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Doherty S, Kianian B, Dass G, Edward A, Kone A, Manolova G, Sivayokan S, Solomon M, Surenthirakumaran R, Lopes-Cardozo B. Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02684-4. [PMID: 38713387 DOI: 10.1007/s00127-024-02684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Research indicates that exposure to conflict, natural disasters, and internal displacement can increase mental health conditions. Since the end of the civil conflict within Sri Lanka, the country has worked to increase access to mental health services to meet the needs of conflict-affected populations, however, gaps remain. To address this, integration of mental health services into primary care can reduce the strain on growing specialized care. As part of a larger study primary care practitioners (doctors), public health professionals (nurses, midwives), and community representatives (teachers, social workers) were trained to deliver mental health services in primary care across the heavily impacted Northern Province. The aim was to reduce mental health stigma among enrolled healthcare workers and community representatives by 50%. METHODS Stigma was measured across all participant groups at six time points: pre- and post- initial training at baseline, pre- and post- refresher training 3-months after initial training, and pre- and post- refresher training 6-months after initial training. RESULTS Results indicate a small improvement in average stigma scores at the 6-month refresher point for primary care practitioners, and no meaningful difference in average scores across time points for public health professionals or community representatives. CONCLUSION World Health Organization mhGAP training appears to reduce stigma among primary care practitioners and could be an effective strategy to counteract mental health stigma in low resource settings. Future research should investigate underlying mechanisms of stigma reduction to improve delivery of mental health services in primary care and community settings.
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Affiliation(s)
- Shannon Doherty
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK.
| | - Behzad Kianian
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Giselle Dass
- THEME Institute, 50/13, Old Kesbawa Road, Boralesgamuwa, Sri Lanka
| | - Anne Edward
- THEME Institute, 50/13, Old Kesbawa Road, Boralesgamuwa, Sri Lanka
| | - Ahoua Kone
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Gergana Manolova
- World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Sambasivamoorthy Sivayokan
- Department of Community and Family Medicine, University of Jaffna, Ramanathan Road, PO Box 57, Thirunelvely, Jaffna, Sri Lanka
| | - Madonna Solomon
- THEME Institute, 50/13, Old Kesbawa Road, Boralesgamuwa, Sri Lanka
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, University of Jaffna, Ramanathan Road, PO Box 57, Thirunelvely, Jaffna, Sri Lanka
| | - Barbara Lopes-Cardozo
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
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Daniel M, Kallakuri S, Gronholm PC, Wahid SS, Kohrt B, Thornicroft G, Maulik PK. Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India. Front Psychiatry 2024; 15:1337662. [PMID: 38356906 PMCID: PMC10864454 DOI: 10.3389/fpsyt.2024.1337662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background The International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership is a multi-country international research program in seven sites across five low- and middle-income countries (LMICs) in Africa and Asia to develop, contextually adapt mental health stigma reduction interventions and pilot these among a variety of target populations. The aim of this paper is to report on the process of culturally adapting these interventions in India using an established framework. Methods As part of this larger program, we have contextualized and implemented these interventions from March 2022 to August 2023 in a site in north India. The Ecological Validity Model (EVM) was used to guide the adaptation and contextualization process comprising eight dimensions. Findings Six dimensions of the Ecological Validity Model were adapted, namely language, persons, metaphors, content, methods, and context; and two dimensions, namely concepts and goals, were retained. Conclusion Stigma reduction strategies with varied target groups, based on culturally appropriate adaptations, are more likely to be acceptable to the stakeholders involved in the intervention, and to be effective in terms of the program impact.
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Affiliation(s)
- Mercian Daniel
- Research Department, George Institute for Global Health, New Delhi, India
| | - Sudha Kallakuri
- Research Department, George Institute for Global Health, New Delhi, India
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Syed Shabab Wahid
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Pallab K. Maulik
- Research Department, George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Department of Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Kaur A, Kallakuri S, Mukherjee A, Wahid SS, Kohrt BA, Thornicroft G, Maulik PK. Mental health related stigma, service provision and utilization in Northern India: situational analysis. Int J Ment Health Syst 2023; 17:10. [PMID: 37106395 PMCID: PMC10134673 DOI: 10.1186/s13033-023-00577-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Stigma, discrimination, poor help seeking, dearth of mental health professionals, inadequate services and facilities all adversely impact the mental health treatment gap. Service utilization by the community is influenced by cultural beliefs and literacy levels. We conducted a situational analysis in light of the little information available on mental health related stigma, service provision and utilization in Haryana, a state in Northern India. This involved: (a) qualitative key informant interviews; (b) health facility records review; and (c) policy document review to understand the local context of Faridabad district in Northern India. Ethical approvals for the study were taken before the study commenced. Phone call in-depth interviews were carried out with a purposive sample of 13 participants (Mean = 38.07 years) during the COVID-19 pandemic, which included 4 community health workers, 4 people with mental illness, 5 service providers (primary health care doctors and mental health specialists). Data for health facility review was collected from local primary health and specialist facilities while key policy documents were critically analysed for service provision and stigma alleviation activities. Thematic analysis was used to analyse patterns within the interview data. We found poor awareness and knowledge about mental illnesses, belief in faith and traditional healers, scarcity of resources (medicines, trained professionals and mental health inpatient and outpatient clinics), poor access to appropriate mental health facilities, and high costs for seeking mental health care. There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.
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Affiliation(s)
- Amanpreet Kaur
- Jindal School of Psychology & Counselling, O.P. Jindal Global University, Sonipat, India
- The George Institute for Global Health, Delhi, India
| | | | | | - Syed Shabab Wahid
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC USA
- Department of Global Health, Georgetown University, Washington, DC USA
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC USA
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Pallab K. Maulik
- The George Institute for Global Health, Delhi, India
- University of New South Wales, Sydney, Ausralia Australia
- Prasanna School of Public Health, Manipal University, Manipal, India
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Yatirajula SK, Kallakuri S, Paslawar S, Mukherjee A, Bhattacharya A, Chatterjee S, Sagar R, Kumar A, Lempp H, Raman U, Singh R, Essue B, Billot L, Peiris D, Norton R, Thornicroft G, Maulik PK. An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums: protocol for the ARTEMIS project. Trials 2022; 23:612. [PMID: 35906663 PMCID: PMC9336093 DOI: 10.1186/s13063-022-06539-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. METHODS The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived-a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. DISCUSSION The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. TRIAL STATUS Protocol version - V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) TRIAL REGISTRATION: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries ( https://www.who.int/clinical-trials-registry-platform/network/primary-registries ) Reference No. CTRI/2022/02/040307 . Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.
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Affiliation(s)
| | | | | | | | | | | | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar
- Dr.A.V. Baliga Memorial Trust, New Delhi, India
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Usha Raman
- University of Hyderabad, Hyderabad, India
| | | | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laurent Billot
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Robyn Norton
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Imperial College, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- University of New South Wales, Sydney, Australia.
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