title: Offering mental health services in a conflict affected region of Pakistan: who comes, and why?
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Islamabad, Punjab, Pakistan.
authors: Safieh
authors: S
authors: Shah
authors: Operational Research Unit (LuxOR), Médecins Sans Frontières - Operational Centre Brussels, Luxembourg, Luxembourg.
authors: Rafael
authors: R
authors: Van den Bergh
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
authors: Benedicte
authors: B
authors: Van Bellinghen
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
authors: Nathalie
authors: N
authors: Severy
authors: Mental Health Clinic, Médecins Sans Frontières- Operational Centre Brussels, Timurgara, Khyber Pakhtunkhwa, Pakistan.
authors: Sana
authors: S
authors: Sadiq
authors: Mental Health Clinic, Médecins Sans Frontières- Operational Centre Brussels, Timurgara, Khyber Pakhtunkhwa, Pakistan.
authors: Sher Ali
authors: SA
authors: Afridi
authors: Mental Health Clinic, Médecins Sans Frontières- Operational Centre Brussels, Timurgara, Khyber Pakhtunkhwa, Pakistan.
authors: Asma
authors: A
authors: Akhtar
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
authors: Jacob
authors: J
authors: Maïkére
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
authors: Catherine
authors: C
authors: Van Overloop
authors: Pakistan Ministry of Health (MoH), District Headquarter Hospital, Timurgara, Khyber Pakhtunkhwa, Pakistan.
authors: Saeed-ur-Rehman
authors: Pakistan Ministry of Health (MoH), District Headquarter Hospital, Timurgara, Khyber Pakhtunkhwa, Pakistan.
authors: Tahir Bashir-ud-Din
authors: TB
authors: Khilji
authors: Pakistan Ministry of Health (MoH), District Headquarter Hospital, Timurgara, Khyber Pakhtunkhwa, Pakistan.
authors: Saleem-ur-Rehman
authors: Institute of Tropical Medicine, Antwerp, Belgium.
authors: Johan
authors: J
authors: van Griensven
authors: Médecins Sans Frontières - Operational Centre Luxembourg, Headquarters, Luxembourg, Luxembourg.
authors: Serge
authors: S
authors: Schneider
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
authors: Philippe
authors: P
authors: Bosman
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Islamabad, Punjab, Pakistan.
authors: Erwin Lloyd D
authors: EL
authors: Guillergan
authors: Medical Department, Médecins Sans Frontières - Operational Centre Brussels, Headquarters, Brussels, Belgium.
authors: Francesca
authors: F
authors: Dazzi
authors: Operational Research Unit (LuxOR), Médecins Sans Frontières - Operational Centre Brussels, Luxembourg, Luxembourg.
authors: Rony
authors: R
authors: Zachariah
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000628:therapy; D002648:Child; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy