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Kermode M, Choudhurimayum RS, Rajkumar LS, Haregu T, Armstrong G. Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India. Harm Reduct J 2020; 17:68. [PMID: 32993646 PMCID: PMC7523306 DOI: 10.1186/s12954-020-00413-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs. Methods All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out. Results Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone. Conclusion Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia.
| | | | - Lenin Singh Rajkumar
- Department of Psychiatry, Regional Institute of Medical Science, Imphal, Manipur, India
| | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
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Khanna T, Garg P, Akhtar F, Mehra S. Association between gender disadvantage factors and postnatal psychological distress among young women: A community-based study in rural India. Glob Public Health 2020; 16:1068-1078. [PMID: 32928069 DOI: 10.1080/17441692.2020.1820066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Common mental health disorders are studied extensively among adult women globally. However, they remain under-researched among young women. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average. A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in the last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. Psychological distress was found among 50 respondents (21.9%). Young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors. Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress, is imperative, along with addressing gender inequitable practices.
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Affiliation(s)
- Tina Khanna
- MAMTA Health Institute for Mother and Child, Delhi, India.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Priyanka Garg
- MAMTA Health Institute for Mother and Child, Delhi, India
| | - Faiyaz Akhtar
- MAMTA Health Institute for Mother and Child, Delhi, India
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, Delhi, India
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Degefa M, Dubale B, Bayouh F, Ayele B, Zewde Y. Validation of the PHQ-9 depression scale in Ethiopian cancer patients attending the oncology clinic at Tikur Anbessa specialized hospital. BMC Psychiatry 2020; 20:446. [PMID: 32912183 PMCID: PMC7488004 DOI: 10.1186/s12888-020-02850-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although depression is highly prevalent among cancer patients, it is often underdiagnosed and poorly managed particularly in developing nations. These shortcomings can have substantial adverse effects not only on the disease prognosis but also on patients' quality of life. The Patient Health Questionnaire-9 is a widely used depression screening tool but it has not been validated among patients with chronic illnesses such as cancer in Ethiopia. We aim to validate the PHQ-9 among Ethiopian cancer patients in an outpatient setting. METHODS A cross-sectional study was conducted among cancer patients attending the oncology clinic at Tikur Anbessa Specialized Hospital (TASH). We assessed criterion validity and performance of the PHQ-9 test against the gold standard Mini-International Neuropsychiatric Interview (MINI) diagnostic tool among patients with cancer. The MINI was administered by psychiatric nurses who were blind to the initial PHQ-9 screening tool. RESULTS A total of 163 patients completed the 2 stages of a diagnostic interview in the study. The majority (64%) of the participants were women, the mean age was 46 (13.5) years. Using the gold standard MINI test the prevalence of Major Depressive Episode (MDE) was 15%. The internal consistency (Cronbach's α) for PHQ-9 was 0.78 suggesting good (acceptable) internal consistency for the reliability of the test scores. When the total PHQ-9 score was used to identify cases of MDE, the Area under the Curve (AUC) was 0.93 (95% confidence interval [CI], 0.88-0.97) on Receiver Operating Characteristic (ROC) analysis. This shows evidence for the excellent discriminating power of the PHQ-9 between cases and non-cases of MDE. At cutoff point ≥4, the PHQ-9 had a sensitivity of 88% and specificity of 78.1% on the ROC curve to detect MDE. CONCLUSION PHQ-9 is a reliable and valid instrument to detect MDE among individuals with chronic conditions such as cancer patients in outpatient settings and it can be used in resource-limited settings for early diagnosis and proper therapy of such patients.
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Affiliation(s)
- Mikyas Degefa
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Benyam Dubale
- grid.7123.70000 0001 1250 5688Department of Pyschiatry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikirte Bayouh
- grid.7123.70000 0001 1250 5688Department of Pyschiatry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biniyam Ayele
- grid.7123.70000 0001 1250 5688Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Zewde
- grid.7123.70000 0001 1250 5688Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Jaisoorya TS, Thamby A, Manoj L, Kumar GS, Gokul GR, Narayanaswamy JC, Arumugham SS, Thennarassu K, Reddy YCJ. Prevalence of hoarding disorder among primary care patients. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:168-173. [PMID: 32876135 PMCID: PMC8023159 DOI: 10.1590/1516-4446-2020-0846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.
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Affiliation(s)
- T S Jaisoorya
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Abel Thamby
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - L Manoj
- National Health Mission (NHM), Thiruvananthapuram, Kerala, India
| | - G Sunil Kumar
- National Health Mission (NHM), Thiruvananthapuram, Kerala, India
| | - G R Gokul
- National Health Mission (NHM), Thiruvananthapuram, Kerala, India
| | | | - Shyam Sundar Arumugham
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - K Thennarassu
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
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Singla DR, Ratjen C, Krishna RN, Fuhr DC, Patel V. Peer supervision for assuring the quality of non-specialist provider delivered psychological intervention: Lessons from a trial for perinatal depression in Goa, India. Behav Res Ther 2020; 130:103533. [DOI: 10.1016/j.brat.2019.103533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
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Scott S, Arrieta A, Kumar N, Menon P, Quisumbing A. Multidimensional predictors of common mental disorders among Indian mothers of 6- to 24-month-old children living in disadvantaged rural villages with women's self-help groups: A cross-sectional analysis. PLoS One 2020; 15:e0233418. [PMID: 32574218 PMCID: PMC7310838 DOI: 10.1371/journal.pone.0233418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/05/2020] [Indexed: 01/11/2023] Open
Abstract
Common mental disorders (CMD) among mothers cause disability, negatively affect child development, and have high long-term economic costs. Little is known about how factors across multiple life dimensions, modeled together, are differentially related to maternal mental health in high poverty contexts. Further, there is limited evidence on determinants of CMD in areas where self-help groups (SHGs) exist to promote women's wellbeing. Filling this evidence gap is important given the high prevalence of CMD and the rapid expansion of SHGs in rural India. Cross-sectional data were collected from 1644 mother-infant pairs living in disadvantaged rural villages across five Indian states-Jharkhand, Madhya Pradesh, West Bengal, Odisha, and Chhattisgarh-surveyed in the Women Improving Nutrition through Group-based Strategies study. CMD were assessed using the 20-item Self Reporting Questionnaire (SRQ). We examined 31 factors across four life dimensions: work (work type, time spent in labor, domestic and caretaking activities), agency (SHG membership, decision-making, gender attitudes), health/nutrition (underweight, fertility, diet diversity, child illness), and household/environment (dependency ratio, wealth, food security, shocks, water, sanitation). Survey-adjusted multivariate logistic and ordinary least squares regression models were fit to examine predictors of CMD or SRQ score. On average, mothers were 26 (range 18-46) years old and their children were 15 (range 6-24) months old. CMD defined as ≥ 8 positive SRQ responses were reported by 262 women (16%). Protective factors included being engaged in agricultural labor as a main occupation relative to being a housewife (AOR 0.18, 95% CI 0.10-0.32), more time working (0.85, 0.77-0.93), higher decision-making (0.33, 0.16-0.69), SHG membership (0.73, 0.56-0.96), and having an improved toilet (0.49, 0.33-0.72). Risk factors included food insecurity (1.13, 1.07-1.20) and shocks to non-farm livelihoods (2.04, 1.10-3.78). Practitioners and policymakers should aim to improve food security, economic wellbeing and social capital, such as that created through SHG membership, to improve maternal mental health. Future research should aim to understand why working outside the home, albeit in agricultural work, appears to protect maternal mental health in this context.
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Affiliation(s)
- Samuel Scott
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Alejandra Arrieta
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Neha Kumar
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Purnima Menon
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Agnes Quisumbing
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
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Su ZZ, Li BB, Li B, Wu YY, Fu LY, Wu X, Wang PX. Associations among sexuality-related factors, recent two-week morbidity and annual hospitalization in female migrant workers: a cross-sectional study in southern China. PSYCHOL HEALTH MED 2020; 26:991-1004. [PMID: 32490687 DOI: 10.1080/13548506.2020.1774626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To explore the influence of sexuality-related factors on recent two-week morbidity and annual hospitalization in female migrant workers, 880 Chinese rural-to-urban female migrant workers aged 16-57 years were studied. Clustered logistic regression analyses revealed that women who never or seldom experienced lubrication difficulties had a lower risk of recent two-week morbidity (adjusted odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.17-0.60, P< 0.001; adjusted OR = 0.35, 95% CI = 0.18-0.69, P= 0.003) than those who always experienced lubrication difficulties; women who never felt a lack of sexual interest had a significantly lower risk of annual hospitalization (adjusted OR = 0.40, 95% CI = 0.20-0.79, P= 0.009) than those who always or seldom lacked sexual interest, and women who never felt sexual satisfaction had a higher risk of annual hospitalization (adjusted OR = 3.08, 95% CI = 1.75-5.42, P< 0.001) than those who always or seldom experienced sexual satisfaction. The independent contributions of sexuality-related factors to the risk of recent two-week morbidity and annual hospitalization were 5.8% and 29.5%, respectively. This study suggests that sexuality may have a modest influence on recent two-week morbidity and a dominant impact on annual hospitalization.
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Affiliation(s)
- Zhen-Zhen Su
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Bing-Bing Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Bo Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Yan-Yan Wu
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Li-Ying Fu
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Xiao Wu
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Pei-Xi Wang
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China.,General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China
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Sathyanath MS, Kundapur R. Epidemiological Correlates of Psychological Distress in a Rural Community of South India: A Cross-sectional Study. Indian J Community Med 2020; 45:240-243. [PMID: 32905159 PMCID: PMC7467195 DOI: 10.4103/ijcm.ijcm_129_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022] Open
Abstract
Context: Integration of mental health into primary care is essential to establish access to mental health services. Screening the community for psychological distress is the first step. Aims: The aim of the study was to estimate the burden and the determinants of psychological distress in a rural community. Settings and Design: This was a community-based cross-sectional study among adult members of a rural community of Nitte Village in Udupi district in Karnataka, South India. Methodology: Three hundred and ten households were surveyed using the World Health Organization Self-Reported Questionnaire (SRQ). A cutoff value of 8 in SRQ was taken as screening positive. Statistical Analysis Used: Descriptive data were analyzed in proportions, whereas Chi-square test and regression analysis were used to explore associations. Results: Hypertension and diabetes were the two common comorbidities. The prevalence of psychological distress was 42.4 per thousand. “Being easily tired” and “feeling tired all the time” were the two most common responses out of the SRQ checklist. Distress was significantly associated with gender, educational status, and marital status. Conclusions: The prevalence of psychological distress was 42.4 per thousand, and somatic complaints were common presentations of distress in the study population.
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Affiliation(s)
- M Shreyaswi Sathyanath
- Department of Community Medicine, AJ Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India
| | - Rashmi Kundapur
- Department of Community Medicine, K S Hegde Medical Academy, Mangalore, Karnataka, India
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Belayneh Z, Mekuriaw B, Mehare T, Shumye S, Tsehay M. Magnitude and predictors of common mental disorder among people with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2020; 20:689. [PMID: 32410600 PMCID: PMC7345520 DOI: 10.1186/s12889-020-08800-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Common mental disorders are frequent psychiatric comorbid conditions among people with HIV/AIDS. The presence of such psychiatric disorders negatively affects the treatment adherence, viral load suppression, quality of life, treatment outcomes and functionality of people with HIV/AIDS. However, available studies in Ethiopia have a great variation and inconsistency of reported results have been observed regarding the magnitude and associated factors of common mental disorder. Thus, conducting a systematic review and meta-analysis of existing literatures can have a paramount importance to show its summarized figure. METHODS Literatures search was performed using databases (PubMed/Medline, Science Direct and PsycINFO. Grey literatures were also searched from Google and Google Scholar. Data were extracted from primary studies using a data extraction format prepared in Microsoft Excel and exported to STATA-version 14 statistical software for analysis. The I2 test was used to assess the heterogeneity of primary articles. The result of the test showed that there was heterogeneity between primary studies. This leads us to execute a random effect meta-analysis to estimate the pooled prevalence of common mental disorder with corresponding 95% confidence interval. RESULTS A total of 13 primary studies comply with the inclusion criteria were included in this systematic review. The pooled prevalence of common mental disorder was found to be 28.83% (95% CI: 17.93, 39.73) among people with HIV/AIDS in Ethiopia. The highest prevalence of common mental disorder (35.20%) was observed among studies in which Kessler-10 was used as a screening tool. Single marital status (OR = 1.83; 95%CI: 1.03, 3.27), HIV/AIDS-related stigma (OR = 2.21; 95%CI: 1.68, 2.90) and current job unavailability (OR = 1.38; 95%CI: 1.01, 1.88) had statistically significant association with common mental disorder. CONCLUSION The result of this review showed that nearly one among three individuals with HIV/AIDS is suffering from common mental disorder in Ethiopia. This calls a need to integrate the mental health and psycho-social support into the HIV/AIDS care. TRIAL REGISTRATION PROSPERO- CRD42019132402. Registered on 05/08/2019.
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Affiliation(s)
- Zelalem Belayneh
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Birhanie Mekuriaw
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Tsegaye Mehare
- Bio-Medical Department, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Seid Shumye
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Doran EL, Bartel AP, Ruhm CJ, Waldfogel J. California's paid family leave law improves maternal psychological health. Soc Sci Med 2020; 256:113003. [PMID: 32464413 DOI: 10.1016/j.socscimed.2020.113003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 02/26/2020] [Accepted: 04/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effect of California's first in the nation paid family leave policy on maternal postpartum psychological distress for women overall and for disadvantaged groups. METHODS We use restricted data from 11 waves of the National Health Interview Survey, from 2000 to 2010, to examine mothers with children under the age of 12 months (n = 7379). Outcomes included three measures obtained from the six-item Kessler Psychological Distress Scale: an aggregated score and thresholds for mild and moderate psychological distress. For inference, we used synthetic control models, comparing mothers with infants in California to mothers with infants in the control group, pre-law and post-law. RESULTS Access to paid family leave was associated with a 0.636-point decrease (95% CI = -1.202, -0.070) in postpartum psychological distress symptoms among mothers with infants, representing a 27.6% decrease from the pre-treatment mean. It was also associated with a 9.1 percentage point reduction (95% CI = -17.8, -0.4) in mild postpartum distress, a 38.4% reduction from the pre-treatment mean. Populations that typically lack access to paid family leave, particularly single and younger mothers, may have seen even larger effects. CONCLUSIONS Paid family leave was associated with improved mental health for California mothers, suggesting that expansions of state or federal paid family leave policies have the potential to improve maternal postpartum health.
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Affiliation(s)
- Elizabeth L Doran
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Ann P Bartel
- Columbia Business School, 3022 Broadway, 623 Uris Hall New York, NY, 10027, USA
| | - Christopher J Ruhm
- Frank Batten School of Leadership and Public Policy University of Virginia 235 McCormick Rd.P.O. Box 400893 Charlottesville, VA, 22904, USA
| | - Jane Waldfogel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
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Roberts T, Shidhaye R, Patel V, Rathod SD. Health care use and treatment-seeking for depression symptoms in rural India: an exploratory cross-sectional analysis. BMC Health Serv Res 2020; 20:287. [PMID: 32252760 PMCID: PMC7137455 DOI: 10.1186/s12913-020-05162-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a large "treatment gap" for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. METHODS Data were analysed from a two round cross-sectional community survey conducted in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors using univariable regression. RESULTS 86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p < 0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54 and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors. CONCLUSIONS These findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential role of marriage in facilitating treatment-seeking.
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Affiliation(s)
- Tessa Roberts
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Rahul Shidhaye
- Department of Research, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit D Rathod
- Department of Population Health, Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London, UK
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Mahapatro M, Singh SP. Coping strategies of women survivors of domestic violence residing with an abusive partner after registered complaint with the family counseling center at Alwar, India. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:818-833. [PMID: 31816108 DOI: 10.1002/jcop.22297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Coping is one of the most important and widely studied aspects of domestic violence (DV). Women adopt a wide variety of coping strategies to manage abuse, ranging from individual estrangement to institutional entitlements. The condition of women becomes complex when they seek institutional support while living with an abusive husband and his family under the common hearth. The present study aims to analyze the coping strategy of mediation between informal and formal justice while residing with an abusive husband and his family. Further, the study explores the coping strategy as an outcome of the contextual factor and associated psychological distress. It is a prospective intervention study with a 4-month span building awareness, counseling (individual, couple, and family counseling), and case-specific advice (safety plan, choice-making, and problem-solving). A baseline and endline assessment with SRQ-20 and in-depth interviews were carried out on 299 married women who had registered a complaint with a family counseling center (FCC); Mahila Suraksha Evam Salah Kendra (MSSK) in Alwar district, India. To understand the context and the coping strategy adopted by women, in-depth interviews were carried out. The results show that there is a differential impact of DV, psychological distress, and coping strategy based on contextual factor; women having an informal support system have a better result in coping; and intervention at the formal system resulted in improving coping strategy and simultaneously reducing psychological distress. As the mediation period is interminable and traumatic, the institutional support to women survivors of DV is an important policy alternative for improving survivors' well-being, especially in an unsupportive informal context.
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Affiliation(s)
| | - Sudhir P Singh
- School of Public Policy & Governance, MDI Gurugram, Gurgaon, Haryana, India
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Srinivasan M, Reddy MM, Sarkar S, Menon V. Depression, Anxiety, and Stress among Rural South Indian Women-Prevalence and Correlates: A Community-Based Study. J Neurosci Rural Pract 2020; 11:78-83. [PMID: 32140007 PMCID: PMC7055615 DOI: 10.1055/s-0039-1700595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background
The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living.
Objective
The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry.
Methods
A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression.
Results
A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3–19.3), 10.6% (95% CI: 7.5–14.5), and 5% (95% CI: 3–8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women.
Conclusion
About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.
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Affiliation(s)
- Manikandan Srinivasan
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Mahendra M Reddy
- Department of Community Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
| | - Sonali Sarkar
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry (JIPMER), India
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Joag K, Kalha J, Pandit D, Chatterjee S, Krishnamoorthy S, Shields-Zeeman L, Pathare S. Atmiyata, a community-led intervention to address common mental disorders: Study protocol for a stepped wedge cluster randomized controlled trial in rural Gujarat, India. Trials 2020; 21:212. [PMID: 32085716 PMCID: PMC7035701 DOI: 10.1186/s13063-020-4133-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 02/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While lay-health worker models for mental health care have proven to be effective in controlled trials, there is limited evidence on the effectiveness and scalability of these models in rural communities in low- and middle-income countries (LMICs). Atmiyata is a rural community-led intervention using local community volunteers, called Champions, to identify and provide a package of community-based interventions for mental health, including evidence-based counseling for persons with common mental disorders (CMD). METHODS The impact of the Atmiyata intervention is evaluated through a stepped wedge cluster randomized controlled trial (SW-CRCT) with a nested economic evaluation. The trial is implemented across 10 sub-blocks (645 villages) in Mehsana district in the state of Gujarat, with a catchment area of 1.52 million rural adults. There are 56 primary health centers (PHCs) in Mehsana district and villages covered under these PHCs are equally divided into four groups of clusters of 14 PHCs each. The intervention is rolled out in a staggered manner in these groups of villages at an interval of 5 months. The primary outcome is symptomatic improvement measured through the GHQ-12 at a 3-month follow-up. Secondary outcomes include: quality of life using the EURO-QoL (EQ- 5D), symptom improvement measured by the Self-Reporting Questionnaire-20 (SRQ-20), functioning using the World Health Organization's Disability Assessment Scale (WHO-DAS-12), depression symptoms using the Patient Health Questionnaire (PHQ-9), anxiety symptoms using Generalized Anxiety Disorder Questionnaire (GAD-7), and social participation using the Social Participation Scale (SPS). Generalized linear mixed effects model is employed for binary outcomes and linear mixed effects model for continuous outcomes. A Return on Investment (ROI) analysis of the intervention will be conducted to understand whether the intervention generates any return on financial investments made into the project. DISCUSSION Stepped wedge designs are increasingly used a design to evaluate the real-life effectiveness of interventions. To the best of our knowledge, this is the first SW-CRCT in a low- and middle-income country evaluating the impact of the implementation of a community mental health intervention. The results of this study will contribute to the evidence on scaling-up lay health worker models for mental health interventions and contribute to the SW-CRCT literature in low- and middle-income countries. TRIAL REGISTRATION The trial is registered prospectively with the Clinical Trial Registry in India and the Clinical Trial Registry number- CTRI/2017/03/008139. URL http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=70845.17209. Date of registration- 20/03/2017.
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Affiliation(s)
- Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Deepa Pandit
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Susmita Chatterjee
- George Institute for Global Health, Elegance Tower, 311-312, Third Floor, JasolaVihar, New Delhi, Delhi 110025 India
| | - Sadhvi Krishnamoorthy
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Laura Shields-Zeeman
- Netherlands Institute for Mental health and Addiction (Trimbos Institute), Da Costakade 45, 3521 VT Utrecht, the Netherlands
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
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Aryal N, Regmi PR, van Teijlingen E, Trenoweth S, Adhikary P, Simkhada P. The Impact of Spousal Migration on the Mental Health of Nepali Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1292. [PMID: 32079358 PMCID: PMC7068335 DOI: 10.3390/ijerph17041292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/04/2022]
Abstract
Spousal separation, lack of companionship, and increased household responsibilities may trigger mental health problems in left-behind female spouses of migrant workers. This study aimed to examine mental ill-health risk in the left-behind female spouses of international migrant workers in Nepal. A cross-sectional survey was carried out in the Nawalparasi district. Study areas were purposively chosen; however, participants were randomly selected. Nepali versions of the 12-item General Health Questionnaire (GHQ), Beck Depression Inventory (BDI), and Connor-Davidson Resilience Scale (CD-RISC) were used. Mental ill-health risk was prevalent in 3.1% of the participants as determined by GHQ. BDI identified mild or moderate depression in 6.5% of the participants with no one having severe depression. In bivariate analysis, a high frequency of communication with the husband was associated with lower mental ill-health risk and depression, as well as increasing resilience. Reduced return intervals of husbands and a high frequency of remittance were also associated with a low GHQ score. In a multiple regression model, adjusting for potential confounding variables, participants who communicated with their husbands at least once a day had a greater mean CD-RISC score (i.e., high resilience against mental ill-health risk) compared to those who did so at least once a week; a mean difference of 3.6 (95% CI 0.4 to 6.9), P = 0.03. To conclude, a low mental ill-health risk was found in the female spouses of migrants.
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Affiliation(s)
- Nirmal Aryal
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
| | - Pramod R. Regmi
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
- Chitwan Medical College, Tribhuvan University, Bharatpur P.O. Box No. 42, Nepal
- Datta Meghe Institute of Medical Sciences, Wardha 442001, India
| | - Edwin van Teijlingen
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
- Manmohan Memorial Institute of Health Sciences, Tribhuvan University, Kathmandu P.O. Box No. 15201, Nepal;
- Nobel College, Pokhara University, Kathmandu GPO 10420, Nepal
| | - Steven Trenoweth
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK; (P.R.R.); (E.v.T.); (S.T.)
| | - Pratik Adhikary
- School of Public Health, University of California, Berkeley, CA 94720-7360, USA;
- Green Tara Nepal, Kathmandu GPO 9874, Nepal
| | - Padam Simkhada
- Manmohan Memorial Institute of Health Sciences, Tribhuvan University, Kathmandu P.O. Box No. 15201, Nepal;
- Nobel College, Pokhara University, Kathmandu GPO 10420, Nepal
- School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
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Joag K, Shields-Zeeman L, Kapadia-Kundu N, Kawade R, Balaji M, Pathare S. Feasibility and acceptability of a novel community-based mental health intervention delivered by community volunteers in Maharashtra, India: the Atmiyata programme. BMC Psychiatry 2020; 20:48. [PMID: 32028910 PMCID: PMC7006077 DOI: 10.1186/s12888-020-2466-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many community-based intervention models for mental health and wellbeing have undergone robust experimental evaluation; however, there are limited accounts of the implementation of these evidence-based interventions in practice. Atmiyata piloted the implementation of a community-led intervention to identify and understand the challenges of delivering such an intervention. The goal of the pilot evaluation is to identify factors important for larger-scale implementation across an entire district in India. This paper presents the results of a feasibility and acceptability study of the Atmiyata intervention piloted in Nashik district, Maharashtra, India between 2013 and 2015. METHODS A mixed methods approach was used to evaluate the Atmiyata intervention. First, a pre-post survey conducted with 215 cases identified with a GHQ cut-off 6 using a 3-month interval. Cases enrolled into the study in one randomly selected month (May-June 2015). Secondly, a quasi-experimental, pre-post design was used to conduct a population-based survey in the intervention and control areas. A randomly selected sample (panel) of 827 women and 843 men age between 18 to 65 years were interviewed to assess the impact of the Atmiyata intervention on common mental disorders. Finally, using qualitative methods, 16 Champions interviewed to understand an implementation processes, barriers and facilitators. RESULTS Of the 215 participants identified by the Champions as being distressed or having a common mental disorder (CMD), n = 202 (94.4%) had a GHQ score at either sub-threshold level for CMD or above at baseline. Champions accurately identified people with emotional distress and in need of psychological support. After a 6-session counselling provided by the Champions, the percentage of participants with a case-level GHQ score dropped from 63.8 to 36.8%. The second sub-intervention consisted of showing films on Champions' mobile phones to raise community awareness regarding mental health. Films consisted of short scenario-based depictions of problems commonly experienced in villages (alcohol use and domestic violence). Champions facilitated access to social benefits for people with disability. Retention of Atmiyata Champions was high; 90.7% of the initial selected champions continued to work till the end of the project. Champions stated that they enjoyed their work and found it fulfilling to help others. This made them willing to work voluntarily, without pay. The semi-structured interviews with champions indicated that persons in the community experienced reduced symptoms and improved social, occupational and family functioning for problems such as depression, domestic violence, alcohol use, and severe mental illness. CONCLUSIONS This study shows that community-led interventions using volunteers from rural neighbourhoods can serve as a locally feasible and acceptable approach to facilitating access social welfare benefits, as well as reducing distress and symptoms of depression and anxiety in a low and middle-income country context. The intervention draws upon social capital in a community to engage and empower community members to address mental health problems. A robust evaluation methodology is needed to test the efficacy of such a model when it is implemented at scale.
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Affiliation(s)
- Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004, India.
| | - Laura Shields-Zeeman
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Da Costakade 45, 3521 VS Utrecht, the Netherlands
| | - Nandita Kapadia-Kundu
- grid.21107.350000 0001 2171 9311Johns Hopkins Centre for Communication Programs, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21202 USA
| | - Rama Kawade
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004 India
| | - Madhumitha Balaji
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004 India ,grid.471010.3Sangath, South Goa, Goa 403720 India
| | - Soumitra Pathare
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004 India
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“Is there a medicine for these tensions?” Barriers to treatment-seeking for depressive symptoms in rural India: A qualitative study. Soc Sci Med 2020; 246:112741. [DOI: 10.1016/j.socscimed.2019.112741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 11/21/2022]
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Bantjes J, Kagee A, Saal W. The Utility of the Hopkins Symptom Checklist as a Trans-Diagnostic Screening Instrument for Common Mental Disorders Among Persons Seeking HIV Testing. AIDS Behav 2020; 24:629-636. [PMID: 31041626 DOI: 10.1007/s10461-019-02524-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is a need for effective psychiatric screening of HIV test seekers, given the high rates of psychopathology in this population. We used receiver operating characteristic curve analysis to establish the utility of the short version of the Hopkins Symptom Checklist (HSCL-25) to correctly identify common mental disorders (CMDs) among persons seeking HIV testing. The HSCL-25 is moderately accurate in identifying CMDs (sensitivity = 69%, specificity = 71%). The HSCL-25 performed better than the Beck Depression Inventory at detecting depressive disorders, and was comparable to the Beck Anxiety Inventory and Posttraumatic Stress Scale-Self-report at detecting cases of generalised anxiety disorder and posttraumatic stress disorder, respectively. However, the instrument generates a high number of false positives and is poor at detecting cases of alcohol use disorder, which limits its utility as a trans-diagnostic screening tool in HIV testing sites.
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Joshi U, Lyngdoh T, Shidhaye R. Validation of hindi version of Edinburgh postnatal depression scale as a screening tool for antenatal depression. Asian J Psychiatr 2020; 48:101919. [PMID: 31927197 DOI: 10.1016/j.ajp.2019.101919] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/25/2019] [Accepted: 12/25/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Antenatal depression is recognized as one of the strongest predictors of postnatal depression, which itself is a strong predictor of mental disorders. The detection of antenatal depression is important and requires an accurate and valid screening tool. The Edinburgh Postnatal Depression Scale (EPDS) is one of the most extensively studied screening instruments for assessing postnatal depression. AIM To validate a linguistically and contextually appropriate Hindi version of the EPDS for use in women attending antenatal care in Sehore, Madhya Pradesh. METHODS AND MATERIAL A rigorously translated and modified Hindi version of the EPDS was developed and validated using the Hindi version of the PHQ-9 as a gold standard. A consecutive sample of women (n = 100) attending antenatal check-ups in healthcare facilities in Sehore district were interviewed. RESULTS The validity measure of Receiver Operator Characteristic curve was plotted for different cutoffs of EPDS. The optimal cutoff score for the Hindi validation of the EPDS was 9/10 for antenatal depression with sensitivity, specificity, positive and negative predictive value of 65.38%, 79.73%, 53.13%, and 86.76% respectively and area under the curve 0.7346. The internal consistency using Cronbach's alpha was 0.86 indicating good homogeneity. CONCLUSION Findings of this study suggest that the Hindi version of the EPDS can be used as a valid measure to screen antenatal depression in India.
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Affiliation(s)
- Udita Joshi
- Sangath, 120, Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh 462016, India.
| | - Tanica Lyngdoh
- Indian Institute of Public Health, Delhi. Plot No. 47, Sector 44, Institutional Area, Gurgao 122003, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharastra 413736, India
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Ribeiro IBDS, Correa MM, Oliveira G, Cade NV. Common mental disorders and socioeconomic status in adolescents of ERICA. Rev Saude Publica 2020; 54:04. [PMID: 31939577 PMCID: PMC9586442 DOI: 10.11606/s1518-8787.2020054001197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/03/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adolescence is a stage of great social, family and emotional demands, and the literature has related common mental disorder (CMD) with poor living conditions. OBJECTIVE To investigate the relationship between CMD and socioeconomic status in Brazilian adolescents aged 12 to 17 years. METHOD This is a cross-sectional study with data from the Study of Cardiovascular Risk in Adolescents (ERICA - Estudo de Riscos Cardiovasculares em Adolescentes). The outcome was CMD and the exposure was socioeconomic status assessed by race/skin color, maternal schooling, resident/room relationship, type of school, existence of maid and bathroom at home, and work activity. For the calculation of prevalence, the survey mode was used and, in the multivariate analysis, logistic regression with p < 5%, as well as the 95% confidence interval. RESULTS The prevalence of CMD in girls was 23.3%, and in boys, 11.1%. The variables associated with CMD in girls were age between 15 and 17 years (OR = 1.34; 1.17-1.51), studying in private school (OR = 1.13; 1.01-1.27), having a housemaid (OR = 1.15; 1.00-1.34) and, as a protective factor, unpaid work (OR = 0.64; 0.55-0.75). Boys also had a higher chance of CMD in the highest age group (OR = 1.42; 1.18-1.71) and when they had a housemaid (OR = 1.26; 1.02-1.57), whereas unpaid work decreased this chance (OR = 0.79; 0.67-0.95). CONCLUSION Socioeconomic variables that were associated with CMD were suggestive of higher economic class, whereas unpaid work favored the mental health of adolescents, results contrary to the literature on socioeconomic status and CMD.
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Affiliation(s)
| | - Marcia Mara Correa
- Universidade Federal do Espírito Santo. Hospital Universitário Cassiano Antônio de Moraes. Vitória, ES, Brasil
| | - Gabriela Oliveira
- Universidade Federal do Espírito Santo. Programa de Pós-Graduação em Saúde Coletiva. Vitória, ES, Brasil
| | - Nágela Valadão Cade
- Universidade Federal do Espírito Santo. Departamento de Enfermagem. Vitória, ES, Brasil
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Aslan J, Cova F, Saldivia S, Bustos C, Inostroza C, Rincón P, Ortiz C, Bühring V. Psychometric Properties of the Patient Health Questionnaire-9 in Elderly Chilean Primary Care Users. Front Psychiatry 2020; 11:555011. [PMID: 33312135 PMCID: PMC7704434 DOI: 10.3389/fpsyt.2020.555011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to assess the measurement properties (reliability, factor structure, and criterion validity) of the Patient Health Questionnaire (PHQ-9) as an instrument for screening major depressive disorder (MDD) in elderly primary care users in Chile. Method: About 582 participants aged between 65 and 80 years were enrolled from primary care centers. They completed the Composite International Diagnostic Interview (CIDI), a survey with sociodemographic characteristics and the PHQ-9. Results: The PHQ-9 revealed an acceptable internal consistency (ω = 0.79 [95% CI: 0.75-0.80] and α = 0.78 [95% CI: 0.75-0.81]); confirmatory factor analysis demonstrated a good fit for both 1- and 2-factor solutions. The chi-square difference test (χ2 = 0.61, gl = 1, p = 0.43) and correlation between the somatic and the cognitive-effective latent factors were very high (r = 0.97, p < 0.001), indicating that the 1 factor model was more parsimonious. Utilizing the CIDI as the gold standard, the area under the curve (AUC) was 0.88 (SE = 0.04, 95% CI: 0.84-0.90). The optimal cut-off score of ≥ 6 yielded good sensitivity and specificity for detecting MDD (0.95 and 0.76, respectively). However, considering the clinical utility index, the cut-off score of ≥9 proved to be a more effective marker for discarding cases of MDD. Conclusion: The PHQ-9 has adequate psychometric properties for elderly primary care users. In clinical settings, it showed its greatest utility in ruling out the presence of an MDD, however, its clinical value for identifying possible cases of MDD is limited. In cases above the cut-off point, it is recommended to perform a more thorough evaluation.
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Affiliation(s)
- Joseph Aslan
- Doctoral Program in Psychology, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Claudio Bustos
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Carolina Inostroza
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Paulina Rincón
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Camila Ortiz
- Master Program in Politics and Government, Universidad de Concepción, Concepción, Chile
| | - Vasily Bühring
- Master Program in Psychology, Universidad de Concepción, Concepción, Chile
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Richardson R, Nandi A, Jaswal S, Harper S. The effect of intimate partner violence on women's mental distress: a prospective cohort study of 3010 rural Indian women. Soc Psychiatry Psychiatr Epidemiol 2020; 55:71-79. [PMID: 31177309 PMCID: PMC7140984 DOI: 10.1007/s00127-019-01735-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Intimate partner violence (IPV) encompasses physical, sexual, and psychological abuse, as well as controlling behavior. Most research focuses on physical and sexual abuse, and other aspects of IPV are rarely investigated. We estimated the effect of these neglected aspects of IPV on women's mental distress. METHODS We used data from 3010 women living in rural tribal communities in Rajasthan, India. Women completed baseline interviews and were re-interviewed approximately 1.5 years later. We measured IPV with questions adopted from the Demographic and Health Survey's Domestic Violence Module, which asked seven questions about physical abuse, three questions about psychological abuse, and five questions about partner controlling behavior. Mental distress was measured with the 12-item General Health Questionnaire (score range 0-12). We used Poisson regression models to estimate the relation between changes in IPV and mental distress, accounting for time-fixed characteristics of individuals using individual fixed effects. RESULTS Women reported an average of 2.1 distress symptoms during baseline interviews. In models that controlled for time-varying confounding (e.g., wealth, other types of abuse), experiencing psychological abuse was associated with an increase of 0.65 distress symptoms (95% CI 0.32, 0.98), and experiencing controlling behavior was associated with an increase of 0.31 distress symptoms (95% CI 0.18, 0.44). However, experiencing physical abuse was not associated with an increase in distress symptoms (mean difference = - 0.15, 95% CI - 0.45, 0.15). CONCLUSIONS Psychological abuse and controlling behavior may be important drivers of the relation between IPV and women's mental health.
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Affiliation(s)
- Robin Richardson
- Department of Epidemiology, Columbia University, 722 West 168 th, New York, NY, 10032, USA.
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada,Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Surinder Jaswal
- Centre for Health and Mental Health, Tata Institute of Social Sciences, Mumbai, India
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada,Institute for Health and Social Policy, McGill University, Montreal, Canada
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What Impedes General Practitioners' Identification of Mental Disorders at Outpatient Departments? A Qualitative Study in Shanghai, China. Ann Glob Health 2019; 85:134. [PMID: 31799127 PMCID: PMC6857524 DOI: 10.5334/aogh.2628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Mental disorders endanger people’s health and lives. General practitioners (GPs) play a valuable role in identifying and treating mental disorders in outpatient clinical settings. However, there are obstacles for GPs’ identification in developing countries. Objective: This study’s aim was to identify the related obstacles and to propose optimized strategies. Methods: We conducted qualitative interviews with 26 GPs from seven randomly sampled community healthcare centers in Shanghai, China. The interview guide was based primarily on the items from mental status evaluation. After transcribing, coding, condensing, and categorizing talking content, we summarized the theme structure and results. Findings: GPs lacked the confidence and skills to conduct psychiatric evaluation and seldom conducted it. Patients’ behaviors also influenced whether evaluations were conducted. The GPs expressed that they were short of strategies and wished to be well trained and have sufficient practice. We found that two major reasons impeded GPs’ identification. First, the GPs had difficulty making a diagnosis: they lacked diagnostic ability and confidence, they had misunderstandings about diagnoses, and they had unclear qualifications for making psychiatric diagnoses. Second, the GPs lacked skills for evaluation and reevaluation: their evaluation had inadequacies of contents and subjects; they lacked mental state examination evaluation, communication, and severity assessment skills and knowledge. Conclusions: This study found that it is difficult for GPs in developing countries to become competent in the diagnosis and systematic evaluation of mental disorders without external help. Unclear qualification also limited GPs’ diagnoses of mental disorders. We proposed that optimized strategies to overcome these challenges lie in support of changes in policy, programs, and utilizing effective tools, such as the mhGAP, GMHAT/PC, BVC, Grille’s assessment tool, and telemedicine.
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Shidhaye R, Murhar V, Muke S, Shrivastava R, Khan A, Singh A, Breuer E. Delivering a complex mental health intervention in low-resource settings: lessons from the implementation of the PRIME mental healthcare plan in primary care in Sehore district, Madhya Pradesh, India. BJPsych Open 2019; 5:e63. [PMID: 31352917 PMCID: PMC6669881 DOI: 10.1192/bjo.2019.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The PRogramme for Improving Mental health care (PRIME) designed, implemented and evaluated a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India.AimsTo provide quantitative measures of outputs related to implementation processes, describe the role of contextual factors that facilitated and impeded implementation processes, and discuss what has been learned from the MHCP implementation. METHOD A convergent parallel mixed-methods design was used. The quantitative strand consisted of process data on mental health indicators whereas the qualitative strand consisted of in-depth interviews and focus group discussions with key stakeholders involved in PRIME implementation. RESULTS The implementation of the MHCP in Sehore district in Madhya Pradesh, India, demonstrated that it is feasible to establish structures (for example Mann-Kaksha) and operationalise processes to integrate mental health services in a 'real-world' low-resource primary care setting. The key lessons can be summarised as: (a) clear 'process maps' of clinical interventions and implementation steps are helpful in monitoring/tracking the progress; (b) implementation support from an external team, in addition to training of service providers, is essential to provide clinical supervision and address the implementation barriers; (c) the enabling packages of the MHCP play a crucial role in strengthening the health system and improving the context/settings for implementation; and (d) engagement with key community stakeholders and incentives for community health workers are necessary to deliver services at the community-platform level. CONCLUSIONS The PRIME implementation model could be used to scale-up mental health services across India and similar low-resource settings.Declaration of interestNone.
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Affiliation(s)
- Rahul Shidhaye
- Senior Research Scientist and Associate Professor,Center for Chronic Conditions and Injuries, Public Health Foundation of India,India
| | | | | | | | - Azaz Khan
- Intervention Coordinator, PRIME, Sangath,India
| | | | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health,University of Cape Town,South Africa; andConjoint Lecturer,University of Newcastle,Australia
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Singla DR, Hollon SD, Fairburn CG, Dimidjian S, Patel V. The Roles of Early Response and Sudden Gains on Depression Outcomes: Findings From a Randomized Controlled Trial of Behavioral Activation in Goa, India. Clin Psychol Sci 2019; 7:768-777. [PMID: 31380144 PMCID: PMC6628464 DOI: 10.1177/2167702619825860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/29/2018] [Indexed: 11/15/2022]
Abstract
The Healthy Activity Program (HAP), a brief, lay-counselor-delivered, behavioral activation psychological treatment, was found to be effective in reducing depressive symptoms among primary care attendees in India. We now examine whether early response predicts depression (PHQ-9) outcomes at the primary endpoint of 3 months and sustained recovery at 12 months after enrollment and the extent to which this effect is influenced by sudden gains in the context of the larger randomized controlled trial. HAP participants (N = 245) who exhibited an early response (150 of 245 or 61.2%), as defined by a 50% reduction in depressive symptoms from baseline to Session 3, had lower depressive symptom scores than those who did not at 3 months (5.29 vs. 10.75, F = 33.21, p < .001) and at 12 months (6.56 vs. 11.02, F = 21.84, p < .001). Further exploratory analyses suggested that this advantage was largely confined to the subset of early responders who also showed sudden gains (87 of 150).
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Affiliation(s)
- Daisy R Singla
- Department of Psychiatry, University of Toronto, and Sinai Health System, Toronto, Canada
| | | | | | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Vikram Patel
- Sangath Center, Goa, India.,Department of Global Health and Social Medicine, Harvard Medical School.,Department of Global Health and Population, Harvard TH Chan School of Public Health
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76
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Richardson RA, Harper S, Bates LM, Nandi A. The effect of agency on women's mental distress: A prospective cohort study from rural Rajasthan, India. Soc Sci Med 2019; 233:47-56. [PMID: 31176057 DOI: 10.1016/j.socscimed.2019.05.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
Agency, the ability to identify goals and then act upon them, is a core component of women's empowerment and has important implications for the rights and well-being of women and girls. However, inadequate measurement of agency impedes empirical investigation, and few studies have investigated the relation between agency and health. Using a theory-based measure of women's agency, we investigated the longitudinal association between agency and mental distress among women living in rural Rajasthan, India. Women completed baseline interviews between June and October 2016 and follow-up interviews between June and November 2017 (n = 2859). We measured mental distress with the Hindi version of the 12 item General Health Questionnaire, which asked women 12 questions about symptoms of mental distress (score range: 0-12). We measured agency using a measurement model which was composed of 23 indicators tapping into four domains of agency and validated in a prior research study. We modeled the relation between women's agency and mental distress using Poisson regression and an individual-level fixed effects approach to account for time-fixed characteristics of individuals. In models that controlled for time-varying confounding (e.g., household wealth, number of sons), a one standard deviation increase in agency was associated with a reduction of 0.21 distress symptoms (95% CI: -0.32, -0.09), which corresponds to a 7% reduction (95% CI: 3%, 11%) relative to the mean. We found that specific domains of agency varied in their association with mental distress; namely, an increase in women's agency regarding her attitudes about gender norms corresponded to a reduction in mental distress, whereas an increase in women's agency regarding speaking up in public corresponded to an increase in mental distress. Our research demonstrates that agency may be a determinant of mental health and that comprehensive measurement can reveal nuanced relationships.
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Affiliation(s)
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Lisa M Bates
- Department of Epidemiology, Columbia University, New York, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
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Bhatia U, Bhat B, George S, Nadkarni A. The prevalence, patterns, and correlates of gambling behaviours in men: An exploratory study from Goa, India. Asian J Psychiatr 2019; 43:143-149. [PMID: 31151082 PMCID: PMC6712305 DOI: 10.1016/j.ajp.2019.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 02/19/2019] [Accepted: 03/25/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is a significant evidence gap on gambling in India, where gambling is viewed predominantly through the legal lens. The aim of this study is to determine the prevalence, patterns, and correlates of gambling. METHODS Cross-sectional data from the follow-up assessment in a cohort (n = 1514 men) from India. The following data were collected using a structured questionnaire: socio-demographic information, gambling, interpersonal violence, tobacco use, alcohol use disorders (AUD), common mental disorders, and suicidality. Logistic regression models were used to examine the correlates of gambling. RESULTS 658 participants (45.4%) reported gambling in the past year, and lottery was the most frequent form of gambling (67.8%). Current gambling was correlated with rural residence (OR 1.42, CI 1.05-1.93, p = 0.02), work-related problems (OR 1.42, CI 1.03-1.96, p = 0.03), interpersonal violence (OR 3.45, CI 1.22-9.75, p = 0.02), tobacco use (OR 1.59, CI 1.16-2.19, p = 0.004), and AUD (OR 2.14, CI 1.35-3.41, p = 0.001). 724 (49.9%) participants reported gambling at least once in their lifetime. Lifetime gambling was correlated with work-related problems (OR 1.57, CI 1.14-2.17, p = 0.006), interpersonal violence (OR 4.03, CI 1.32-12.30 p = 0.02), tobacco use (OR 1.60, CI 1.16-2.20, p = 0.004), and AUD (OR 2.12, CI 1.33-3.40, p = 0.002). Age was significantly associated with playing lottery more frequently (OR 3.24, CI 1.34-7.84, p = 0.009) and tobacco use was significantly associated with playing matka more frequently (OR 1.69, CI 1.08-2.64, p = 0.02). DISCUSSION The high prevalence of gambling and its association with social problems and risk factors for non-communicable diseases warrants further epidemiological research.
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Affiliation(s)
- Urvita Bhatia
- Sangath, H No 451 (168) Bhatkar Waddo, Porvorim, Socorro 403501, India.
| | - Bhargav Bhat
- Sangath, H No 451 (168) Bhatkar Waddo, Porvorim, Socorro 403501, India
| | - Sanju George
- Sangath, H No 451 (168) Bhatkar Waddo, Porvorim, Socorro 403501, India
| | - Abhijit Nadkarni
- Sangath, H No 451 (168) Bhatkar Waddo, Porvorim, Socorro 403501, India
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78
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Shidhaye R, Baron E, Murhar V, Rathod S, Khan A, Singh A, Shrivastava S, Muke S, Shrivastava R, Lund C, Patel V. Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India. BMJ Glob Health 2019; 4:e001344. [PMID: 31179034 PMCID: PMC6528752 DOI: 10.1136/bmjgh-2018-001344] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/20/2019] [Accepted: 04/19/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction Programme for Improving Mental Health Care (PRIME) designed a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India. The objective of this paper is to describe the findings of the district-level impact evaluation of the MHCP. Methods Repeat community-based CS were conducted to measure change in population-level contact coverage for depression and alcohol use disorders (AUD), repeat FDS were conducted to assess change in detection and initiation of treatment for depression and AUD, and the effect of treatment on patient outcomes was assessed using disorder-specific prospective cohort studies. Results PRIME MHCP did not have any impact on contact coverage/treatment seeking for depression (14.8% at the baseline and 10.5% at the follow-up) and AUD (7.7% at the baseline and 7.3% at the follow-up) and had a small impact on detection and initiation of treatment for depression and AUD (9.7% for depression and 17.8% for AUD compared with 0% for both at the baseline) in the health facilities. Patients with depression who received care as part of the MHCP had higher rates of response (52.2% in the treatment group vs 26.9% in the comparison/usual care group), early remission (70.2% in the treatment group vs 44.8% in the comparison/usual care group) and recovery (56.1% in the treatment group vs 28.5% in the comparison/usual care group), but there was no impact of treatment on their functioning. Conclusions While dedicated human resources (eg, Case Managers) and dedicated space for mental health clinics (eg, Mann-Kaksha) strengthen the 'formal' healthcare platform, without substantial additional investments in staff, such as Community Health Workers/Accredited Social Health Activists to improve community level processes and provision of community-based continuing care to patients, we are unlikely to see major changes in coverage or clinical outcomes.
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Affiliation(s)
- Rahul Shidhaye
- Center for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
| | - Emily Baron
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Sujit Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Azaz Khan
- PRIME Project, Sangath, Bhopal, India
| | | | | | | | | | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Sangath, Goa, India
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79
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Sikander S, Ahmad I, Bates LM, Gallis J, Hagaman A, O’Donnell K, Turner EL, Zaidi A, Rahman A, Maselko J. Cohort Profile: Perinatal depression and child socioemotional development ; the Bachpan cohort study from rural Pakistan. BMJ Open 2019; 9:e025644. [PMID: 31061029 PMCID: PMC6502044 DOI: 10.1136/bmjopen-2018-025644] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/20/2018] [Accepted: 03/08/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This is a prospective pregnancy-birth cohort designed to investigate the effects of depression on socioemotional development of children. Perinatal depression is a risk factor for poor child development and for many it has a recurring chronic course. Thus, the exposure to depression can continue through the early years of the child with detrimental developmental outcomes. PARTICIPANTS Between October 2014 and February 2016, we recruited 1154 pregnant women from a rural subdistrict of Pakistan. Data include longitudinal and repeated measures of maternal psychosocial measures and child growth, cognitive and socioemotional measures. Follow-up include mother-child dyad assessments at 3rd, 6th, 12th, 24th and 36th months of child age. All these follow-ups are community based at the household level. We have competed baseline assessment. FINDINGS TO DATE Of the eligible dyads, we followed 885 (76.6%), 929 (91%) and 940 (93.3%) at 3, 6 and 12 months post-childbirth. We include a subsample mother-child dyad DNA and inflammatory biomarkers, 73 and 104, respectively. FUTURE PLANS While we continue to do 24-month and 36-month follow-up assessments, we plan to follow these mother-child dyads up to the age of 7-8 years with some children being exposed to at least 1 year of school environment. Investigators interested in learning more about the study can contact (jmaselko@unc.edu) and (siham.sikander@hdrfoundation.org).
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Affiliation(s)
- Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Public Health, Health Services Academy, Islamabad, Pakistan
| | - Ikhlaq Ahmad
- Human Development Research Foundation, Islamabad, Pakistan
| | - Lisa M Bates
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - John Gallis
- Biostatistics, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ashley Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Karen O’Donnell
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Elizabeth Louise Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, Islamabad, Pakistan
| | - Atif Rahman
- Child Mental Health Unit, University of Liverpool, Liverpool, UK
| | - Joanna Maselko
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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80
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Graner KM, Cerqueira ATDAR. [Integrative review: psychological distress among university students and correlated factors]. CIENCIA & SAUDE COLETIVA 2019; 24:1327-1346. [PMID: 31066836 DOI: 10.1590/1413-81232018244.09692017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
This review sought to identify risk factors and protection from psychic distress among university students. Empirical studies were analyzed in the Web of Science, Medline and Scopus databases. A total of 1,375 articles were located, and after the exclusion criteria were applied, 37 articles made up the final sample, most of which were cross-sectional studies published in the last five years, in developed countries and with students in the health area. The most frequently used instruments for psychic distress screening were the General Health Questionnaire and the Self Reporting Questionnaire, which identified a prevalence of between 18.5% and 49.1% and, as risk factors, conditions related to academic life (24) and to health (22). Twelve studies identified as protective factors: given coping strategies, sense of coherence, self-efficacy, vigor, self-esteem, resilience, among other psychological conditions. This review singles out directions for possible interventions that could contribute to the well-being of students and to stimulate more positive experiences in the educational environment.
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Affiliation(s)
- Karen Mendes Graner
- Departamento de Neurologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho. Av. Prof. Mário Rubens Guimarães Montenegro s/n, Distrito de Rubião Júnior. 18618-970 Botucatu SP Brasil.
| | - Ana Teresa de Abreu Ramos Cerqueira
- Departamento de Neurologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho. Av. Prof. Mário Rubens Guimarães Montenegro s/n, Distrito de Rubião Júnior. 18618-970 Botucatu SP Brasil.
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81
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Tomitaka S, Kawasaki Y, Ide K, Akutagawa M, Ono Y, Furukawa TA. Further evidence that item responses on the Kessler Psychological Distress Scale exhibit the characteristic pattern in the general population. Heliyon 2019; 5:e01387. [PMID: 30963123 PMCID: PMC6434102 DOI: 10.1016/j.heliyon.2019.e01387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/02/2019] [Accepted: 03/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies suggested that item responses on the 6-item Kessler Psychological Distress Scale (K6) exhibit characteristic distributions among the general population. To confirm the reproducibility of these findings, we conducted a pattern analysis of the K6 item responses using large-scale data from a US representative survey. Methods Data were drawn from the 2016, and 2017 National Health Interview Survey in the United States (33,028, and 26,742 individuals, respectively). We analyzed the patterns of item responses for the six items using normal and logarithmic scales and proposed a model of item responses. Results The lines for item responses showed the same pattern among the six items, characterized by crossing at a single point between "none" and "a little," and parallel patterns from "a little" to "all of the time" on a logarithmic scale. The ratio of "some" to "a little," "most" to "some," and "most" to "all of the time" were similar across the six items. The model of item responses, which was based on the findings that the decreasing ratios of "some" to "a little," "most" to "some," and "all of the time" to "most" were similar across the six items, explained the characteristic patterns of item responses. Conclusion These results provide further evidence that item responses on the K6 follow a particular distribution pattern among the general population.
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Affiliation(s)
- Shinichiro Tomitaka
- Department of Mental Health, Panasonic Health Center Tokyo, Japan.,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ide
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.,Department of Drug Evaluation and Informatics School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Maiko Akutagawa
- Department of Drug Evaluation and Informatics School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yutaka Ono
- Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Ma JS, Batterham PJ, Calear AL, Han J. Suicide Risk across Latent Class Subgroups: A Test of the Generalizability of the Interpersonal Psychological Theory of Suicide. Suicide Life Threat Behav 2019; 49:137-154. [PMID: 29315743 DOI: 10.1111/sltb.12426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/24/2017] [Indexed: 11/27/2022]
Abstract
It remains unclear whether the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, ) is generalizable to the population or holds more explanatory power for certain subgroups compared to others. The aim of this study was to (1) identify subgroups of individuals who endorsed suicide ideation in the past month based on a range of mental health and demographic variables, (2) compare levels of the IPTS constructs within these subgroups, and (3) test the IPTS predictions for suicide ideation and suicide attempt for each group. Latent class, negative binomial, linear, and logistic regression analyses were conducted on population-based data obtained from 1,321 adults recruited from Facebook. Among participants reporting suicide ideation, four distinct patterns of risk factors emerged based on age and severity of mental health symptoms. Groups with highly elevated mental health symptoms reported the highest levels of thwarted belongingness and perceived burdensomeness. Tests of the IPTS interactions provided partial support for the theory, primarily in young adults with elevated mental health symptoms. Lack of support found for the IPTS predictions across the subgroups and full sample in this study raise some questions around the broad applicability of the theory.
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Affiliation(s)
- Jennifer S Ma
- Center for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Philip J Batterham
- Center for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- Center for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal. Glob Ment Health (Camb) 2019; 6:e15. [PMID: 31391947 PMCID: PMC6669965 DOI: 10.1017/gmh.2019.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. METHODS A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35-60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. RESULTS A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4-50.4)]. The difference in BDI scores at T2 between PSY and EUC was -7.43 (95% CI -9.71 to -5.14). CONCLUSIONS Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.
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Characteristics of perinatal depression in rural central, India: a cross-sectional study. Int J Ment Health Syst 2018; 12:68. [PMID: 30455730 PMCID: PMC6231264 DOI: 10.1186/s13033-018-0248-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth. In India, increased priority accorded to mental health programs mean it is now possible to reduce the population-level burden of perinatal depression. In this secondary analysis of two studies, we aimed to describe the epidemiological features of depression among community- and facility-based samples of perinatal women from rural central India, and to describe the help-seeking behaviours from those women who screened positive for depression. Methods The Community Study was a multi-round population-based cross-sectional survey (n = 6087). The Facility Study was a multi-round facility-based cross-sectional survey (n = 1577). Both studies were conducted in Sehore District, Madhya Pradesh between 2013 and 2017. Field workers conducted structured interviews with perinatal women. The questionnaire had sections relating to sociodemographic characteristics, depression screening using the Patient’s Health Questionnaire (PHQ9), treatment seeking for depression-related symptoms, and disability. Using data pooled from both studies, we tested each characteristic for association with the total screening score and with screening positive for depression. Results We identified 224 perinatal women from the Community Study and 130 perinatal women from the Facility Study, of whom 8.8% and 18.5% screened positive for depression, respectively. For the continuous PHQ9 score, there was evidence of a “U” shaped association with age, and positive associations with pregnancy, disability score, suicidality and being a health facility attendee. For the binary PHQ9 score, there was evidence of positive associations with pregnancy, disability score, suicidality and being a health facility attendee. Conclusions This study highlights where the largest population-level variations in perinatal depression symptoms are present in this Indian sample, for which mental health service provision should be made a priority. Epidemiological evidence generated by this study, as well as new evidence on peer-delivered interventions for perinatal depression, must be utilized by policy-makers to prioritize mental health services for mothers along with maternal and child health services. Electronic supplementary material The online version of this article (10.1186/s13033-018-0248-5) contains supplementary material, which is available to authorized users.
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Mahadevan J, Tekkalaki B, Narasimha VL, Ransing R, Andrade C. Comments on "Screening for Mental Health Disorders among Pregnant Women Availing Antenatal Care at a Government Maternity Hospital in Bengaluru City". Indian J Psychol Med 2018; 40:598-599. [PMID: 30533969 PMCID: PMC6241176 DOI: 10.4103/ijpsym.ijpsym_354_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bheemsain Tekkalaki
- Department of Psychiatry, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Venkata Lakshmi Narasimha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ramdas Ransing
- Department of Psychiatry, B. K. L. Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Rathod SD, Roberts T, Medhin G, Murhar V, Samudre S, Luitel NP, Selohilwe O, Ssebunnya J, Jordans MJD, Bhana A, Petersen I, Kigozi F, Nakku J, Lund C, Fekadu A, Shidhaye R. Detection and treatment initiation for depression and alcohol use disorders: facility-based cross-sectional studies in five low-income and middle-income country districts. BMJ Open 2018; 8:e023421. [PMID: 30309992 PMCID: PMC6252626 DOI: 10.1136/bmjopen-2018-023421] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To estimate the proportion of adult primary care outpatients who are clinically detected and initiate treatment for depression and alcohol use disorder (AUD) in low-income and middle-income country (LMIC) settings. DESIGN Five cross-sectional studies. SETTING Adult outpatient services in 36 primary healthcare facilities in Sodo District, Ethiopia (9 facilities); Sehore District, India (3); Chitwan District, Nepal (8); Dr Kenneth Kaunda District, South Africa (3); and Kamuli District, Uganda (13). PARTICIPANTS Between 760 and 1893 adults were screened in each district. Across five districts, between 4.2% and 20.1% screened positive for depression and between 1.2% and 16.4% screened positive for AUD. 96% of screen-positive participants provided details about their clinical consultations that day. PRIMARY OUTCOMES Detection of depression, treatment initiation for depression, detection of AUD and treatment initiation for AUD. RESULTS Among depression screen-positive participants, clinical detection of depression ranged from 0% in India to 11.7% in Nepal. Small proportions of screen-positive participants received treatment (0% in Ethiopia, India and South Africa to 4.2% in Uganda). Among AUD screen-positive participants, clinical detection of AUD ranged from 0% in Ethiopia and India to 7.8% in Nepal. Treatment was 0% in all countries aside Nepal, where it was 2.2%. CONCLUSIONS The findings of this study suggest large detection and treatment gaps for adult primary care patients, which are likely contributors to the population-level mental health treatment gap in LMIC. Primary care facilities remain unfulfilled intervention points for reducing the population-level burden of disease in LMIC.
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Affiliation(s)
- Sujit D Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Sandesh Samudre
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Chronic Conditions and Injuries, Public Health foundation of India, New Delhi, India
| | | | - One Selohilwe
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Joshua Ssebunnya
- Makerere University/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Mark J D Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Fred Kigozi
- Makerere University/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Juliet Nakku
- Makerere University/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Crick Lund
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
| | - Rahul Shidhaye
- Centre for Mental Health, Public health foundation of India, New Delhi, India
- CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, The Netherlands
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Richardson RA, Harper S, Schmitz N, Nandi A. The effect of affordable daycare on women's mental health: Evidence from a cluster randomized trial in rural India. Soc Sci Med 2018; 217:32-41. [PMID: 30292875 DOI: 10.1016/j.socscimed.2018.09.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/17/2018] [Accepted: 09/29/2018] [Indexed: 11/30/2022]
Abstract
Access to affordable daycare might improve population mental health. However, evidence is sparse and restricted to middle- and high-income country settings. We conducted a cluster-randomized controlled trial in one low-income setting, rural Rajasthan, India. Communities lacking daycare facilities were identified (n = 160) and randomly selected for assistance in setting up a community-based daycare program (n = 80) or not (n = 80). Women eligible for the daycare program living in these communities completed structured interviews before the intervention (participation rate = 89%) and approximately one year after rollout of the intervention (participation rate = 96%), resulting in a final analytic sample of 3041. Mental distress was measured with the Hindi version of the 12-item General Health Questionnaire (score range: 0-12). We modeled the relation between access to daycare and number of mental distress symptoms (GHQ-12 score) with negative binomial regression using an intention-to-treat approach, which groups women according to if they lived in communities randomized to affordable daycare. We also evaluated the effect of access to daycare on secondary outcomes that may be related to mental distress, including women's work burden, agency, and intimate partner violence (IPV). We found that access to daycare resulted in modest reductions in symptoms of mental distress (mean difference = 0.21, 95% CI: -0.43, 0.02). We found some evidence that daycare reduced IPV, but virtually no change in women's work burden or agency. Our results provide some indication that access to affordable daycare might be one policy lever to improve population mental health.
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Affiliation(s)
- Robin A Richardson
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Norbert Schmitz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada; Department of Psychiatry, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4A 1R3, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
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Indu PS, Anilkumar TV, Vijayakumar K, Kumar KA, Sarma PS, Remadevi S, Andrade C. Reliability and validity of PHQ-9 when administered by health workers for depression screening among women in primary care. Asian J Psychiatr 2018; 37:10-14. [PMID: 30096447 DOI: 10.1016/j.ajp.2018.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression is twice more prevalent among women but remains unidentified in primary care. OBJECTIVE We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18-60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women. RESULTS The internal consistency reliability (Cronbach's alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86-0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88-0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4-92.6), specificity of 90.1% (95% CI, 84.5-95.6%), positive predictive value of 73.4% (95% CI, 62.4-84.4%) and negative predictive value of 93.9% (95% CI, 90.2-97.6%). The accuracy was 88.2% (84.0-92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73-0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%. CONCLUSION When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.
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Affiliation(s)
| | | | | | - K A Kumar
- Former Director of Medical Education, Kerala, India
| | - P Sankara Sarma
- Department of Biostatistics, Achutha Menon Centre for Health Science Studies, Sree Chithira Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Saradamma Remadevi
- School of Health Policy and Planning, Kerala University of Health Sciences, Kerala, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Prevalence and correlates of common mental disorders among dental students in Brazil. PLoS One 2018; 13:e0204558. [PMID: 30261025 PMCID: PMC6160106 DOI: 10.1371/journal.pone.0204558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
This study aimed to estimate prevalence of common mental disorders (CMD) and associated factors among dental students. In this cross-sectional study, 230 students answered a questionnaire and instruments to assess CMD (Self Reporting Questionnaire-20), hazardous alcohol consumption (Alcohol Use Disorder Identification Test), social support (Social Support Scale), perceptions of academic life (Dundee Ready Education Environment Measure), coping (Ways of Coping Inventory) and resilience (Resilience Scale). Bivariate analysis was conducted using the Chi-Square and Mann-Whitney tests. Logistic regression included all explanatory variableswith p<0.20 in the bivariate analysis, besides sex and academic year. The explanatory variables were analyzed in five successive blocks (backward-stepwise), until all variables presented statistical significance in the final model (p<0.05). The prevalence of CMD was 45.2% (95%CI: 38.7–51.6), with no significant differences between sexes. Students with no extracurricular activities, who had negatively self- assessed their health status and their academic performance, were about four times more likely to present CMD, followed by receiving psychological or psychiatric treatment during university (AOR: 2.65; 95%CI: 1.1–6.1) and those with high scores for confrontive coping (AOR: 1.20; 95%CI: 1.0–1.4). Resilience was a protective factor for CMD among dental students (AOR: 0.93; 95%CI: 0.9–1.0). Aspects related to academic performance, health status and confrontive coping strategies were risk factors to students’ mental health. Individuals with high levels of resilience showed lower prevalence of CMD. Further prospective studies could contribute to understanding the role of resilience among this population.
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Srinivasan K, Mazur A, Mony PK, Whooley M, Ekstrand ML. Improving mental health through integration with primary care in rural Karnataka: study protocol of a cluster randomized control trial. BMC FAMILY PRACTICE 2018; 19:158. [PMID: 30205830 PMCID: PMC6134696 DOI: 10.1186/s12875-018-0845-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND People who are diagnosed with both mental and chronic medical illness present unique challenges for the health care system. In resource-limited settings, such as rural India, people with depression and anxiety are often under-served, due to both stigma and lack of trained providers and resources. These challenges can lead to complications in the management of chronic disease as well as increased suffering for patients, families and communities. In this study, we evaluate the effects of integrating mental health and chronic disease treatment of patients in primary health care (PHC) settings using a collaborative care model to improve the screening, diagnosis and treatment of depression in rural India. METHODS This study is a multi-level randomized controlled trial among patients with depression or anxiety and co-morbid diabetes, or cardiovascular disease. Aim 1 examines whether patients screened at community health-fairs are more likely to be diagnosed and treated for these co-morbid conditions than patients screened after presenting at PHCs. Aim 2 evaluates the impact of collaborative care compared to usual care in a cluster RCT, randomizing at the level of the PHCs. Intervention arm PHC staff are trained in mental health diagnoses, treatment, and the collaborative care model. The intervention also involves community-based "Healthy Living groups" co-led by Ashas, using cognitive-behavioral strategies to promote healthy behaviors. The primary outcome is severity of common mental disorders, with secondary outcomes being diabetes and cardiovascular risk, staff knowledge and patient perceptions. DISCUSSION If effective, our results will contribute to the field in five ways: 1) expand on implementation research in low resource settings by examining how multiple chronic diseases can be treated using integrated low-cost, evidence-based strategies, 2) build the capacity of PHC staff to diagnose and treat mental illness within their existing clinic structure and strengthen referral linkages; 3) link community members to primary care through community-based health fairs and healthy living groups; 4) increase mental health awareness in the community and reduce mental health stigma; 5) demonstrate the potential for intervention scale-up and sustainability. TRIAL REGISTRATION http://Clinicaltrials.gov : NCT02310932 registered December 8, 2014 URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ; Clinical Trials Registry India: CTRI/2018/04/013001 retrospectively registered on April 4, 2018.
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Affiliation(s)
- Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, Karnataka India
- Department of Psychiatry, St John’s Medical College Hospital, Bangalore, Karnataka India
| | - Amanda Mazur
- Division of Prevention Sciences, University of California, San Francisco, USA
| | - Prem K. Mony
- Division of Epidemiology and Community Health, St. John’s Medical College and Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Mary Whooley
- Division of Cardiology, University of California, San Francisco, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
| | - Maria L. Ekstrand
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, Karnataka India
- Division of Prevention Sciences, University of California, San Francisco, USA
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Hajebi A, Motevalian A, Amin‐Esmaeili M, Rahimi‐Movaghar A, Sharifi V, Hoseini L, Shadloo B, Mojtabai R. Adaptation and validation of short scales for assessment of psychological distress in Iran: The Persian K10 and K6. Int J Methods Psychiatr Res 2018; 27:e1726. [PMID: 29888523 PMCID: PMC6877187 DOI: 10.1002/mpr.1726] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/14/2018] [Accepted: 04/19/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The aims of the study were to translate into Persian and culturally adapt the Kessler Psychological Distress Scales, K10 and K6, and to assess their reliability and validity. METHOD The sample was recruited from primary health care (PHC) settings by quota nonprobability sampling, stratified by sex and age. Validity was assessed against the Composite International Diagnostic Interview (v2.1). The psychometric properties of K6 and K10 were also compared with the 12-item General Health Questionnaire (GHQ-12). RESULTS A total of 818 participants completed the questionnaire. Cronbach's alpha were 0.92 and 0.87 for K6 and K10, respectively. Optimal cutoff scores for detecting any mood or anxiety disorder in the past 30 days were 15 for K10 and 10 for K6. At these cutoff points, the measures had sensitivities of 0.77 and 0.73, specificities of 0.74 and 0.78, and positive predictive values of 0.48 and 0.52, respectively. Psychometric properties of K10 and K6 were similar to GHQ-12. CONCLUSION Persian K10 and K6 have acceptable psychometric properties as screening instruments for common mental health conditions. Given its brevity and similar psychometric properties to the longer instruments, the Persian K6 appears to be a suitable scale for use in PHC settings and, possibly, epidemiologic studies in Iran.
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Affiliation(s)
- Ahmad Hajebi
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychiatric DepartmentIran University of Medical SciencesTehranIran
| | - Abbas Motevalian
- Department of Epidemiology, School of Public HealthIran University of Medical SciencesTehranIran
| | - Masoumeh Amin‐Esmaeili
- Iranian National Center for Addiction Studies (INCAS)Tehran University of Medical SciencesTehranIran
| | - Afarin Rahimi‐Movaghar
- Iranian National Center for Addiction Studies (INCAS)Tehran University of Medical SciencesTehranIran
| | - Vandad Sharifi
- Department of Psychiatry, School of MedicineTehran University of Medical SciencesTehranIran
| | - Leila Hoseini
- Iranian National Center for Addiction Studies (INCAS)Tehran University of Medical SciencesTehranIran
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies (INCAS)Tehran University of Medical SciencesTehranIran
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of PsychiatryJohns Hopkins UniversityBaltimoreMaryland
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Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018; 18:262. [PMID: 30134869 PMCID: PMC6104009 DOI: 10.1186/s12888-018-1837-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION PROSPERO registration number: 42016046551 .
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Affiliation(s)
- Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Georgina Miguel Esponda
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Dzmitry Krupchanka
- grid.447902.cDepartment of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic ,0000 0001 2322 4988grid.8591.5Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rahul Shidhaye
- 0000 0004 1761 0198grid.415361.4Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit Rathod
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Mathias K, Pandey A, Armstrong G, Diksha P, Kermode M. Outcomes of a brief mental health and resilience pilot intervention for young women in an urban slum in Dehradun, North India: a quasi-experimental study. Int J Ment Health Syst 2018; 12:47. [PMID: 30140307 PMCID: PMC6098661 DOI: 10.1186/s13033-018-0226-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mental illness is a leading cause of the disease burden among young people. Poor mental health is linked to childhood adversity such as gender inequality, poverty and low educational attainment. Psycho-social assets in adolescents can moderate these impacts and be strengthened. The aim of this study was to assess the effectiveness of a brief mental health and resilience intervention among disadvantaged young women in urban North India. Methods We used an uncontrolled repeated measures design to evaluate the effectiveness of the 15-module mental health and resilience curriculum among young women residing in a slum in Dehradun, Uttarakhand. Standardised psychometric assessments were done to assess outcomes of the intervention at three time-points: pre-intervention (T1), post-intervention (T2), and 8-months post-intervention (T3), covering domains of self-efficacy, resilience, anxiety, depression and gender attitudes. Results Young women completing the intervention (n = 106) had all left school before 10th class. A statistically significant improvement in all psychometric measures was found at T2. These improvements were sustained at T3 in the areas of anxiety, depression and gender equality attitudes, while the measures of resilience and self-efficacy had declined to baseline. Conclusions This intervention delivered by community-based peers among highly disadvantaged young women can lead to sustained improvements in anxiety and depression and attitudes to gender equality. While other studies in LMIC have shown increased adolescent resilience through peer-led curriculums, this study demonstrates improvements in mental health and gender attitudes can endure 8-months post-intervention. This low-cost, brief intervention can improve mental health resiliency and self-efficacy among disadvantaged young people. Further research should explore how to bring sustained improvements in resilience.
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Affiliation(s)
- K Mathias
- 1Emmanuel Hospital Association, New Delhi, India.,Present Address: Landour Community Hospital, Mussoorie, Uttarakhand 248179 India
| | - A Pandey
- 2Austin Health, Heidelberg, VIC Australia
| | - G Armstrong
- 3Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Diksha
- 4University of Melbourne, Melbourne, Australia
| | - M Kermode
- 5Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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Divan G, Vajaratkar V, Cardozo P, Huzurbazar S, Verma M, Howarth E, Emsley R, Taylor C, Patel V, Green J. The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting. Autism Res 2018; 12:328-339. [PMID: 30095230 DOI: 10.1002/aur.1978] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 05/09/2018] [Accepted: 05/24/2018] [Indexed: 01/27/2023]
Abstract
The treatment gap for autism globally is high. Our previous PASS intervention, delivered by community based lay health workers, showed effectiveness. This article reports the development and evaluation of a new "PASS 'Plus'" intervention in a rural population in India. Using formative research methods, we supplemented the PASS intervention with additional (Plus) modules to address autism comorbidities. This is the first time that a rigorous methodology has been used to evaluate autism symptom outcomes in a low and middle-income country setting. 40 parent-child dyads were recruited in a pilot randomized controlled trial against usual care (mean age 65 months (34 boys); n = 19 PASS Plus, n = 21 UC). 89% of intervention families partially or entirely completed the 12-session intervention. Intention to treat analysis showed a reduction in mean scores of autism symptom severity, though the confidence interval contains zero, (adjusted mean difference AMD -2.42 95% CI -7.75, 2.92; ES 0.22); large treatment effects on proximal outcomes of proportion of parent synchronous responses (AMD 0.35; 95% CI 0.18, 0.52; effect size ES 3.97) and proportion of child communication initiations with parent (AMD 0·17; 95% CI 0.03, 0.32; ES 1.02). Confidence intervals for effects on mutual shared attention (AMD 0.10; 95% CI -0.07, 0.27; ES 0.5) and co-morbid symptoms (AMD -9.0; 95% CI -24.26, 6.26; ES 0.32) contained zero. There were significant effects to improve parental mental health. PASS Plus shows good feasibility and adds to the evidence of the effectiveness of task sharing complex autism interventions to lay health workers in India. Autism Res 2019, 12: 328-339 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This article describes the development of a comprehensive, community-delivered, intervention for young children with autism, which combines a previously developed parent-mediated communication intervention with support for co-morbid problems like challenging behaviors and sensory sensitivities. The unique aspect of this intervention is that it can be delivered by community health workers, addressing the lack of specialists in low resource settings. Our study reports the encouraging findings of a pilot trial evaluating its feasibility and effectiveness.
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Affiliation(s)
- Gauri Divan
- Sangath, 451 (168) Bhaktar Waddo Succor Bardez, Goa, 403501, India
| | - Vivek Vajaratkar
- Sangath, 451 (168) Bhaktar Waddo Succor Bardez, Goa, 403501, India
| | - Percy Cardozo
- Sangath, 451 (168) Bhaktar Waddo Succor Bardez, Goa, 403501, India
| | - Shilpa Huzurbazar
- Sanwad 318-C, Bhende Galli, Shivaji Chowk, Kolhapur, Maharashtra, India
| | - Mamta Verma
- Sangath, 451 (168) Bhaktar Waddo Succor Bardez, Goa, 403501, India
| | - Elizabeth Howarth
- Centre for Biostatistics, School of Health of Sciences, The University of Manchester, Manchester Academic Health Science Centre, 1.317 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health of Sciences, The University of Manchester, Manchester Academic Health Science Centre, 1.317 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Carol Taylor
- University of Manchester, Institute of Brain, Behaviour and Mental Health, 3rd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Vikram Patel
- Harvard Medical School, Boston; Sangath, Bhaktar Waddo Succor Bardez, Goa, 403501, India
| | - Jonathan Green
- Centre for Biostatistics, School of Health of Sciences, The University of Manchester, Manchester Academic Health Science Centre, 1.317 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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95
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Diagnostic Prevalence of Common Psychiatric Comorbidities of Alcohol Use Disorders in India: a Systematic Review. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9951-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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96
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Labarda CE, Chan CS. Sleep disturbances, posttraumatic stress, and psychological distress among survivors of the 2013 Super Typhoon Haiyan. Psychiatry Res 2018; 266:284-290. [PMID: 29609982 DOI: 10.1016/j.psychres.2018.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 01/03/2018] [Accepted: 03/07/2018] [Indexed: 01/08/2023]
Abstract
Sleep disturbances and their relation with posttraumatic stress and general psychological distress were examined after the 2013 Super Typhoon Haiyan. Sleep disturbances were hypothesized to be associated with posttraumatic stress and general psychological distress in two samples of survivors across two time points (N = 361) in the Philippines. Sample 1 (n = 223) and Sample 2 (n = 138) were collected 18 months and 30 months after the storm, respectively. Results from structural regression modeling indicated that insomnia was associated with both posttraumatic stress and general psychological distress. Poor sleep quality was associated with posttraumatic stress but not with general psychological distress. Findings underscore the longer-term relationship between sleep disturbances and overall sleep quality to posttraumatic stress in the context of a natural disaster. Implications for public mental health interventions in disaster settings are discussed.
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Affiliation(s)
- Charlie E Labarda
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region, PRC
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region, PRC.
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97
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Vissoci JRN, Vaca SD, El-Gabri D, de Oliveira LP, Mvungi M, Mmbaga BT, Haglund M, Staton C. Cross-cultural adaptation and psychometric properties of the Kessler Scale of Psychological Distress to a traumatic brain injury population in Swahili and the Tanzanian Setting. Health Qual Life Outcomes 2018; 16:147. [PMID: 30053816 PMCID: PMC6062865 DOI: 10.1186/s12955-018-0973-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 07/09/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To evaluate the psychometric properties of a Swahili version of the Kessler Psychological Distress scale in an injury population in Tanzania. METHODS Swahili version of the Kessler Psychological Distress scale was developed by translation and back-translation by a panel of native speakers of both English and Swahili. The translated instruments were administered to a sample of Tanzanian adults from a traumatic brain injury registry. The content validity, construct validity, reliability, internal structure, and external reliability were analyzed using standard statistical methods. RESULTS Both translated versions of the Kessler Psychological Distress scale were found to be reliable (>0.85) for all tested versions. Confirmatory factor analysis of one and two factor solution showed adequate results. Kessler Psychological Distress scale scores were strongly correlated to depression and quality of life (R>0.50). CONCLUSIONS This paper presents the first Swahili adaptations of the Kessler Psychological Distress scale as well as the first validation of these questionnaires in Tanzania. The instrument was found to have acceptable psychometric properties, resulting in a new useful tool for medical and social research in this setting.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Duke Emergency Medicine, Duke University Medical Center, 8 Duke University Medical Center Greenspace, Durham, NC, 27703, USA.
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
- Department of Neurosurgery, Duke University, Durham, NC, USA.
| | | | - Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Michael Haglund
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Emergency Medicine, Duke University Medical Center, 8 Duke University Medical Center Greenspace, Durham, NC, 27703, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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98
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A computerized version of the Patient Health Questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care. J Affect Disord 2018; 234:247-255. [PMID: 29549826 DOI: 10.1016/j.jad.2018.01.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/19/2017] [Accepted: 01/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). The aim of the present study is to determine the psychometric properties of a computerized version of the PHQ-4 used to detect emotional disorders (anxiety and depression) in the primary care setting. METHOD A total of 1052 patients with suspected anxiety, depression, or somatic symptoms were recruited from 28 primary care centres participating in the PsicAP trial and completed the full version of the computerized PHQ. In addition, 178 of these patients also underwent in clinical interviews as a gold standard. RESULTS Confirmatory factor analyses showed very good fit indices for a two-factor solution. This model was structurally invariant among the various age and gender groups and internal consistency was acceptable (PHQ-4; α = .83, PHQ-2; α = .86, and GAD-2; α = .76). The best cut-off points to obtain high sensitivity values was 3, on both the PHQ-2 (major depressive disorder) and the GAD-2 (generalized anxiety disorder). The criterion validity (sensitivity and specificity) for the PHQ-2 were .90 and .61 and for the GAD-2, .88 and 0.61. LIMITATIONS The study was not designed as a prevalence study. Therefore, does not contain information on patients whose general practitioners do not consider them to suffer emotional disorders. CONCLUSION This is the first study to provide evidence for the reliability and validity of a computerized version of the PHQ-4. This computerized tool can be used to detect depression and anxiety in a primary care setting.
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99
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van Heyningen T, Honikman S, Tomlinson M, Field S, Myer L. Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women. PLoS One 2018; 13:e0193697. [PMID: 29668725 PMCID: PMC5906008 DOI: 10.1371/journal.pone.0193697] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 02/18/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Antenatal depression and anxiety disorders are highly prevalent in low and middle-income countries. Screening of pregnant women in primary care antenatal settings provides an opportunity for entry to care, but data are needed on the performance of different screening tools. We compared five widely-used questionnaires in a sample of pregnant women in urban South Africa. METHOD Pregnant women attending a primary care antenatal clinic were administered five tools by trained research assistants: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), the Kessler Psychological Distress scale (K10) and a shortened 6-item version (K6), the Whooley questions and the two-item Generalised Anxiety Disorder scale (GAD-2). Following this, a registered mental health counsellor administered the MINI Plus, a structured clinical diagnostic interview. The Area Under the Curve (AUC) from Receiver Operator Characteristic curve analysis was used to summarise screening test performance and Cronbach's α used to assess internal consistency. RESULTS Of 376 participants, 32% were diagnosed with either MDE and/or anxiety disorders. All five questionnaires demonstrated moderate to high performance (AUC = 0.78-0.85). The EPDS was the best performing instrument for detecting MDE and the K10 and K6 for anxiety disorder. For MDE and/or anxiety disorders, the EPDS had the highest AUC (0.83). Of the short instruments, the K10 (AUC = 0.85) and the K6 (AUC = 0.85) performed the best, with the K6 showing good balance between sensitivity (74%) and specificity (85%) and a good positive predictive value (70%). The Whooley questions (AUC = 0.81) were the best performing ultra-short instrument. Internal consistency ranged from good to acceptable (α = 0.89-0.71). However, the PPV of the questionnaires compared with the diagnostic interview, ranged from 54% to 71% at the optimal cut-off scores. CONCLUSIONS Universal screening for case identification of antenatal depression and anxiety disorders in low-resource settings can be conducted with a number of commonly used screening instruments. Short and ultra-short screening instruments such as the K6 and the Whooley questions may be feasible and acceptable for use in these settings.
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Affiliation(s)
- Thandi van Heyningen
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- Lead investigator of the Centre of Excellence in Human Development, University Witwatersrand, Johannesburg, South Africa
| | - Sally Field
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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100
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Tomori C, McFall AM, Solomon SS, Srikrishnan AK, Anand S, Balakrishnan P, Mehta SH, Celentano DD. Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India. Soc Sci Med 2018; 206:110-116. [PMID: 29615297 DOI: 10.1016/j.socscimed.2018.03.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022]
Abstract
Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Aylur K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - P Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services Campus, Taramani, Chennai, 600 113, India
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States; Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
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