Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item The prevalence of depression and its correlates in garment factory employees in Hambantota District, Sri Lanka(Sri Lanka Medical Association, 2021) Obadaarachchi LN, L.N.; Amila, I.L.L.; Vipuladasa, D.D.M.L.; Williams, S.S.Introduction and objectives Garment factory employees are a high-risk population for depression in developing Asian countries. The objective of the study was to determine the prevalence of depression and its association with selected socio-demographic, occupational, personal and family factors in garment factory workers in Hambantota district. Method A cross sectional study using multi stage random sampling was conducted following ethical approval by a recognized ethics review committee. General Health Questionnaire-12 and Beck Depression Inventory–II, previously validated for the Sri Lankan population were used to screen for depression. A specifically designed data collection form was also administered after written informed consent by trained investigators. Results Out of a total sample of 390, the majority were females (n=325, 83.3%). The mean age was 32.9 years (SD 10.45 years). The estimated point prevalence of depression in the study sample was 17.2 % (95 % CI=13.3-21.8%). Depression was associated with presence of a chronic medical condition (OR-3.15, CI 1.53-6.44, p=0.002), family history of psychiatric illness (OR-5.57, CI 2.31-13.47, p<0.001), history of deliberate self-harm (OR-11.23, CI 5.03-25.04, p<0.001), history of psychiatric illness (OR-6.12, CI 2.39-15.73, p<0.001), and being divorced or separated from their partner(OR-3.39, CI 1.51-7.58, p=0.003). The only job-related factor which showed an association with depression was working extra duty hours (CI 1.01-3.02, p=0.04). Conclusions The prevalence of depression among garment factory employees in Hambantota district is higher in comparison to other populations in Sri Lanka. However, it is lower in comparison to garment factory populations in other developing Asian countries.Item Randomized Controlled Trial Investigating the Effectiveness of Cognitive Behaviour Group Therapy Compared to a Waitlist Control in the Treatment of University Students with Social Phobia(Sri Lanka Medical Association, 2020) Hapangama, A.; de Silva, B.G.R.; de Zoysa, P.T.; Kuruppuarachchi, K.A.L.A.; Ravindran, A.; Wickremasinghe, A.R.; Williams, S.S.INTRODUCTION AND OBJECTIVES: Social phobia causes significant impairment in a person’s personal and professional life. However, individually delivered cognitive behavioural therapy (CBT) is costly, limited by the number of trained therapists and not scalable to meet the need for such therapy in the population. In this context, cognitive behavioral group therapy (CBGT) is the viable option. Objective was to determine the treatment effectiveness of CBGT as compared to a waitlist control of university students with social phobia. METHOD: A single-blind randomized controlled trial consisting of an 8-week treatment phase of CBGT versus a waitlist control was conducted among university students with social phobia. The Liebowitz Social Anxiety Scale –Self Rated Sinhala version (LSAS-SR) was administered at screening, baseline, four weeks and eight weeks of the trial. A culturally adapted CBGT was delivered in Sinhala to the intervention group by a trained clinical psychologist. RESULTS: Thirty university students (15 in each arm) with a mean age of 22, meeting DSM IV criteria for Social Anxiety Disorder were included. Repeated measure analysis of the total scores of the LSAS-SR in the CBGT arm showed statistically significant (p<0.001) reduction in the total scores (13.3) as compared to the waitlist arm after controlling for age and gender. CONCLUSION: CBGT is superior to waitlist control in university students with social phobia.Item Nutrition of patients with mild-to-moderate Alzheimers disease using the Mini Nutritional Assessment (MNA)(Sri Lanka Medical Association., 2019) Fernando, M.G.; Silva, K.D.R.R.; de Silva, M.P.; Obadaarachchi, L.N.; Yalegama, L.L.W.C.; Dissanayake, A.S.; Williams, S.S.INTRODUCTION & OBJECTIVES: Focus on the nutrition of patients with Alzheimer's disease is limited despite the need for optimization of overall patient health to improve well being and outcome. The objective of this study was to look at the nutrition and energy intake of patients with mild to moderate dementia. METHODS: Sixty patients with mild-to-moderate AD (Mini Mental State Examination score: 12-25; male:28; female: 32; age >65 years) were recruited from the clinics at the North Colombo Teaching Hospital, Ragama and Lanka Alzheimer's Foundation as part of the VCO-AD study, after informed consent. Baseline nutritional status was assessed by a Mini Nutritional Assessment (MNA) tool and dietary intake via a 24-hour dietary recall. RESULTS: The total energy intake of the study population (men: 1822±645 kcal/day, women: 1380±346 kcal/day) was lower than recommended standards. The percentage energy from fat, protein and carbohydrates (30.7±7.6%, 12.7±2.7%, and 56.8±8.7%, respectively) met recommendations. The energy intake from saturated fat (19.7±6.9%) however was higher than the recommendation. Vitamin C, D, E, folate, calcium, potassium, selenium and iodine intake (37.4±30.4 mg/day, 2.2±3.1 µg/day, 2.4±1.4 mg/day, 219±125 µ/day, 483.8±230.8 mg/day, 1853.9±590.8 mg/day, 38.1±22.7 µg/day, and 59.8±35.4 µg/day respectively) was lower than the estimated average requirements (EAR). MNA results showed that 20% were at risk of malnutrition. CONCLUSION: A higher saturated fat intake and lower vitamin intake were concerns in this population of patients with mild to moderate dementia.Item Psychological morbidity in adult survivors of the 2016 landslide in Aranayaka(Sri Lanka Medical Association, 2018) Bandara, G.R.B.S.; Pathiraja, P.M.R.B.I.; Bandara, I.M.H.W.; Williams, S.S.INTRODUCTION AND OBJECTIVES: A large landslide affected Aranayaka in the Kegalle District in Sri Lanka in May2016 leaving many residents dead or injured and the survivors displaced in temporary camps. This study assessed the prevalence of psychological morbidity one year after this incident. METHODS: A descriptive cross-sectional study was carried out among adult survivors in the relief camps. The number of individuals selected from each site was determined applying probability proportionate to the size technique to achieve a sample size of 405. A self-administered questionnaire, consisting of socio demographic details, the extent of the trauma and the psychological support received and a Sinhala version of the K-10 and PSSR-17 questionnaires were administered after informed consent. RESULTS: The prevalence of depression and moderate or severe PTSD were 22.5% and 19% respectively. Both depression and moderate or severe PTSD were present in 11.6%, and 29.9% had either depression or moderate/ severe PTSD. Lower educational level (P=0.03), single status (P=0.007), lower economic status (P<0.001) and past history of physical (P=0.044) and psychological (P=0.004) illnesses were associated with depression. Female gender (P=Or.026), single status (P=0.028), lower economic status (P=0.000), Tamil ethnicity (P=0.007) and chronic physical illness (P=0.002) were associated with PTSD. Depression and PTSD were also related to exposure to traumatic events (P<0.001). CONCLUSION: Nearly a third of those affected by the disaster had depression or PTSD a year after the event. Those of a lower income and education, females, single, widowed or divorced and those with a history of physical illness or past history of psychological issues were at higher risk.Item A preliminary study of the psycho-social burden of bipolar disorder on siblings(Sri Lanka Medical Association, 2017) Fernando, P.S.; Ranaweera, H.P.A.L.; Karunarathna, K.A.S.T.; Kaushalya, N.I.; Samarasinghe, G.; Peiris, M.U.P.K.; Williams, S.S.INTRODUCTION & OBJECTIVES: Bipolar disorder (BD) is a recurrent mood disorder with a prevalence of 1-2% in the general population. Individuals with BD experience significant impacts on family and social relationships, suffer from occupational instability, and are at greater risk of self-harm and suicide. This research aims to examine experiences and concerns of siblings of individuals with BD. METHODS: Quantitative data was collected from siblings of persons with BD through the psychiatry clinics at North Colombo Teaching Hospital after informed consent. For data collection, the ‘Sibling Impact Questionnaire–Bipolar Disorder’ (SIQ-BD) was developed. The SIQ-BD measures the impact on a sibling of a person with BD, across three timeframes, the ‘past year’, ‘over the years’, and ’worst time’. RESULTS: Out of 48 siblings (14 males, 34 females; mean age 42.7 years), 44 (11 males, 33 females) act as care givers to their siblings. The highest burden was during the ‘worst time’; and during this ‘worst time’ 16.7% of siblings worried that their sibling may commit suicide ‘very much so’, followed by 12.5% and 6.2% during the ‘whole time’ and ‘past year’ respectively. On a positive note, stigma was reported as high by only one sibling during the ‘worst time’ and none during the ‘past year’ and ‘whole time’. The highest disruption to daily life was experienced during the ‘worst time’. Providing financial support during the past year was significantly associated with higher burden (p=0.002). CONCLUSION: Siblings of persons with BD experience a mixed burden with low perception of stigma in this preliminary study.Item Cognitive behavioral therapy for university students with social phobia: A method to culturally adapt group therapy(Sri Lanka Medical Association, 2016) de Silva, B.G.R.; de Zoysa, P.; Williams, S.S.INTRODUCTION AND OBJECTIVES: Social phobia is a debilitating anxiety disorder with negative social implications. University students in Sri Lanka appear to have high prevalence rates of social phobia according to preliminary studies. Establishing a methodology by which interventions such as, Cognitive Behavioral Group Therapy (CBGT) could be culturally adapted is the objective of this study. METHOD: The gold standard CBGT was used to construct the structure of the intervention. CBGT interventions that have been modified to suit university student participant groups in the West were reviewed to revise the structure of the therapy. Existing cross-cultural therapy adaptation models were identified to derive factors to be taken in to consideration within this adaptation process. A study of other mental health intervention programs that have been cross-culturally adapted in diverse cultural settings was carried out. RESULTS: The methodology obtained constituted of three steps. The intervention program was initially reviewed by a panel of clinical psychologists to assess for appropriateness of content. Thereafter, the finalized layout, including activity worksheets were translated to Sinhala Language, and re-translated to English to test for accuracy. Finally, the translated documents were assessed by a panel of mental health experts in Sri Lanka and consensus was reached. CONCLUSIONS: A practical methodology to cross-culturally adapt psychological therapy for social phobia in the Sri Lankan context was developedItem A study on anxiety and depression among military personnel injured in the war(Sri Lanka Medical Association, 2001) Ariyaratne, R.; Arulrajah, S.; Ariyananda, D.; Ariyaratne, J.; Athanayake, S.; Azhar, M.; Bandara, A.; Bandara, R.; Williams, S.S.; Kuruppuarachchi, K.A.L.A.OBJECTIVES: To determine the proportion of army personnel with symptoms of anxiety and depression following injuries on the battlefield and to identify associated factors. DESIGN, SETTING AND METHODS: We administered a pretested closed and open ended questionnaire and a validated Sinhala translation of the Beck Depression and Beck Anxiety Inventory to 128 injured soldiers at the Military Hospital in Colombo between 9th and 11th of December 1999. We excluded soldiers with head injuries or impaired consciousness and those blind or deaf. RESULTS: In terms of the Beck Depression Inventory 35.15% had scores for severe depression, 15,62% for moderate depression and 28.1% for mild depression. In terms of the Beck Anxiety Inventory 7.81% has scores for severe anxiety, 5.46% for moderate anxiety and 36.7% for mild anxiety. There was a significant association between severity of depression and anxiety (Chi square for linear trend =21.8, p < 0.001). We also found a significant association between severity of depression and thoughts of deserting the army (Chi square for linear trend = 10.674, pO.OOl and severity of depression and problems at work or in the family (Chi square for linear trend = 4.373. p < 0.05). Among those who scored for severe depression there was a suicidal risk in 42.33%. CONCLUSIONS: We found that the majority of injured soldiers had symptoms of depression and nearly half had symptoms of anxiety, There was a significant association between severity of depression and thoughts of deserting the army and problems at work or in the family. The suicidal risk among depressed patients was high.Item Eating attitudes and behaviours among adolescent girls in the Colombo District, Sri Lanka(Sri Lanka Medical Association, 2012) Wijeratne, L.T.; Kuruppuarachchi, K.A.L.A.; Pathmeswaran, A.; Williams, S.S.INTRODUCTION: Eating disorders are considered by some to be a culture bound phenomena confined to the west. Its prevalence among young adolescents in Sri Lanka is not known. AIMS: To describe the concerns and attitudes regarding weight and body shape among adolescent school girls in the Colombo district. METHODS: A descriptive cross sectional study was conducted in selected National, type 1AB, type 1C and type 2 schools in the Colombo district, using a self administered questionnaire that included demographic data and the Eating Attitude Questionnaire ( EAT26 ). The EAT 26 was translated to Sinhalese and validated using the Delphi technique. Results: The study population consisted of 1564 adolescent school girls from 18 schools. A high risk for developing an eating disorder in terms of the EAT 26 questionnaire was seen in 217 [ 14%) and a moderate risk in 554 ( 36%). 14% believed they were fatter than their peers. Of those who believed they were fatter than others, 25% had an EAT26.score indicating a high risk for developing an eating disorder. Dieting was undertaken by 34% to lose weight. CONCLUSIONS: Risk for eating disorders is present in adolescent girls in Sri Lanka. Clinicians need to consider this differential diagnosis in young females presenting with weight loss.Item Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors?(Sri Lanka Medical Association, 2013) Williams, S.S.; Pinidiyapathirage, M.J.; Wijeratne, L.T.; Kasturiratne, A.; Peris, M.U.P.K.; Williams, H.S.A.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To determine the prevalence of psychological morbidity and its relationship to diabetes mellitus, hypertension and alcohol use in an urban population in Sri Lanka. METHODS: This study was conducted in the Ragama Health Study cohort that consists of 2986 individuals, between 35-64 years of age, living in the Ragama Medical Officer of Health area in the district of Gampaha. Subjects were selected using age-stratified random sampling, from the electoral lists in 2007, and investigated using clinical, bio¬chemical and anthropometric examinations. Psychological morbidity was estimated using a pre-validated K10 questionnaire which has high sensitivity and specificity for non psychotic psychiatric disorders and a self administered GHQ 30 questionnaire. Baseline age-adjusted prevalence and three year incidence of hypertension and diabetes were estimated. Odds ratios for independent risk factors were calculated. RESULTS: The prevalence of psychological morbidity identified using the K10 questionnaire ranged from 18- 26% in a total population of 2919. Females had a higher prevalence of psychologrcal morbidity than males (28.6% vs 22.4%; p<0.001). Diabetic or hypertensive status and alcohol use did not predict psychological morbidity. A self report of overall low health status was predictive of psychological morbidity OR1.925 (95% CI 1.62 - 2.28). DISCUSSION: High prevalence of psychological morbidity was identified in this community study. Females are more at risk. In the initial analysis, psychological status was not associated with diabetes mellitus, hypertension or alcohol use.Item Reliability and factor analysis of the Sinhalese version of the Liebowitz Social Anxiety Scale-Self Reported Version (LSAS-SR)(Sri lanka Medical Association, 2015) Hapangama, A.; de Silva, T.; Kuruppuarachchi, K.A.L.A.; Wickremasinghe, A.R.; Williams, S.S.INTRODUCTION AND OBJECTIVES: Despite being one of the most prevalent mental illnesses, lack of awareness and confusion with shyness contributes to under-diagnosis of social phobia. Our objective was to evaluate test-retest reliability, internal consistency and factor analysis of the Sinhalese version of LSAS-SR - which is widely used in the English speaking world as a screening tool for social phobia. METHOD: The established process of translation by bilingual professionals/ back translation to establish consistency was carried out. Face validity and cultural acceptability of the translation was established using the Delphi technique. Pilot evaluation was conducted and standard psychometric procedures were used to evaluate test- retest reliabilityand internal consistency. The subjects were 871 SriLankan university students. RESULTS: Prevalence of social phobia among study population was 9.2%.Pearson's correlation coefficient was 0.998, 0.994 and 0.993 for fear and avoidance subscales and total sore respectively (p<0.01). Cronbach's alpha for fear and avoidance subscales with total score for each subscale was 0.753 and 0.752 respectively. Cronbach's alpha of total score of each sub scale with total score of LSAS-SR was 0.722.Factor analysis resulted in 5 dimensions and these were: factor I - speaking in a group, factor II-activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement/ disapproval and factor V - social interaction in leisure activity. CONCLUSION: The findings confirm that this Sinhalese version of LSAS-SR has similar test-retest reliability, internal consistency and factor analysis as the original instrument and can be usedto screen for social phobia in Sri Lanka.