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Prevalence of Needle Phobia among Young Patients Presenting to Tertiary Care Government Hospitals of Karachi, Pakistan

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Needle phobia-Fear of needles (trypanophobia), is extreme fear of medical procedures involving injections or hypodermic needles. It is of 4 types: Vasovagal type, Associative type, Resistive type and Hyperalgesic type. Needle phobia has recently been included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) within the diagnostic category of Blood-Injection- Injury Phobia. Our objective is to evaluate prevalence of needle phobia among young patients presenting to tertiary care government hospitals of Karachi, Pakistan. It is Cross-sectional study conducted at OPDs of Civil Hospital Karachi, Jinnah Hospital Karachi and Abbasi Shaheed Hospital Karachi, Pakistan from Feburary,2013 to July,2013. here were total two seventy three study ubjects between ages of 14-25years. Performawas explained to every subject and verbal consent was taken before filling the Performa. Out of two seventy three study subjects, fear of needles was present in 37·2% (n=99) with majority of needle phobic were females 76·8% (n=70). Resistive type of phobia predominated prevalent but in few cases hyperalgesic type was also found. Elbow, Deltoid and Hand was feared the most with needle insertion .Family History of Needle Phobia was prevalent in thirty subjects and even blood tests and other medical treatment involving needle insertion were completely avoided by twenty three young patients. There was strong relationship between type of phobia and body part feared by needle insertion with gender. But there is still need of further investigation.
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
Prevalence of Needle Phobia among Young Patients Presenting to
Tertiary Care Government Hospitals of Karachi, Pakistan
Dr. FAHAD KHAN 1, BAKHTAWAR MEMON 2, HAFEEZ-UR-REHMAN 2,
SANA SALEH MUHAMMAD 2, ARIF ALI 3
1. MBBS, FCPS part 2 Trainee in Department of General Medicine, Civil hospital Karachi,
Pakistan
2. Students of Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
3. Statistician in Research Department, Dow University of Health Sciences, Karachi , Pakistan
E M A I L A D D R E S S : K h a n f a h a d 0 5@ G m a i l . C o m
Bakhtawar Memon: Email- bakhtawar2004@hotmail.com
Hafeez-ur-Rehman Email- haffee92@hotmail.com
Sana Saleh Muhammad Email- dr.sanasaleh@gmail.com
Arif Ali Email- arif.ali@duhs.edu.pk
ABSTRACT:
Needle phobia-Fear of needles
(trypanophobia), is extreme fear of medical
procedures involving injections or hypodermic
needles. It is of 4 types: Vasovagal type,
Associative type, Resistive type and
Hyperalgesic type. Needle phobia has
recently been included in the American
Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) within the
diagnostic category of Blood-Injection-
Injury Phobia. Our objective is to evaluate
prevalence of needle phobia among young
patients presenting to tertiary care
government hospitals of Karachi, Pakistan.
It is Cross-sectional study conducted at OPDs
of Civil Hospital Karachi, Jinnah Hospital
Karachi and Abbasi Shaheed Hospital
Karachi, Pakistan from Feburary,2013 to
July,2013.
There were total two seventy three study
subjects between ages of 14-25years. Performa
was explained to every subject and verbal
consent was taken before filling the Performa.
Out of two seventy three study subjects, fear of
needles was present in 37·2% (n=99) with
majority of needle phobic were females 76·8%
(n=70). Resistive type of phobia predominated
prevalent but in few cases hyperalgesic type was
also found. Elbow, Deltoid and Hand was
feared the most with needle insertion .Family
History of Needle Phobia was prevalent in thirty
subjects and even blood tests and other medical
treatment involving needle insertion were
completely avoided by twenty three young
patients.
There was strong relationship between type of
phobia and body part feared by needle insertion
with gender. But there is still need of further
investigation.
Keywords:
Needle phobia; resistive type of needle phobia;
tertiary care government hospital of Karachi,
Pakistan; young patients
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
1. INTRODUCTION
It is an immense fear of a needle or injection that
is not in proportion to the actual danger. Fear of
needles known as trypanophobia, it is extreme
fear of medical procedures may involve needles
and injections. It is of four types: [1]
VASOVAGAL: It affect 50% of those many
needle phobia, hence it is most common. It is an
inherited reflex reaction. Such people fear the
sight, thought or feeling of needles and needle
like objects.
ASSOCIATIVE: It affects 30% of those afflicted
and is second most common type. It stems after
experiencing or witnessing a relative or friend
undergoing such traumatic painful medical
procedure and in patients who associate such
painful medical procedure involving needles with
past negative experience.
RESISTIVE: 20% of needle phobia is resistive, it
is characterized by fears for needles along with
being controlled or bridled. It develops due to
poor handling and past experience of being
forced physically and emotionally.
HYPERALGESIC: 10% or such population
becomes needle phobic due to hypersensitivity to
painful stimulus. It is inherited hyperalgesia.
Pain is very severe and unbearable and they are
unable to understand how anyone can bear such
pain.
10% of population is emotionally stirred from
recently recognized medical condition known as
Needle Phobia. Health care system is now much
concerned with this condition because most of
people with trypanophobia avoid basic medical
care [2]. Now it has being included under
diagnostic category of Blood-Injection-Injury
phobia in American Psychiatric Association's
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV) [3]. Most
common cause of this phobia is inherited
vasovagal reflex reaction triggered by needle
piercing. This inherited reflex become evident
after several exposure of needles. Hence it is
inherited as well as learned behavior [2].
As compared to other phobias, in which patient
experience tachycardia following exposure to
feared object, needle phobics typically
experience anticipatory tachycardia and
hypertension for short period of time followed by
bradycardia and hypotension on needle insertion
and may b accompanied by pallor, tinnitus,
diaphoresis, syncope, and some may experience
systole or even death [4].
No such evaluation of prevalence of phobia of
injections has been observed in health care
system. Researchers have been done to estimate
the frequency of needle phobia. According to Ni
retal 4, 23% of travelers attending a travel health
clinic suffered from fear of needles.6 to 15% of
college students reported fear of dental care
[5,6]. Precautions including counseling ,support,
education are used to reduce solicitude about fear
of needles [7,8,9].
The main purpose of this research was to
evaluate the frequency of needle phobia among
young patients visiting tertiary care government
hospital in Karachi, Pakistan. Other objectives
were to elucidate that how many youngster
refrain medical care due to this type of phobia
and to aware medical professionals about needle
phobia.
2. MATERIALS AND METHODS
Two Seventy Three participants attending OPD
get to know about fear of needles, its types and
its effect on daily life through a Performa.
Setup: The study was carried out at Civil
hospital Karachi, Jinnah hospital Karachi
(JPMC) and Abbasi Shaheed hospital.
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
Participants were patients visiting CHK, JPMC
and Abbasi Shaheed hospital, medical and
surgical OPDs. The exclusion criterion was
patients of age group below 15 or above 24 years
and patients who are admitted in wards of CHK,
JPMC and Abbassi Shaheed Hospital.The
inclusion criterion applied was to the people of
age group 15 to 24. Young patients visiting
CHK, JPMC and Abbasi Shaheed hospital
medical and surgical OPDs from February to
July 2013 using a Performa especially prepared
for the purpose.
Although some patients visited two or three
times, each person was enrolled only once. A
pre-test of 10 Performas was done on young
patients of civil hospital Karachi. Performa was
first explained to the participants by volunteers
and then was filled by them. Verbal consent was
also taken by every participant. The study was
also approved by Ethical Review Board of Dow
University of Health Sciences.
Study Design: Cross sectional study
Questionnaires: Each patient was asked to fill
out an anonymous structured questionnaire
regarding fear of injections. The purpose of the
study was explained to the patients. Hearing the
explanation and agreeing to fill out the
questionnaire constituted informed verbal
consent. Demographic characteristics were
inquired and each study subject was asked, in
native language, a combination of structured 14
open-ended and close-ended type questions,
regarding their fear of needles, by single
volunteer. Questionnaire was adapted from
CTRN: Change That’s Right Now..[10] and few
questions were added, that explored study
subject’s behaviour towards needles, their
negative experience involving needles, avoidance
of basic medical care due to this fear, prevalence
of same fear in family, type of fear and body part
most feared was also explored. All such
information and responses were assessed and
recorded by same volunteer.
Statistical analysis: Data was entered in Epidata
software and was analyzed in SPSS (version
16.0) . Mean and standard deviation was for
continuous variable and frequency and
percentages were used for categorical variable.
Independent sample T-test and Chi-square test
were used to find the association between two
variables. P-value was set at 0.05.
3. RESULT
A total of 273 patients participated in the study
(95% response rate) over survey period of 6
months. The research was conducted among
youngsters with a Mean age of 20·18 ±
3·60years, (age range=14-25).Male and female
ratio was approximately same. The baseline
demographic details are given in table1.
According to the study, Fear of needle was
present in 37·2% (n=99) (table 1) with majority
of needle phobic were females 76·8% (n=70)
(p=<0·001). Education has statically insignificant
relationship with needle phobia. (Table2)
Table 3 show an association of type of phobia
with age and gender. In case of gender, Resistive
type of phobia predominated in male and female
with slight increase in male (60·9 %) (p =
0·029). For purpose of analyses age was
classified into 2 groups (below 18 and 18 &
above). Age group below 18 has same ratio of
Resistive and Hyperalgesic type of phobia
(30·3%) where as age group 18 & above
complained predominantly of Resistive type of
phobia (48·5%). However, Age distribution was
insignificant with types of phobia.
Table 4 shows an association of parts of body
mostly involved in needle phobia with gender
and age. Males most commonly feared needle
injection at elbow and deltoid region with same
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
ratio (28·0%) and in female hand was most
feared region (39·5%) (p=0·029). In case of age,
below 18 most common part feared was deltoid
region (45·5%) where as in age 18 or above,
hand was the most commonly feared region
(39·7 %). However, Age distribution was
insignificant with body part feared the most
Table 1.Demographic characteristics and needle phobia. Frequency distribution of
demographic characteristics and needle phobia in study participants
Characteristics
Frequency
Age (Years )Mean±SD
20.18±3.60
Gender
Female
135
Male
131
Education
Illiterate
74
Primary
70
Secondary
111
Graduate
11
Caste
Sindhi
30
Punjabi
31
Pushto
73
Balochi
26
Urdu
63
Hazara
11
Memon
8
Other
24
Fear of needles and sharp
objects
Yes
99
No
167
Level of anxiousness?
Extremely anxious
24
Very anxious
12
Somewhat anxious
27
A little
35
Not at All
1
Avoid blood tests and medical
care
Always
23
Never
46
Sometimes
30
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
Family history
Yes
30
No
69
Past experience
Personal injury
22
family injury
11
infectious disease before
3
family gone through a disease
6
Anyone died
3
Type of needle phobia
Vasovagal
10
Associative
25
Resistive
42
Hyperalgesic
22
Which part most involved
Hand
36
Elbow
12
Deltoid
35
Gluteal region
18
Table 2.Association between needle phobia and different demographic variables of study
participant
Needle Phobia
VARIABLES
YES
NO
t-test/ Chi
square test
P-Value
N
%
N
%
Age (Years )
Mean±SD
19±3.4
20.6±3.6
-2.55
0.011
GENDER
Female
70
76.8
59
35.3
42.700
<0.001
Male
23
23.2
108
64.7
EDUCATION
Illiterate
26
26.3
48
28.7
0.738
0.864 !
Primary
29
29.3
41
24.6
Secondary
40
40.4
71
42.5
Graduation
4
4
7
4.2
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
Table 3. Association of Type of Needle Phobia with Gender And Age
Vasovagal
Associative
Resistive
Hyperalgesic
t-test/ Chi
square test
P-Value
N
%
N
%
N
%
N
%
7.848
0.049
Male
2
8.7
1
4.3
14
60.9
6
26.1
Female
8
10.5
24
31.6
28
36.8
16
21.1
Age
<18
5
15.2
8
24.2
10
30.3
10
30.3
4.439
0.218 !
Age 18
or
Above
5
7.6
17
25.8
32
48.5
12
18.2
Table 4. Association of Part of Body mostly involved in needle phobia with Gender And Age
Hand
Elbow
Deltoid
Gluteal
Region
t-test/ Chi
square test
P-Value
N
%
N
%
N
%
N
%
Male
6
24.0
7
28.0
7
28.0
5
20.0
9.042
0.029
Female
30
39.5
5
6.6
28
36.8
13
17.1
Age<18
9
27.3
3
9.1
15
45.5
6
18.2
2.938
0.401 !
Age 18
or
above
27
39.7
9
13.2
20
29.4
12
17.6
! = statically insignificant
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
4. DISCUSSION
This evidence based study conducted in tertiary
care hospitals of Karachi, Pakistan demonstrated
needle phobia estimate of at approximately
37·2%, is credible with majority being females.
These results are higher than previously
evaluated rates in previous studies. It is also
evident that there is progressive rise in needle
phobics. As study was performed on four
hundred and forty nine Canadian women in
1982 and it was found that 21·2% of them had
mild to severe fear, and 9% had a phobic level
of fear of injections, blood, injury, and health
care professionals[12]. One more study in 1969
assessed that 9% of people between 10 to 50
years of age in US have needle phobia, and
5·7% consulted a doctor about this
condition[13]. 11% of one hundred English
office patients had fear of painful injections[14].
Through in-hospital interviews, 22% of one
hundred and eighty four adolescent maternity
patients in Nashville, had a fear of drawing of
blood due to which they avoid prenatal care[15].
In some previous surveys, 23% of two hundred
Swedes[16] and 27% of one
hundred and seventy seven US college
students[17] dont donate blood because of this
fear. According to Hamilton, 1995 prevalence
rate was at least 10%[2] whereas it was also
estimated 21·7%[7] and 22%[2].
Genetic factors as well as learned element to
needle phobia can also be affiliated. Needle
phobia and family history with needle phobia
are not strongly associated in our study as it was
reported for fear of needles by Hamilton[2].
Evidences showed that only few percentage of
respondents have genetic factors to needle fear
in family(30.3%) a ratio little lower than what
stated before[10] However, we found out a
strong association of learned behavior of needle
phobia with its resistive type. As previously
evident that a patient developed needle phobia
when he was a child because of verbal
mistreatment and inhibited by health care
professional during many unpleasant medical
procedures[18]. In a study of fifty six persons
with trypanophobia, 52% developed it after
experiencing a painful medical procedure, with
a mean age at onset of 8·06 years, and another
24% had this fear after an episode of seeing
another child, mostly a sibling, have a painful
experience to needles[19].
Patients with needle phobias simply avoid
health care; sometimes for many years. Our
study stated that 23·2% avoided blood tests and
complete medical care, These figures agree with
a recent study conducted in 2009[10]. Results
also match with study conducted before that
22% avoid prenatal care because they had fear
of drawing of blood[15]
Our study on basis of evidences also stated that
male gender mostly fear deltoid region and
elbow for needle insertion where as female
gender avoid needle insertion in hand, reasons
for it was not further evaluated. Hence, there is
need of further investigations behind the reason
of needle phobia at different parts of body.
Our research result of needle phobia projected
avoidance of medical treatment to a limited
extent where as family history of needle phobia
did not impart a role in fear of needles among
patients of tertiary care government hospitals of
Karachi, Pakistan.
Limitation of this study
There were various restrictions in the study and
founded to be an introductory investigation
requiring further research. The sample size was
moderate and comprised of unknown number of
people who didn’t reported for medical care in
OPD at that time. The passive method of
presenting performa resulted in low interest and
unknown selection bias there were unsatisfied
reactions in up to 5% in sections of performa.
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
Hence there may be some chances of errors in
representing the views of general population or
indeed the society.
5.CONCLUSION
Our study showed that there were more needle
phobics as compared to previous studies,
majority were females. Resistive type was more
often encountered in male as well as female.
Elbow and deltoid region was feared by males
and hand was mostly feared by females. There
was strong relationship between type of phobia
and body part mostly feared by needle insertion
with gender. Hence, there is need of further
investigations behind the reason of needle
phobia at different parts of body.
6. REFERENCES
[1] Prasenjit Banerjee. Trypanophobia
[Internet]. Available from:
http://www.hxbenefit.com/trypanophobia.html
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[2] Hamilton, J.G. (08/1995). Needle Phobia: A
Neglected Diagnosis. J Fam Practice, 41(2),
169-75.
[3] American Psychiatric Association.(1994).
Diagnostic and statistical manual of mental
disorders. 4th ed. Washington, DC, 405-11.
[4] Ellinwood, E.H., &Hamilton, J.G. (1991).
Case report of a needle phobia. J Fam Practice,
32, 420-3.
[5] Domoto, P.K., Weinstein, P., Melnick, S.,
Ohmura, M., Uchida, H., Ohmachi, K.., et al.
(1988 Aug). Results of a dental fear survey in
Japan: implications for dental
public health in Asia. Community Dent Oral
Epidemiol, 16(4), 199-201.
[6] Rao. A., Sequeire, P.S., Peter, S. (1997 Oct-
Dec). Characteristics of dental fear amongst
dental and medical students. Indian J Dent
Res., 8(4), 111-4.
[7] Nir, Y., Paz, A., Sabo, E., & Potasman, I.
(2003 Mar). Fear of injections in young adults:
prevalence and associations. Am J Trop Med
Hyg., 68(3), 341-4.
[8] Thurgate, C., &Heppell, S. (2005 Nov).
Needle phobia-
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are. Paediatr Nurs., 17(9), 15-8.
[9] Yim, L. (2006 Aug). Belonephobia--a fear
of needles. Aust Fam Physician, 35(8), 623-4.
[10] Seymour Segnit. Trypanaphobia [Internet].
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http://www.changethatsrightnow.com/trypanoph
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[11] Wright, S., Yelland, M., Heathcote, K., Ng,
S.K., &Wright, G. (2009 Mar). Fear of needles
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[12] Costello, Charles G. (1982). Fears and
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[13] Agras S, Sylvester D, Oliveau D. (1969).
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[14] Keep PJ, Jenkins JR. (1978 Oct). From
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International Journal of Research (IJR) Vol-2, Issue-1 January 2015 ISSN 2348-6848
[15] Cartwright PS, McLaughlin FJ, Martinez
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[16] Arvidsson SB, Ekroth RH, Hansby
AM, Lindholm AH, William-Olsson G. (1984
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[17] Oswalt RM, Napoliello M.(1974).
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[18] Jacobsen PB. (1991 Sep). Treating a man
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[19] Ost LG.(1991). Acquisition of blood and
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