2WHO Collaborating Centre for Mental Health, Institute of Psychiatry, London SE5 8AF
  1. Correspondence to: I Mirza, Larkswood Centre, Thorpe Coombe Hospital, London E17 3HP
  • Accepted 5 March 2004


Objectives To assess the available evidence on the prevalence, aetiology, treatment, and prevention of anxiety and depressive disorders in Pakistan.

Design Systematic review of published literature.

Studies reviewed 20 studies, of which 17 gave prevalence estimates and 11 discussed risk factors.

Main outcome measures Prevalence of anxiety and depressive disorders, risk factors, effects of treatment.

Results Factors positively associated with anxiety and depressive disorders were female sex, middle age, low level of education, financial difficulty, being a housewife, and relationship problems. Arguments with husbands and relational problems with in-laws were positively associated in 3/11 studies. Those who had close confiding relationships were less likely to have anxiety and depressive disorders. Mean overall prevalence of anxiety and depressive disorders in the community population was 34% (range 29-66% for women and 10-33% for men). There were no rigorously controlled trials of treatments for these disorders.

Conclusions Available evidence suggests a major social cause for anxiety and depressive disorders in Pakistan. This evidence is limited because of methodological problems, so caution must be exercised in generalising this to the whole of the population of Pakistan.


  • Funding None.

  • Competing interests None declared.

  • Ethical approval Not required.

  • Embedded Image References w1-w20 are listed on

  • Contributors IM proposed the idea, which was further developed by RJ. IM performed the literature search and data extraction. IM and RJ both wrote the paper. IM is guarantor for the study.

  • Accepted 5 March 2004
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