Offering mental health services in a conflict affected region of Pakistan: who comes, and why?

PLoS One. 2014 Jun 25;9(6):e97939. doi: 10.1371/journal.pone.0097939. eCollection 2014.

Abstract

Background: North West Pakistan is an area ravaged by conflict and population displacement for over three decades. Recently, drone attacks and military operations have aggravated underlying mental disorders, while access to care is limited. Among patients attending a mental health clinic integrated in district hospital conducted by psychologists; we describe service utilization, patient characteristics, presenting complaints, morbidity patterns, and follow-up details.

Methodology/principal findings: A retrospective study using routinely collected programme data was conducted from February to December 2012. A total of 1545 consultations were conducted for 928 patients (86% females). There were 71(8%) children and adolescents. An increase was observed from February to July, followed by a decline. 163 new patients (18%) were on psychotropic medication at presentation. The most common morbidity in females (36%) were symptoms of adjustment disorders and acute reactions. Depression and anxiety were common in both genders while post traumatic disorder was frequent in males (21%). Out of the 928 new patients, 639(69%) had a follow up visit planned with their psychologist, but only 220(34%) new patients returned for a follow up visit.

Conclusion: In a district hospital, mental health services managed by psychologists were well attended. There is a need to consider widening the current package of care to cater to the diversity of mental health disorders, gender difference, children and adolescents. Standardized diagnostic and monitoring tools would also need to be adapted accordingly and to assess patient progress. Innovative approaches to tackle the problem of the low return rate are needed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / epidemiology
  • Anxiety / therapy
  • Child
  • Depression / epidemiology
  • Depression / therapy
  • Female
  • Health Services Accessibility
  • Humans
  • Male
  • Mental Health Services / statistics & numerical data*
  • Pakistan / epidemiology
  • Retrospective Studies
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / therapy

Grants and funding

This research was supported through an operational research course, which was jointly developed and run by the Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg (LUXOR); the Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France and The Union South-East Asia Regional Office, Delhi, India. Additional support for running the course was provided by the Institute for Tropical Medicine, Antwerp, Belgium; the Center for International Health, University of Bergen; the University of Nairobi, Kenya and Partners In Health, Rwanda. This course is under the umbrella of the World Health Organization's special Programme for Research and Training in Tropical Diseases (WHO-TDR) SORT-IT program me (Structured Operational Research and Training Initiative) for capacity building in low- and middle-income countries. Funding for the course was provided by Médecins Sans Frontiéres Luxembourg, Brussels Operational Centre, Luxembourg, the Bloomberg Philanthropies and the Department for International Development (DFID), UK. There are no commercial funders and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.