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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.

Background Pakistan has one of the highest reported rates of childhood intellectual disabilities in the world. Prevalence estimates vary from 19.1/1000 for serious intellectual disability to 65/1000 for mild intellectual disability Methods We surveyed carers of persons with intellectual disabilities (n=100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers (n=16) and key primary health providers (n=10). We also carried out focus groups (n=7). Data was triangulated and interpreted in light of peer reviewed literature Results There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean SRQ score 8.4; 95%CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with intellectual disability contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for intellectual disabilities. Conclusions Our findings suggest that there is significant delay in detection of intellectual disabilities especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost effective, community level interventions, which can be integrated into existing healthcare systems.

was highly valued by trainees and appears to be most effectively provided on a formal basis with adequate supervision. Our survey showed that in this region most clinical experience was adequately supervised though there were problems with FT, IDP and CBT supervision (on two schemes).

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The prevalence of psychological distress was lower in urban Karachi than that reported previously for rural Punjab province, Pakistan. However, in urban Karachi, as in rural Punjab, socioeconomic status seemed to have more of an impact on the mental health of women than that of men.

Aims and MethodTo develop a child and adolescent mental health service in a low-income country. This was a collaborative effort involving governmental and non-governmental organisations in the UK and Pakistan, where a training clinic was established.ResultsWe assessed and treated 169 children and adolescents. A team of mental health professionals was trained, including one consultant psychiatrist; the consultant psychiatrist is now leading the clinic. Links were further developed with healthcare, social care and educational organisations, as well as efforts made to engage the public in relation to child and adolescent mental health.Clinical ImplicationsOur development highlights a model of research collaboration and service development which may be sustainable in low-income settings. Such initiatives need support from a variety of organisations. There is a need to consider whether there should be a formal funding mechanism to support the Royal College of Psychiatrists Senior Volunteer Programme.

The project aimed to improve productivity of psychiatric out patient clinic using quality improvement techniques through “Listening Into Action", a national programme designed to engage and support front-line clinicians to make improvements to patient care. We identified reasons as to why our patients missed appointments and then introduced a system to reduce “did not attend” (DNA) rates.Non-attendance at appointments results in a waste of resources and increases waiting times. It has been reported that DNA rates in mental health are higher compared to other settings. Therefore, reducing DNA rates are a priority for mental health care providers.We collected DNA rates over a period of months over May 2013 to September 2013. We conducted a patient survey to inquire why the patients missed their appointments. The aim of the project and results from the survey were presented and discussed at the multi-disciplinary team meeting to generate ideas for improvement and engage the team with the project. As the most frequent response from the survey was ‘forgetting the appointment’, we decided to introduce text messaging as an intervention to remind patients of their appointments. We also ensured that staff updated the mobile phone records for the patients at each appointment. We monitored the DNA rates after introducing this change on a monthly basis.Following our intervention, there was an overall reduction in DNA rates for all disciplines from 11.4% to 10.62% with the greatest change for medical DNA's from 17.7% to 11.8 %.Results from a patient survey showed that the reasons for non-attendance are multi-factorial and require a complex approach. Our intervention was a simple one but still it demonstrated some effectiveness. Reducing DNA rates requires interventions to be regularly monitored so that their effect is sustained over a period of time.