In this study, we explored the attitudes towards Medically Unexplained Symptoms (MUS) of 500 GP's in Karachi, Pakistan. Using a questionnaire previously developed by Reid et al (2001), we aimed to investigate whether GP's attitudes towards medically unexplained symptoms are similar to those of GP's in the developed world.

500 GP's on the database of primary care centres at the Pakistan Institute of Learning and Living in Karachi, were all sent a covering letter explaining the purpose of the survey with a case vignette, a questionnaire, and a stamped addressed envelope. One month later, non-respondents received a telephone call from an investigator to remind them of the study.

Of the 429 respondents, 68.5% (294) were male and 31.5% (135) female. Although 80.2% of respondents felt that the main role of GP's was to provide support and reassurance, 76.9% of respondents also agreed that GP's had a role in referring patients with MUS for further investigations to identify a cause. 204 (47.55%) respondents agreed that somatization was useful concept, only 146 (34.03%) felt that there was effective treatment for it.

For the most part Pakistani GPs’ attitudes towards MUS are similar to those of their counterparts in the West. Both agree that the GP had an important role in providing reassurance and counselling. However, our survey also shows that Pakistani GP's are less likely to place emphasis on an underlying psychiatric diagnosis and tend to focus on looking for an underlying physical cause.

To examine psychological distress and quality of life in patients with medically unexplained symptoms (MUS) compared to those with medically explained symptoms (MES) in a primary care setting in Karachi, Pakistan.

472 patients attending a GP clinic in Karachi completed questionnaires to assess somatic symptoms, anxiety, depression, and quality of life. The patients’ GP recorded whether the complaint was medically unexplained or medically explained.

Patients with MUS were more likely to be employed (p=0.01) educated to a higher level (p<0.001), have less difficulty meeting day-today need (p=0.05) and have a higher percentage of people showing concern and interest in what they are doing (p<0.001). In addition, they have fewer problems with mobility (p=0.001), with usual activities (p=0.05), with pain/discomfort (p=0.004) and with anxiety/depression (p<0.001). They have a smaller number of family members (p=0.05), a higher income (p=0.019), a lower level of depression (p=0.05) and a lower number of life events (p<0.001). In terms of significant independent risk factors for medically unexplained symptoms, there were three such risk factors, the number of life events (OR 0.88, p<0.001), problems with anxiety/depression as measured on the EQ-5D (OR 0.53, p=0.003) and the amount of concern shown by people (OR 1.82, p=0.006).

Compared to people with MES, those with MUS had experienced less psychological distress and better health-related quality of life. Furthermore, those with MES had higher scores on the life events checklist and were more likely to come from larger families, be illiterate, unemployed and to have financial problems.

It has been estimated that the global burden of suicide is a million deaths per year (WHO, 2014). Rates of self-harm in British South Asian (BSA) women are higher compared to their white counterparts. Limited evidence is available on effective preventative strategies and culturally sensitive interventions for these patients.

To understand common perceptions about self-harm, identify any barriers to accessing services and service improvement recommendations including appropriate interventions for BSA women.

To examine the views of health professionals on the culturally adapted problem solving therapy (C-MAP) in BSA women.

The design was a qualitative study using focus group discussion. This is part of a larger exploratory trial, to test a culturally adapted problem solving therapy (C-MAP) in British South Asian women who have a history of self-harm (Husain et al., 2011). Three focus groups were held with Asian lay members of the community, health professionals and service users. The data was analysed using a manual content analysis and indexing technique.

Results showed lack of identification of self-harm by health professionals. Common self-harm methods reported were serious overdoses, use of household chemicals, burning and cutting. Lack of trust in GP s was one common reason for non-disclosure of self-harm behaviour. Need for increased awareness, working along with local Imams, better cultural sensitivity among health professionals and non-judgmental support were some solutions offered to address these barriers.

The results of this study have provided insight into developing strategies to prevent and manage self-harm in British South Asian women.

The authors have not supplied their declaration of competing interest.