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Offering a sustainable solution to for achieving the 'Millennium Mental Health Development Goal': The psychospiritual model.

Posted by plosmedicine on 30 Mar 2009 at 23:46 GMT

Author: Pashtoon Murtaza Kasi
Position: Medical Student
Institution: Aga Khan University, Karachi, Pakistan.
Additional Authors: Haider Naqvi, Abdul Malik Achakzai, Ahmed Ijaz Gilani, Asma Tariq, Wajeeha Javed, Muhammad Hameed, Fawad Muhammad Shoaib, Fahd Khalid Syed, Fazal Manzoor, Ali Hyder Zaidi, Saman Shahid, Shuja Saleem,
Submitted Date: September 22, 2005
Published Date: September 23, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In the article by Miranda et al [1], the authors have rightly pointed out that mental health is an important issue for developing countries. In a recent analysis of studies of anxiety and depression in Pakistan, the prevalence was estimated to be around 34% (29-66% for females) [2]. A sustainable solution is needed.

A 'landmark' study [3] by Dr. Badar Sabar Ali and colleagues identifies one such solution and concludes, 'counseling by minimally trained community counselors reduced levels of anxiety and/or depression in women of their own community'.

A modification or addition to the psychological model is, however, required for two reasons. Firstly, counselors will still not be the first level of contact, especially for women with anxiety and depression, particularly in countries like Pakistan. Different types of religious healers do, however, have such contact [4]. Secondly, in a similar community with anxiety and depression, the most frequently used coping style within the previous month was found to be 'Religion' [5]. 48.1% of individuals used this coping style on a moderate to frequent basis [personal communication Kasi et al].

So, psychological counseling, offered by health care professionals (medical students, doctors, nurses or even traditional birth care attendants because of the limited number of psychiatrists), should include the 'spiritual' aspect of the individual's life as well. After a typical counseling session, the medical care provider could probably spend a little time talking with the individual about her spiritual life, because religious coping can reduce levels of anxiety and depression [6].

Alternatively, one can empower 'structured' religious organizations operating within a community to identify and counsel patients with anxiety and depression. The manual [7], developed from the randomized controlled trial referred to earlier [3], could be offered to the counseling units of these religious organizations.

So a psycho-spiritual treatment model could be a sustainable solution to ameliorate anxiety and depression, especially amongst women in countries like Pakistan, thus helping the achievement of a millennium mental health development goal.

[1] Miranda JJ, Patel V [2005] Achieving the Millennium Development Goals: Does Mental Health Play a Role? PLoS Med 2[10]: e291
[2] Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ. 2004 Apr 3;328[7443]:794
[3] Ali BS, Rahbar MH, Naeem S, Gul A, Mubeen ???S, Iqbal A. The effectiveness of counseling on anxiety and depression by minimally trained counselors: a randomized controlled trial. Am J Psychother. 2003;57[3]:324-36.$
[4] Gilani AI, Gilani UI, Kasi PM, Khan MM [2005] Psychiatric Health Laws in Pakistan: From Lunacy to Mental Health. PLoS Med 2[11]: e317
[5] Carver, C. S. [1997]. You want to measure coping but your protocol???s too long: Consider the Brief COPE.International Journal of Behavioral Medicine, 4, 92-100.
[6] Koenig HG, Cohen HJ, Blazer DG, Pieper C, Meador KG, Shelp F, Goli V, DiPasquale B. Religious coping and depression among elderly, hospitalized medically ill men. Am J Psychiatry. 1992 Dec;149[12]:1693-700
[7] Kasuar S. Khan, Badar S. Ali, Riffat Moazam Zaman, Sanober Mubeen, Aliya Iqbal. Addressing Anxiety and Depression: An introductory guide to community women. [Manual developed by researchers at the Aga Khan University Karachi, Pakistan]

Competing interests declared: none