International Journal of Public Health

, Volume 63, Issue 6, pp 693–702 | Cite as

Social support intervention to promote resilience and quality of life in women living in Karachi, Pakistan: a randomized controlled trial

  • Saima S. HiraniEmail author
  • Colleen M. Norris
  • K. Jessica Van Vliet
  • Sander Veldhuyzen Van Zanten
  • Rozina Karmaliani
  • Gerri Lasiuk
Original Article



This study tested the efficacy of a 6-week social support intervention for enhancing resilience and quality of life among women living in low socioeconomic areas of Karachi, Pakistan.


One hundred and twenty women were randomly allocated to the intervention (n = 60) or control group (n = 60). Women in the intervention group attended a 6-week social support program, while those in the control group attended a single mental health awareness session. Outcome variables were measured via the resilience scale-14 item (RS-14), the resilience scale for adults (RSA), and World Health Organization quality of life brief scale (WHOQOL-BREF).


Compared to participants in the control group, women in the intervention group reported improvements in resilience measured by RS-14 (p = 0.022) and the structured style subscale of the RSA (p = 0.043). A medium effect size was also measured on the structured style subscale (d = 0.6, 95% CI = 0.62874, 2.57126). No significant findings were noted on QOL scores.


Community-based social support interventions are a gender-sensitive-, culturally appropriate-, and resource-sparing approach to promote women’s resilience and improve their mental health.


Resilience Women Social support Mental health promotion 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. Ahmer S, Faruqui RA, Aijaz A (2007) Psychiatric rating scales in Urdu: a systematic review. BMC Psychiatry. PubMedPubMedCentralCrossRefGoogle Scholar
  2. Ali BS, Rahbar AL, Tareen A, Gui L, Samad L (2002) Prevalence of and factors associated with anxiety and depression among women in lower middle class semi-urban community of Karachi, Pakistan. J Pak Med Assoc 52:513–517PubMedGoogle Scholar
  3. Bhamani SS, Pasha O, Karmaliani R, Asad N, Azam I (2015) Validation of the Urdu version of Wagnild and Young’s long and short resilience scales among 20 to 40 year old married women living in urban squatter settlements of Karachi. J Nurs Meas 23:425–435. CrossRefPubMedGoogle Scholar
  4. Canadian Institute of Health Information (2012) The role of social support in reducing psychological distress.
  5. Cohen S, Underwood LG, Gottlieb BH (eds) (2000) Social support measurement and interventions: A guide for health and social scientists. Oxford University, New YorkGoogle Scholar
  6. Den Oudsten BL, Zijlstra WP, De Vries J (2012) The minimal clinical important difference in the World Health Organization Quality of Life instrument-100. Support Care Cancer. CrossRefGoogle Scholar
  7. Dennis CL, Hodnett E, Reisman HM, Kenton L, Weston J, Zupancic J et al (2009) Effects of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Diener E, Suh E (1997) Measuring quality of life: economic, social, and subjective indicators. Soc Indic Res 40:189–216CrossRefGoogle Scholar
  9. Economou M, Kokkosis M, Triantafillou E, Christodoulou G (2001) Quality of life and mental health: conceptual approaches and clinical and assessment issues. Arch Hell Med 18:239–253Google Scholar
  10. Friborg O, Hjemdal O, Rosenvinge JH, Martinussen M (2003) A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment? Int J Methods Psychiatr Res 12:65–76CrossRefPubMedGoogle Scholar
  11. Hinton A, Downey J, Lisovicz N, Mayfield-Johnson S, White-Johnson F (2004) The community health advisor program and the deep south network for cancer control: health promotion programs for volunteer community health advisors. Fam Community Health 22:20–27Google Scholar
  12. Hussain N, Chaudary IB, Afridi MA, Tomenson B, Creed F (2007) Life stress and depression in a tribal area of Pakistan. Br J Psychiatry 190:36–41CrossRefGoogle Scholar
  13. Jaeschke R, Singer J, Guyatt GH (1989) Ascertaining the minimal clinically important difference. Controll Clin Trials 10:407–415CrossRefGoogle Scholar
  14. Jane-Llopis E, Hosman C, Jenkins R, Anderson P (2003) Predictors of efficacy in depression prevention programmes. Br J Psychiatry 183:384–397. CrossRefPubMedGoogle Scholar
  15. Karmaliani R, Shehzad S, Hirani SS, Asad N, Hirani SAA, McFarlane J (2011) Meeting the 2015 millennium development goals with new interventions for abused women. Nurs Clin N Am 46:485–493. CrossRefGoogle Scholar
  16. Kessler RC, McLeod JD (1985) Social support and mental health in community samples. Academic Press, New YorkGoogle Scholar
  17. Lakey B, Cohen S (2000) Social support theory and selecting measures of social support. In: Cohen S, Gordon LU, Gottlieb BH (eds) Social support measurement and interventions: a guide for health and social scientists. Oxford University, New YorkGoogle Scholar
  18. Mujeeb A, Zubair A (2012) Resilience, stress, anxiety, depression among internally displaced persons affected by armed conflict. Pak J Soc Clin Psychol 10:20–26Google Scholar
  19. Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S (2007) Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry 4:35–40PubMedPubMedCentralGoogle Scholar
  20. Patel V, Araya R, Chatterjee S (2007) Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 370:991–1005CrossRefPubMedGoogle Scholar
  21. Pfeiffer PN, Heisler M, Piette JD, Rogers MAM, Valenstein M (2011) Efficacy of peer support interventions for depression: a meta-analysis. Gen Hosp Psychiatry 33:29–36. CrossRefPubMedGoogle Scholar
  22. Rabbani F, Qureshi F, Rizvi N (2008) Perspectives on domestic violence: case study from Karachi, Pakistan. East Mediterr Health J 14:415–426PubMedGoogle Scholar
  23. Rahman A, Malik A, Sikander S, Roberts C, Creed F (2008) Cognitive behavioral therapy- based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster randomized control trial. Lancet 372:902–909CrossRefPubMedPubMedCentralGoogle Scholar
  24. Rahman A, Hamdani SU, Awan NR, Bryant RA, Dawson KS, Khan MF, Azeemi MM et al (2016) Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict affected area of Pakistan: a randomized clinical trial. Journal of American Medical Association 316(24):2609–2617. CrossRefGoogle Scholar
  25. Rose GE (2008) The population strategy of prevention. In: Rose G, Khaw KT, Marmot M (eds) Rose’s strategy of preventive medicine. Oxford University Press, Oxford. CrossRefGoogle Scholar
  26. Roux L, Pratt M, Tengs TO, Yore MM, Yanagawa TL, Van Den Bos J, Rutt C et al (2008) Cost effectiveness of community-based physical activity interventions. Am J Prev Med 35(6):578–588. CrossRefPubMedGoogle Scholar
  27. Rutter M (2012) Resilience as a dynamic concept. Development of Psychopathology 24:335–344CrossRefGoogle Scholar
  28. Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS et al (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health surveys. Arch Gen Psychiatry 66:785–795. CrossRefPubMedPubMedCentralGoogle Scholar
  29. Skevington SM, Lotfy M, O’Connell KA (2004) The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial a report from the WHOQOL group. Qual Life Res 13:299–310CrossRefPubMedGoogle Scholar
  30. Southwick SM, Vythilingam M, Charney DS (2005) The psychobiology of depression and resilience to stress: implications for prevention and treatment. Ann Rev Clin Psychol 1:255–291CrossRefGoogle Scholar
  31. Stansfeld SA, Fuhrer R, Head J (1997) etal (1997) Work and psychiatric disorder in the whitehall II study. J Psychosom Res 43:73–81CrossRefPubMedGoogle Scholar
  32. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol 43(2):476–493. (Epub 19 Mar 2014) CrossRefPubMedPubMedCentralGoogle Scholar
  33. Tamres L, Janicki D, Helgeson VS (2002) Sex differences in coping behavior: a meta-analytic review. Person Soc Psychol Rev 6:2–30CrossRefGoogle Scholar
  34. Taylor SE (2006) Tend and befriend: behavioral bases of affiliation under stress. Assoc Psychol Sci 15:273–277Google Scholar
  35. Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RAR, Updegraff JA (2000) Biobehavioral responses to stress in females: tend-and-befriend, not fight-or- flight. Psychol Rev 107:411–429CrossRefPubMedGoogle Scholar
  36. Thara R, Patel V (2006) Women’s mental health: a public health concern. Regional Health Forum WHO South-East Asia Region 5(1) Accessed 10 June 2013
  37. Uchino BN, Cacioppo JT, KiecoltGlaser JK (1996) The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychol Bull 119:488–531CrossRefPubMedGoogle Scholar
  38. Wachs TD, Black MM, Engle PL (2009) Maternal depression: a global threat to children’s health, development, and behavior and to human rights. Child Dev Perspect 3:51–59CrossRefGoogle Scholar
  39. Wagnild G (2009) A review of the resilience scale. J Nurs Manag 17(2):105–113. CrossRefGoogle Scholar
  40. Wagnild G, Young H (1993) Development and psychometric evaluation of the Resilience Scale. J Nurs Meas 1:165–178PubMedGoogle Scholar
  41. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet 370:841–850CrossRefGoogle Scholar
  42. World Health Organization (1996) WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment. Accessed 15 March 2014
  43. World Health Organization (2004) A response to the need for comprehensive, consistent, and comparable information on diseases and injuries at global and regional level. Accessed 25 July 2013
  44. World Health Organization (2008) The global burden of diseases. Accessed from 10 Aug 2013
  45. World Health Organization. (2014a). Global burden of disease. Retrieved from
  46. World Health Organization (2014b) Social determinants of mental health. Accessed 1 Oct 2016
  47. Xu J, Ou L (2014) Resilience and quality of life among Wenchuan earthquake survivors: the mediating role of social support. Public Health 128:430–437CrossRefPubMedGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Saima S. Hirani
    • 1
    Email author
  • Colleen M. Norris
    • 2
  • K. Jessica Van Vliet
    • 3
  • Sander Veldhuyzen Van Zanten
    • 4
  • Rozina Karmaliani
    • 5
  • Gerri Lasiuk
    • 6
  1. 1.School of Nursing and MidwiferyThe Aga Khan UniversityKarachiPakistan
  2. 2.Faculty of Nursing, Public Health, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  3. 3.Educational PsychologyUniversity of AlbertaEdmontonCanada
  4. 4.Division of Gastroenterology, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  5. 5.Department of Community Health Sciences, School of Nursing and MidwiferyThe Aga Khan UniversityKarachiPakistan
  6. 6.College of NursingUniversity of SaskatchewanReginaCanada

Personalised recommendations