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Demographic factors, social problems and material amenities as predictors of psychological distress: a cross-sectional study in Karachi, Pakistan

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Abstract

Purpose

Previous research has shown high prevalence rates for stress and psychiatric morbidity in rural areas of Pakistan, but prevalence findings from urban areas vary widely (between 18 and 70 %). Many of these studies have focused on special populations and may not be representative of the general population in urban settings. The purpose of the present study was to ascertain prevalence and predictors of psychological distress in a representative sample of community dwelling adults from mid-low to low-income urban areas of Karachi, Pakistan.

Method

A cross-sectional survey was undertaken utilizing probability-based sampling from five mid-low to low-income communities of Karachi. Measures included the twelve-item Urdu version of general health questionnaire (GHQ-12), a demographic questionnaire, and questions about financial, health-related and family problems and about access to services and material amenities owned.

Results

Seventeen per cent of respondents (N = 1,188) were positive for psychological distress. More females were distressed than males and migrant groups had higher prevalence of distress as compared with natives of the city. Although other studies have shown low education or income to be associated with emotional distress and non-psychotic psychiatric morbidity, our study suggested that having limited income or education may make one more vulnerable to social problems that in turn may be associated with greater distress. An access to services and material amenities had a small but significant association with decreased distress.

Conclusion

The overall national prevalence rates may not reveal the influence of gender, region (rural v. urban) and migration on psychological distress. Further research is needed to address mental health of migrant groups in urban centers of Pakistan.

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References

  1. Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG (2002) Psychological distress as a risk factor for coronary heart disease in the Whitehall II study. Int J Epidemiol 31:248–255

    Article  PubMed  Google Scholar 

  2. May M, McCarron P, Stansfeld S, Ben-Shlomo Y, Gallacher J, Yarnell J, Smith GD, Elwood P, Ebrahim S (2002) Does psychological distress predict the risk of ischemic stroke and transient ischemic attack?: the Caerphilly study. Stroke 33:7–12. doi:10.1161/hs0102.100529

    Article  PubMed  Google Scholar 

  3. Herzig L, Muhlemann N, Burnand B. Favrat B, Verdon F, Bischoff T, Haftgoli N, Vaucher P (2012) Development of mental disorders 1 year after exposure to psychosocial stressors; a cohort study in primary care patients with physical complaints. BMC Psychiatry 12:120. doi:10.1186/1471-244X-12-120

  4. Lawrence D, Mitrou F, Zubrick SR (2011) Non-specific psychological distress, smoking status and smoking cessation: United States National Health Interview Survey 2005. BMC Public Health 11:256–268. http://www.biomedcentral.com/1471-2458/11256. Accessed 13 Sept 2012

  5. Moller CI, Tait RJ, Byrne DG (In press) Self-harm, substance use and psychological distress in the australian general population. Addic. doi:10.1111/j.1360-0443.2012.04021.x

  6. Johnson J, Weissman MM, Klerman GL (1992) Service utilization and social morbidity associated with depressive symptoms in the community. J Am Med Assoc 267(11):1478–1483

    Article  CAS  Google Scholar 

  7. Mirza I, Jenkins R (2004) Risk factors, prevalence and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ 328:794–798

    Article  PubMed  Google Scholar 

  8. Husain N, Creed F, Tomenson B (2000) Depression and social stress in Pakistan. Psychol Med 30:395–402

    Article  CAS  PubMed  Google Scholar 

  9. Mumford DB, Saeed K, Ahmad I, Latif S, Mubbashar MH (1997) Stress and psychiatric disorder in rural Punjab: a community survey. Br J Psychiatry 170:473–478. doi:10.1192/bjp.170.5.473

    Google Scholar 

  10. Kazi A, Fatmi Z, Hatcher J, Kadir MM, Niaz U, Wassarman GA (2006) Social environment and depression among pregnant women in urban areas of Pakistan: the importance of social relations. Soc Sci Med 63(6):1466–1476. doi:10.1016/j.socscimed.2006.05.019

    Article  PubMed  Google Scholar 

  11. Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y (2006) Prevalence of depression and anxiety and their associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc 56:583–586. http://jpma.org.pk/PdfDownload/959.pdf. Accessed 15 Dec 2011

    Google Scholar 

  12. Ali NS, Ali BS, Azam IS (2009) Post partum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study. BMC Public Health 9:384–393. doi:10.1186/1471-2458-9-384

    Article  PubMed Central  PubMed  Google Scholar 

  13. Nusrat H, Parveen A, Husain M, Saeed Q, Jafri F, Rahman R, Tomenson B, Chaudhry IB (2011) Prevalence and psychosocial correlates of perinatal depression: a cohort study from urban Pakistan. Arch Womens Ment Health 14:395–403. doi:10.1007/s00737-011-0233-3

    Article  Google Scholar 

  14. Husain N, Chaudhry I, Afsar S, Creed F (2004) Psychological distress among patients attending a general medical outpatient clinic in Pakistan. Gen Hosp Psychiatry 26:277–281. doi:10.1016/j.genhosppsych.2004.03.005

    Article  PubMed  Google Scholar 

  15. Khan H, Kalia S, Itrat A, Khan A, Kamal M, Khan MA, Khalid R, Khalid S, Javed S, Javed S, Umer A, Naqvi H (2007) Prevalence and demographics of anxiety disorders: a snapshot from a community health care center in Pakistan. Ann Gen Psychiatry 6:30–35. (http://www.annals-general-psychiatry.com/contents/6/1/30). Accessed 3 April 2012

    Google Scholar 

  16. Khan KH, Shah MH (2003) Anxiety and depression: comparative study of somatic symptoms between two population groups. Prof 10(4):298–301

    Google Scholar 

  17. Khuwaja AK, Qureshi R, Azam SI (2004) Prevalence and factors associated with anxiety and depression among family practitioners in Karachi, Pakistan. J Pak Med Assoc 54:45–50

    CAS  PubMed  Google Scholar 

  18. Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan NA, Khan S (2004) Students, stress and coping strategies: a case of Pakistani medical school. Educ Health 17:346–353

    Article  Google Scholar 

  19. Ali BS, Rahbar MH, Tareen AL, Gui A, Samad L, Naeem S (2002) Prevalence and factors associated with anxiety and depression among women in a lower middle class semi-urban community of Karachi, Pakistan. J Pak Med Assoc 52:513–519. http://jpma.org.pk/PdfDownload/2439.pdf. Accessed 12 Dec 2011

  20. Gadit AAM, Mugford G (2007) Prevalence of depression among households in three capital cities of Pakistan: need to revise mental health policy. PLoS ONE 2:e209. doi:10.1371/journal.pone.0000209

    Article  Google Scholar 

  21. Mumford DB, Minhas FA, Akhtar I, Akhter S, Mubbashar MH (2000) Stress and psychiatric disorder in urban Rawalpindi: community survey. Br J Psychiatry 177:557–562

    Article  CAS  PubMed  Google Scholar 

  22. Hasan A, Mohib M “Urban Slums Reports: the case of Karachi, Pakistan” (PDF). http://www.ucl.ac.uk/dpu-projects/Global_Report/pdfs/Karachi.pdf. Accessed 1 June 2012

  23. Coutinho ESF, Filho NA, Mari JJ, Rodrigues L (1996) Minor psychiatric morbidity and internal migration in Brazil. Soc Psychiatry Psychiatr Epidemiol 31:173–179

    Article  Google Scholar 

  24. Li L, Wang H, Ye X, Jiang M, Lou Q, Hesketh T (2007) The mental health status of Chinese rural-urban migrant workers. Soc Psychiatry Psychiatr Epidemiol 42:716–722

    Article  PubMed  Google Scholar 

  25. Weich L, Lewis G (1998) Material standard of living, social class, and the prevalence of the common mental disorders in Great Britian. J Epidemiol Community Health 52:8–14

    Article  CAS  PubMed  Google Scholar 

  26. Fryers T, Melzer D, Jenkins R (2003) Social inequalities and common mental disorders: a systematic review of the evidence. Soc Psychiatry Psychiatr Epidemiol 38:229–237. doi:10.1007/s00127-003-0627-2

    Article  PubMed  Google Scholar 

  27. Freyers T, Melzer D, Jenkins R, Brugha T (2005) The distribution of the common mental disorders: social inequalities in Europe. Clin Pract Epidemiol Ment Health 1:14. doi:10.1186/1745-0179-1-4

  28. Rahman AU, Hayat Y, Habib Z, Iqbal J (2011) Rural-Urban disparities in Khyber Pakhtunkhwa Pakistan. Sarhad J Agric 27(3):477–483. http://www.aup.edu.pk/sj_pdf/rural%20urban%20disparities.PDF. Accessed 1 Jan 2013

  29. Goldberg DP, William P (1988) A user’s guide to the general health questionnaire. NFER-Nelson, Windsor

  30. Araya R, Wynn R, Lewis G (1992) Comparison of two self administered psychiatric questionnaires (GHQ-12 and SRQ-20) in primary care in Chile. Soc Psychiatry Psychiatr Epidemiol 27:168–173. doi:10.1007/BF00789001

    Article  CAS  PubMed  Google Scholar 

  31. Goldberg DP, Gater R, Sartorious N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197

    Article  CAS  PubMed  Google Scholar 

  32. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A (2003) The 12-item General Health Questionnaire (GHQ- 12): translation and validation study of the Iranian version. Health Qual Life Outcomes 1:66–69. http://www.hqlo.com/content/1/1/66. Accessed 17 August 2007

  33. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S, Simon G, Weiss HA (2008) Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med 38:221–228

    Article  CAS  PubMed  Google Scholar 

  34. Minhas FA, Mubbashar MH (1996) Validation of General Health Questionnaire in a primary care setting of Pakistan. J Coll Physicians Surg Pak 6:133–136

    Google Scholar 

  35. Goldberg DP, Oldehinkel T, Ormel J (1998) Why GHQ threshold varies from one place to another. Psychol Med 28:915–921

    Article  CAS  PubMed  Google Scholar 

  36. StataCorp (2009) Stata Statistical Software. Release 10.1: Special Edn. Stata Corporation, College Station, TX

  37. Abou-Saleh MT, Ghubash R, Daradkeh TK (2001) Al Ain community psychiatric survey: I. Prevalence and socio-demographic correlates. Soc Psychiatry Psychiatr Epidemiol 36:20–28

    Article  CAS  PubMed  Google Scholar 

  38. Poongothai S, Pradeepa R, Ganesan A, Mohan V (2009) Prevalence of depression in a large urban South Indian population: the Chennai Urban Rural Epidemiological Study (CURES 70). PLoS ONE 4(9):e7185. doi:10.1371/journal.pone.0007185

    Article  PubMed Central  PubMed  Google Scholar 

  39. Caron J, Liu A (2010) A descriptive study of the prevalence of psychological distress and mental disorders in the Canadian population: comparison between low-income and non-low-income populations. Chronic Dis Can 30(3):84–94

    CAS  PubMed  Google Scholar 

  40. Pratt LA, Dey AN, Cohen AJ (2007) Characteristics of adults with serious psychological distress as measured by the K6 Scale: United States 2001–04. Adv Data 382:1–18. http://198.246.98.21/nchs/data/ad/ad382.pdf. Accessed 13 Sept 2012

    Google Scholar 

  41. Mumford DB, Nazir M, Jilani FU, Baig IY (1996) Stress and psychiatric disorder in the Hindu Kush: a community survey of mountain villages in Chitral, Pakistan. Br J Psychiatry 168:299–307. doi:10.1192/bjp.168.3.299

    Article  CAS  PubMed  Google Scholar 

  42. Romans S, Cohen M, Forte T (2011) Rates of depression and anxiety in Urban and Rural Canada. Soc Psychiatry Psychiatr Epidemiol 46:567–575. doi:10.1007/s00127-010-0222-2

    Article  PubMed  Google Scholar 

  43. Li L, Wang H, Ye X, Jiang M, Lou Q, Hesketh T (2007) The mental health status of Chinese rural-urban migrant workers. Soc Psychiatry Psychiatr Epidemiol 42:716–722

    Article  PubMed  Google Scholar 

  44. Pinto-Meza A, Moneta MV, Alonso J, Angermeyer MC, Bruffaerts R, de Almeida JMC, de Girolamo G, de Graaf R, Florescu S, Masfety VK, O’Neill S, Vassilev S, Haro JM (2013) Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol 48:173–181. doi:10.1007/s00127-012-0536-3

    Article  PubMed  Google Scholar 

  45. Judd FK, Jackson HJ, Komiti A, Murray G, Hodgins G, Fraser C (2002) High prevalence disorders in urban and rural communities. Aust N Z J Psychiatry 36:104–113

    Article  PubMed  Google Scholar 

  46. Mumford DB, Bavington JT, Bhatnagar KS, Hussain Y, Mirza S, Naraghi MM (1991) The Bradford Somatic Inventory: a multiethnic inventory of somatic symptoms reported by anxious and depressed patients in Britain and the Indo-Pakistan subcontinent. Br J Psychiatry 158:379–386

    Article  CAS  PubMed  Google Scholar 

  47. Ali BS, Reza H, Khan MM (1998) Development of an indigenous screening instrument in Pakistan: the Aga Khan University Anxiety and Depression Scale. J. Pak Med Assoc 48(9):261–265

    CAS  PubMed  Google Scholar 

  48. Norris FH, Stevens SP, Pfefferbaum B, Wyche KF, Pfefferbaum RL (2008) Community resilience as a metaphor, theory, set of capacities, and strategies for disaster readiness. Am J Community Psychol 41:127–150. doi:10.1007/s10464-007-9156-6

    Article  PubMed  Google Scholar 

  49. Jejeebhoy S, Sathar ZA (2001) Women’s autonomy in India and Pakistan: the influence of religion and region. Popul Dev Rev 27:687–712. doi:10.1111/j.1728-4457.2001.00687.x

    Article  Google Scholar 

  50. Taga, AA (2012) Gender gap in Pakistan: a sociological analysis. Acad Res Int 2(3):629–636. http://www.savap.org.pk/journals/ARInt./Vol.2%283%29/2012%282.3-76%29.pdf. Accessed 16 Sept 2012

    Google Scholar 

  51. Qadir F, Khan MM, Medlin G, Prince M (2011) Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age: a life course perspective. BMC Public Health 11:745. http://www.biomedcentral.com/1471-2458/11/745

  52. Karmaliani R, Asad N, Bann CM, Moss N, Mcclure EM, Pasha O, Wright LL, Goldenberg RL (2009) Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. Int J Soc Psychiatry 55:414–424

    Article  PubMed  Google Scholar 

  53. Rabbani F, Raja FF (2000) The minds of mothers: maternal mental health in urban squatter settlement in Karachi. J Pak Med Assoc 50:306–313

    CAS  PubMed  Google Scholar 

  54. Solar O, Irwin A (2010) A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (policy and practice). http://www.who.int/ConceptualframeworkforactiononSDH_eng.pdf. Accessed 24 March 2013

  55. Overseas Development Institute (2006) Internal migration, poverty and development in Asia: briefing paper. http://dspace.cigilibrary.org/jspui/bitstream/123456789/22592/1/Internal%20Migration%20Poverty%20and%20Development%20in%20Asia.pdf?1. Accessed 31 May 2012

  56. Khan AH, Shehnaz L. (2000) Determinants of internal migration in Pakistan: evidence from the labour force survey, 1996–1997. Pak Dev Rev 39(4, Part II):695–712

    Google Scholar 

  57. Pakistan Institute of Legislative Development and Transparency (PILDAT). Background Paper: Ethnic Conflict in Sind. PILDAT 2011. http://www.pildat.org/Publications/publication/Conflict_Management/EthnicConflictinSindhOctober2011.pdf. Accessed 25 May 2012

  58. Trofimov, Y (2009) Refugee crises inflames ethnic strife in Karachi. The Wall Street Journal, Asia. Sunday, May 31, 2009. http://online.wsj.com/article/SB124363974401367773.html. Accessed 8 June 2012

  59. Kish L (1965) Survey sampling. Wiley, New York

    Google Scholar 

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Acknowledgments

This study was funded by Asia Foundation and was conducted by Pakistan Association for Mental Health. The author is grateful to the leaders, volunteers and members of the communities represented in this study without whose support this study would not have been possible. The author is also grateful to Dr. S. Haroon Ahmed at the Pakistan Association for Mental Health and to Dr. Kimberlie Dean at School of Psychiatry/Faculty Medicine, University of New South Wales, for their valuable feedback and comments regarding the first draft of this manuscript. I thank Ms. Mujahida Jabbar, Ms. Sana Sadia, Ms. Nausheen Noor, Mr. Danish Abdul Majid, Mr. Jibran Azam, and Dr. Zahid Iqbal for their dedicated work on this research project.

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The author declares that she has no conflict of interest.

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  1. College of Management Sciences, PAF-KIET, Main Campus, Korangi, Karachi, 75190, Pakistan

    Rubeena Kidwai

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Correspondence to Rubeena Kidwai.

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Kidwai, R. Demographic factors, social problems and material amenities as predictors of psychological distress: a cross-sectional study in Karachi, Pakistan. Soc Psychiatry Psychiatr Epidemiol 49, 27–39 (2014). https://doi.org/10.1007/s00127-013-0692-0

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