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Life stress and depression in a tribal area of Pakistan

  • N. Husain (a1), I. B. Chaudhry (a1), M. A. Afridi (a2), B. Tomenson (a3) and F. Creed (a3)...
Abstract
Background

Depression is common in Pakistan but no research on this subject has been reported from the North West Frontier Province (NWFP), host to numerous Afghan refugees.

Aims

To measure depressive symptoms and associated features in a population-based sample.

Method

A Pushto translation of the Self Reporting Questionnaire (SRQ) was administered to 471 adults living in a village in one of the federally administered tribal areas. Respondents were also assessed with a life events checklist for social problems, a social support questionnaire and the Brief Disability Questionnaire.

Results

Sixty per cent (95/158) of women and 45% (140/313) of men scored 9 or more on the SRQ. High SRQ score was associated with few years of education, higher social problem score, less social support and greater disability. High social problem score was the strongest correlate.

Conclusions

This population reports more depressive symptoms than other communities in Pakistan and this probably reflects the very high degree of social stress experienced in the NWFP, which has been affected by years of turmoil in neighbouring Afghanistan.

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Copyright
Corresponding author
Dr N. Husain, Division of Psychiatry, Rawnsley Building, University of Manchester, Oxford Road, Manchester M13 9WL, UK. Email: nusrat.husain@manchester.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Life stress and depression in a tribal area of Pakistan

  • N. Husain (a1), I. B. Chaudhry (a1), M. A. Afridi (a2), B. Tomenson (a3) and F. Creed (a3)...
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eLetters

Low SES and other factors to consider.

Archana Jauhari, Staff Grade, Psychiatry
01 February 2007

I read the article by Husain et al with interest. It is quite interesting study as mental illness is quite neglected in low socioeconomic and tribal areas. Because of taboo of mental illness and social system people find it hard to accept having mental health problems and keeping this in mind self-reported questionnaire (used in this study) might under estimate the problem.

In developing world, mental illnesses may present in a more socially acceptable manner of physical symptoms. It has been seen that low socioeconomic status, literacy rate and psychological sophistication are associated with high prevalence of conversion disorder, as evident in developing countries compared with developed world.

On the other hand, confounding factor in the study could be physical illness like anaemia. Many of the women in child bearing age group in low socioeconomic area suffer from low haemoglobin level that can present withsymptoms similar to depression.

In this study, as most of these people are from refugee area, it willbe interesting to see if their depressive symptoms are related to PTSD or not.

Over all the study is appreciated as it raises the awareness of need for mental health support for these people.
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Conflict of interest: None Declared

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Psychiatric Morbidity in Afghan Refugees

AADIL JAN SHAH, SHO Psychiatry
01 February 2007

I would like to congratulate N.Husain et.al.,for their recently published study "Life stress & depression in a tribal area of Pakistan".It reflects that most of the participants in this study were Afghan refugees who have been living in North West Frontier Province (NWFP) of Pakistan.The authors have done a commendable job as very few studies in the past have concentrated on this neglected cross section of people.Afghans have been refugees in different countries after Afghanistan was invaded by former Soviet Union in 1979.A large number of Afghans migrated to Pakistan & have been living in under developed & poor areas like NWFP.This already war traumatised population have been through different types of stressors since,resulting in psychological & emotional problems.Depression & PTSD are the most common.It seems that the present study has covered a tribal population which included both Afghan refugees & local Pakistanis in NWFP.There are previous studies which have concentrated mainly on Afghan refugees living in different parts of world,especially US.The Afghan refugees in Pakistan have been poorly studied.Therefore present study is an enlightment for researchers to focus on this traumatised population.A study done by Farooq Naeem et.al.,in 2004 (Psychiatric morbidity among Afghan refugees in Peshawar,Pakistan)found that 80% of the people who attended a Psychiatric clinic met the diagnosis of PTSD which is quite significant.A WHO fact-finding mission to Pakistan found that 30% of Afghan refugees are presenting psychosomatic complaints resulting from psychological illness.It is quite astonishing that 60% of women & 45% of men scored 9 or more on SRQ in the present study.This study also reflects the poor living conditions of these people with lack of education & social problems which adds to their trauma.There is a desperate need to improve their living conditionsand educate these people,so they could recognise their symptoms & seekhelp, as the condition like Depression is treatable & will improve their quality of life significantly.In doing so, help is need from worldwide.There is also a need for future research which could compare thepercentage of psychiatric illness in Afghan refugees in developed countries (like US)with refugees living in poor areas like NWFP (Pakistan).

Declaration of interest : None.

References

David Sahar,MD,San Francisco CA,Depression Among Afghan refugees in West,June 1998,Afghan Mosiac Magazine.

Hussain,N.,Choudhry,I.B.,Tomenson,B.,et al(2007)Life stress and depression in a tribal area of Pakistan,The British Journal of Psychiatry,190:36-41.

Mghir R, Freed W, Raskin A, Katon W. (1995) Depression and posttraumatic stress disorder among a community sample of adolescent and young adult Afghan refugees. J Nerv Ment Dis. 1995 Jan;183(1):24-30.

Naeem,F.,Mufti,K.A.,Ayub,M., et.al.,2004 Psychiatric morbidity among Afghan refugees in Peshawar Pakistan.
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Conflict of interest: None Declared

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