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Ametaj AA, Denckla CA, Stevenson A, Stroud RE, Hall J, Ongeri L, Milkias B, Hoffman J, Naisanga M, Akena D, Kyebuzibwa J, Kwobah EK, Atwoli L, Gichuru S, Teferra S, Alemayehu M, Zingela Z, Stein DJ, Pretorius A, Newton CR, Mwema RM, Kariuki SM, Koenen KC, Gelaye B. Cross-cultural equivalence of the Kessler Psychological Distress Scale (K10) across four African countries in a multi-national study of adults. SSM - MENTAL HEALTH 2024; 5:100300. [PMID: 38706931 PMCID: PMC11064105 DOI: 10.1016/j.ssmmh.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all. Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confirmatory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries. Monte Carlo simulations showed a correlation of 0.998, a good replication of population values, indicating minimal noninvariance, or variation. Items "so nervous," "lack of energy/effortful tasks," and "tired" were consistently equivalent for intercepts and factor loadings, respectively. However, items "depressed" and "so depressed" consistently differed across study countries (R2 = 0) for intercepts and factor loadings for both items. The K10 scale likely functions equivalently across the four countries for most items, except "depressed" and "so depressed." Differences in K10 items were more common in Kenya and Ethiopia, suggesting cultural context may influence the interpretation of some items and the potential need for cultural adaptations in these countries.
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Affiliation(s)
- Amantia A. Ametaj
- Institute of Health Equity and Social Justice, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rocky E. Stroud
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jasmine Hall
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Barkot Milkias
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jacob Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Molly Naisanga
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | - Edith K. Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Stella Gichuru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkam Alemayehu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zukiswa Zingela
- Executive Dean’s Office, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Adele Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charles R.J.C. Newton
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rehema M. Mwema
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
| | - Symon M. Kariuki
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bizu Gelaye
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Chaudhry D, Khandelwal S, Bahadur C, Daniels B, Bhattacharyya M, Gangakhedkar R, Desai S, Das J. Prevalence of long COVID symptoms in Haryana, India: a cross-sectional follow-up study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100395. [PMID: 38586062 PMCID: PMC10998228 DOI: 10.1016/j.lansea.2024.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
Background Emerging research indicates growing concern over long COVID globally, although there have been limited studies that estimate population burden. We aimed to estimate the burden of long COVID in three districts of Haryana, India, using an opportunity to link a seroprevalence study to follow-up survey of symptoms associated with long COVID. Methods We used a population-based seroprevalence survey for COVID-19 conducted in September 2021 across Haryana, India. Adults from three purposively selected districts (Rohtak, Gurugram, and Jhajjar) were eligible to participate; 2205 of 3213 consented to participate in a survey on health status. Trained investigators administered a structured questionnaire that included demographic characteristics, self-reported symptoms of illness in the last six months before the survey, mental health, and history of COVID-19. Findings Unadjusted regression estimates indicated positive correlations between symptomatic complaints and COVID-19 exposure, suggesting lingering effects of COVID-19 in this population. The overall physical morbidity index was higher among those who tested positive for COVID-19, as was the incidence of new cases. However, both morbidity and incidence became statistically insignificant after adjustment for multiple comparisons. Cough emerged as the only statistically significant individual persistent symptom. Sex-stratified analyses indicated significant estimates only for physical morbidity in women. Interpretation This study is one of the first from India that uses a large population-based sample to examine longer term repercussions of COVID infections. The burden of long COVID should primarily be addressed in clinical settings, where specialised treatment for individual cases continues to evolve. Our analyses also provide insight into the size and nature of studies required to assess the population-level burden of long COVID. Funding This paper was produced under the auspices of the Lancet COVID 19 Commission India Task Force, which was supported financially by the Reliance Foundation. The Lancet COVID 19 Commission was set up in July 2020 and submitted its final report by October 2022. This report by the India Task Force was prepared during the same period.
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Affiliation(s)
- Dhruva Chaudhry
- Dept of Pulmonary & Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India
| | | | | | | | | | | | | | - Jishnu Das
- Georgetown University, Washington, DC, USA
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Moreno-Serra R, Leon-Giraldo S, Jater-Maldonado N, Casas G, Bernal O. Trends in mental health before and after the onset of the COVID-19 pandemic: a longitudinal survey of a conflict-affected population in Colombia. Int J Ment Health Syst 2024; 18:4. [PMID: 38317169 PMCID: PMC10845752 DOI: 10.1186/s13033-024-00621-1] [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: 04/03/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Focusing on the Meta region in Colombia, we investigated the relationship between mental health, the COVID-19 pandemic, and social determinants of health influenced by over five decades of civil conflict. We studied the post-2016 peace agreement trends in mental health for the population of Meta, before and after the local onset of the pandemic. METHOD We conducted three rounds of a longitudinal health survey in years 2018 with N = 1309 (Women = 709; Men = 600); 2019 with N = 1106 (Women = 597; Men = 509); and 2020 with N = 905 (Women = 499; Men = 406). We measured mental health through the Self-Report Questionnaire (SRQ-20), investigating population trends in the average SRQ score and SRQ-positive frequency (SRQ + , indicating positive tendency towards experiencing mental health disorders). RESULTS Between 2018 and 2020, there were reductions in the mean SRQ-20 score by 1.74 points (95% CI -2.30 to -1.18) and in SRQ + frequency by 15 percentage points (95% CI -21.0 to -9.0) for the Meta population. Yet specific subgroups have become more vulnerable to mental illness during the pandemic, for example older age groups (e.g., increase in mean SRQ score among over 60 s by 2.49 points, 95% CI 0.51 to 4.46) and people living with children younger than five years-old (e.g., increase in mean SRQ score by 0.64 points, 95% CI 0.07 to 1.20). Increased mental health vulnerability among specific subgroups may be related to differences in the likelihood of knowing people who tested positive for COVID-19 or died from itf having been in quarantine. CONCLUSION Our findings support the importance of public policies in Colombia (and other low- and middle-income countries) that address the social determinants of mental illness whose influence was likely exacerbated by the pandemic, including persistent job insecurity leading to work and financial pressures, and inadequate support networks for isolated individuals and vulnerable caregivers.
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Affiliation(s)
| | - Sebastian Leon-Giraldo
- School of Government, Universidad de los Andes, Bogotá, Colombia.
- Interdisciplinary Centre of Development Studies, Universidad de los Andes, Bogotá, Colombia.
| | | | - German Casas
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Oscar Bernal
- School of Government, Universidad de los Andes, Bogotá, Colombia
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Tugnawat D, Singh A, Anand A, Bondre A, Chandke D, Dhurve P, Joshi U, Khan A, Muke S, Negi B, Nikhare K, Rathore D, Ramaswamy R, Haney JR, Sen Y, Sharma K, Shrivastava R, Verma N, Vishwakarma R, Vishwakarma D, Vorapanya V, Patel V, Bhan A, Naslund JA. ESSENCE: An Implementation Research Program to Scale Up Depression Care in Rural Communities. Psychiatr Serv 2024; 75:167-177. [PMID: 37904491 DOI: 10.1176/appi.ps.202100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND Task sharing may involve training nonspecialist health workers (NSHWs) to deliver brief mental health interventions. This approach is promising for reducing the global mental health treatment gap. However, capacity is limited for training large cadres of frontline workers in low- and middle-income countries, hindering uptake of these interventions at scale. METHODS The ESSENCE (enabling translation of science to service to enhance depression care) project in Madhya Pradesh, India, aims to address these challenges through two sequential randomized controlled trials. First, a training trial will evaluate the effectiveness and cost-effectiveness of digital training, compared with conventional face-to-face training, in achieving clinical competency of NSHWs in delivering an intervention for depression. This initial trial will be followed by an implementation trial aimed at evaluating the effectiveness of a remote enhanced implementation support, compared with routine implementation support, in addressing barriers to delivery of depression care in primary care facilities. RESULTS This project involved developing and pilot testing a scalable smartphone-based program for training NSHWs to deliver a brief psychological intervention for depression screening. This initial research guided a randomized trial of a digital training approach with NSHWs to evaluate the effectiveness of this approach. This trial will be followed by a cluster-randomized trial to evaluate the effectiveness of remote implementation support in ensuring efficient delivery of depression care in primary care facilities. NEXT STEPS Findings from these trials may inform sustainable training and implementation support models to integrate depression care into primary care for scale-up in resource-constrained settings.
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Affiliation(s)
- Deepak Tugnawat
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Abhishek Singh
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Aditya Anand
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ameya Bondre
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dinesh Chandke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Pooja Dhurve
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Udita Joshi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Azaz Khan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Shital Muke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Babita Negi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kalyani Nikhare
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dharmendra Rathore
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Rohit Ramaswamy
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Juliana Restivo Haney
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Yogendra Sen
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kamlesh Sharma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ritu Shrivastava
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Narendra Verma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ram Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Deepali Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vorapat Vorapanya
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vikram Patel
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Anant Bhan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - John A Naslund
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
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Nadkarni A, Garg A, Agrawal R, Sambari S, Mirchandani K, Velleman R, Gupta D, Bhatia U, Fernandes G, D’souza E, Amonkar A, Rane A. Acceptability and feasibility of assisted telepsychiatry in routine healthcare settings in India: a qualitative study. OXFORD OPEN DIGITAL HEALTH 2023; 1:oqad016. [PMID: 38025140 PMCID: PMC10668329 DOI: 10.1093/oodh/oqad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023]
Abstract
Technology-enabled interventions are often recommended to overcome geographical barriers to access and inequitable distribution of mental healthcare workers. The aim of this study was to examine the acceptability and feasibility of an assisted telepsychiatry model implemented in primary care settings in India. In-depth interviews were conducted with patients who received telepsychiatry consultations. Data were collected about domains such as experience with communicating with psychiatrists over a video call and feasibility of accessing services. Data were analysed using a thematic analysis approach. Patients recognized that technology enabled them to access treatment and appreciated its contribution to the improvement in their mental health condition. They reported that the telepsychiatry experience was comparable to face-to-face consultations. They had a positive experience of facilitation by counsellors and found treatment delivery in primary care non-stigmatizing. While some adapted easily to the technology platform because of increased access to technology in their daily lives, others struggled to communicate over a screen. For some, availability of care closer to their homes was convenient; for others, even the little travel involved posed a financial burden. In some cases, the internet connectivity was poor and interfered with the video calls. Patients believed that scale could be achieved through adoption of this model by the public sector, collaboration with civil society, enhanced demand generation strategies and leveraging platforms beyond health systems. Assisted telepsychiatry integrated in routine healthcare settings has the potential to make scarce specialist mental health services accessible in low resource settings by overcoming geographical and logistical barriers.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ankur Garg
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ravindra Agrawal
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Seema Sambari
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Kedar Mirchandani
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Devika Gupta
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Urvita Bhatia
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Godwin Fernandes
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ethel D’souza
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Akshada Amonkar
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Anil Rane
- Institute of Psychiatry & Human Behaviour , Bambolim, Goa 403108, India
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Wang Y, Ye JL, Chen T, Zhang L. Assessment of psychometric properties of the Huaxi Emotional-distress Index questionnaire (HEI)in a large sample of general hospital inpatients. Gen Hosp Psychiatry 2023; 84:188-193. [PMID: 37572466 DOI: 10.1016/j.genhosppsych.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Huaxi Emotional-distress Index questionnaire (HEI) is a 9-item questionnaire designed to measure psychological distress. The present study aimed to validate the factor structure of the HEI and its reliability and validity using a large sample from inpatients of West China Hospital. METHODS HEI data were collected from inpatients of various departments at West China Hospital in 2019 through the hospital's data management platform (total sample, N = 55,396). The internal consistency reliability of the HEI was examined. Exploratory factor analysis (N = 27,696) and confirmatory factor analysis(N = 27,700) were conducted to validate the construct validity. RESULTS Three factors, namely depression (DEP), anxiety (ANX), and suicidal risk (SR), were extracted through exploratory factor analysis, which accounted for 79.55% of the total variance.The results of confirmatory factor analysis supported the fit for the three-component model oblique model as the best-fitting model compared with one-component model and two-component model. The internal consistency of the HEI was α =0.918. The internal consistencyα of ANX, DEP and SR is 0.87,0.814,0.843 respectively. CONCLUSIONS HEI is a validated and concise tool that serves a dual purpose of screening for mood disorders and assessing depressive and anxiety symptoms as well as suicidal risk among inpatients in Chinese general hospitals.
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Affiliation(s)
- Ye Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jia-Lu Ye
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Chen
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lan Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
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Pathare S, Joag K, Kalha J, Pandit D, Krishnamoorthy S, Chauhan A, Shields-Zeeman L. Atmiyata, a community champion led psychosocial intervention for common mental disorders: A stepped wedge cluster randomized controlled trial in rural Gujarat, India. PLoS One 2023; 18:e0285385. [PMID: 37289730 PMCID: PMC10249851 DOI: 10.1371/journal.pone.0285385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/11/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND While effective lay-health worker models for mental health care have been demonstrated through efficacy trials, there is limited evidence of the effectiveness of these models implemented in rural LMIC settings. AIM To evaluate the impact of a volunteer community-led intervention on reduction in depression and anxiety symptoms and improvement in functioning, and social participation among people living in rural Gujarat, India. METHODS Stepped-wedge cluster randomized controlled trial was used to assess the effectiveness of delivery of psychosocial intervention across 645 villages in Mehsana district of Gujarat, India between April 2017 and August 2019. The primary outcome was an improvement in depression and/or anxiety symptoms assessed using GHQ-12 at 3-month follow-up. Secondary outcomes were improvement in (a) depression and anxiety (Patient Health Questionnaire, (PHQ-9), Generalized Anxiety Disorder (GAD-7) & Self-Reporting Questionnaire-20 (SRQ-20); b) quality of life (EQ- 5D); c) functioning (WHO-DAS-12), and social participation (Social Participation Scale SPS). Generalized linear mixed-effects models were used to assess the independent effect of the intervention. RESULTS Out of a total of 1191 trial participants (608- intervention & 583-control), 1014 (85%) completed 3-month follow-up. In an adjusted analysis, participants in the intervention condition showed significant recovery from symptoms of depression or anxiety (OR 2.2; 95% CI 1.2 to 4.6; p<0.05) at the end of 3-months, with effects sustained at 8-month follow-up (OR 3.0; 95% CI 1.6 to 5.9). Intervention participants had improved scores on the PHQ-9 (Adjusted mean difference (AMD) -1.8; 95%CI -3.0 to -0.6), and SRQ-20 (AMD -1.7; 95%CI -2.7 to -0.6), at 3-months and PHQ-9, GAD-7, SRQ-20, EQ-5D and WHO-DAS at 8 months follow-up. CONCLUSION Findings suggest that Atmiyata had a significant effect on recovery from symptoms of depression and anxiety with sustained effects at 8-month follow-up. TRIAL REGISTRATION Trial registration details. The trial was registered prospectively with the "Clinical Trial Registry in India" (registry number: CTRI/2017/03/008139).
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Affiliation(s)
- Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Deepa Pandit
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | | | - Laura Shields-Zeeman
- Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Utrecht, the Netherlands
- Faculty of Interdisciplinary Social Sciences, Utrecht University, Utrecht, the Netherlands
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8
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Ranjan A, Thiagarajan S, Garg S. Measurement of unmet healthcare needs to assess progress on universal health coverage - exploring a novel approach based on household surveys. BMC Health Serv Res 2023; 23:525. [PMID: 37221549 DOI: 10.1186/s12913-023-09542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) aims to ensure universal access to quality healthcare according to health needs. The extent to which population health needs are met should be a key measure for progress on UHC. The indicators in use for measuring access mostly relate to physical accessibility or insurance coverage. Or, utilization of services is taken as indirect measure for access but it is assessed against only the perceived healthcare needs. The unperceived needs do not get taken into account. The present study was aimed at demonstrating an approach for measuring the unmet healthcare needs using household survey data as an additional measure of UHC. METHODS A household survey was conducted in Chhattisgarh state of India, covering a multi-stage sample of 3153 individuals. Healthcare need was measured in terms of perceived needs which would be self-reported and unperceived needs where clinical measurement supplemented the interview response. Estimation of unperceived healthcare needs was limited to three tracer conditions- hypertension, diabetes and depression. Multivariate analysis was conducted to find the determinants of the various measures of the perceived and unperceived needs. RESULTS Of the surveyed individuals, 10.47% reported perceived healthcare needs for acute ailments in the last 15 days. 10.62% individuals self-reported suffering from chronic conditions. 12.75% of those with acute ailment and 18.40% with chronic ailments received no treatment, while 27.83% and 9.07% respectively received treatment from unqualified providers. On an average, patients with chronic ailments received only half the medication doses required annually. The latent need was very high for chronic ailments. 47.42% of individuals above 30 years age never had blood pressure measured. 95% of those identified with likelihood of depression had not sought any healthcare and they did not know they could be suffering from depression. CONCLUSION To assess progress on UHC more meaningfully, better methods are needed to measure unmet healthcare needs, taking into account both the perceived and unperceived needs, as well as incomplete care and inappropriate care. Appropriately designed household surveys offer a significant potential to allow its periodic measurement. Their limitations in measuring the 'inappropriate care' may necessitate supplementation with qualitative methods.
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Affiliation(s)
- Alok Ranjan
- Department of Humanities and Social Sciences, Indian Institute of Technology, Jodhpur, India
- State Health Resource Center, Chhattisgarh, India
| | | | - Samir Garg
- State Health Resource Center, Chhattisgarh, India.
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Muanido A, Cumbe V, Manaca N, Hicks L, Fabian KE, Wagenaar BH. Prevalence and associated factors of common mental disorders in primary care settings in Sofala Province, Mozambique. BJPsych Open 2023; 9:e12. [PMID: 36632814 PMCID: PMC9885355 DOI: 10.1192/bjo.2022.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Mozambique, the prevalence of common mental illness in primary care is not well established. AIMS This study aimed to assess the prevalence of, and associated factors for, common mental illness in patients accessing primary care services in three Ministry of Health clinics in Mozambique. METHOD Adult patients were recruited from the waiting rooms of prenatal, postpartum and general out-patient consultations. A mental health professional administered a diagnostic interview to examine prevalence of major depressive disorder (MDD), generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and any substance misuse or dependence. Generalised linear mixed models were used to examine the odds of each disorder and sociodemographic associations. RESULTS Of 502 patients interviewed, 74.1% were female (n = 372) and the average age was 27.8 years (s.d. = 7.4). Of all participants, 23.9% (n = 120) met diagnostic criteria for at least one common mental disorder; 8.6% were positive for MDD (n = 43), 13.3% were positive for GAD (n = 67), 4.8% were positive for PTSD (n = 24) and 4.0% were positive for any substance misuse or dependence (n = 20). Patients attending prenatal or postpartum consultations had significantly lower odds of any common mental disorder than patients attending out-patient primary care. Age was negatively associated with MDD, but positively associated with substance misuse or dependence. CONCLUSIONS Over 20% of patients attending primary care in Mozambique may have common mental disorders. A specific focus on patients attending general out-patient visits, young people for depression, and older people and men for substance misuse/dependence would provide a targeted response to high-risk demographics.
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Affiliation(s)
| | - Vasco Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Mozambique
| | | | - Lee Hicks
- Health Alliance International, Washington, USA
| | - Katrin E. Fabian
- Department of Global Health, University of Washington, Washington, USA
| | - Bradley H. Wagenaar
- Health Alliance International, Washington, USA; Department of Global Health, University of Washington, Washington, USA; and Department of Epidemiology, University of Washington, Washington, USA
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10
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Kusumajaya AAN, Mubasyiroh R, Sudikno S, Nainggolan O, Nursanyoto H, Sutiari NK, Adhi KT, Suarjana IM, Januraga PP. Sociodemographic and Healthcare Factors Associated with Stunting in Children Aged 6-59 Months in the Urban Area of Bali Province, Indonesia 2018. Nutrients 2023; 15:nu15020389. [PMID: 36678259 PMCID: PMC9863855 DOI: 10.3390/nu15020389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Stunting is a worldwide public health concern, including in Indonesia. Even when living in an urban area with urban characteristics, it is still possible for children to be at risk of stunting. The aim of this study was to determine the sociodemographic and healthcare factors associated with stunting in a province experiencing tourism growth, namely, Bali. Cross-sectional data on Bali Province from the Indonesian Basic Health Research Survey (Riskesdas, 2018) were used as the basis for the research analysis. A total of 846 respondents under five years of age were analyzed, indicating a stunting prevalence of 19.0%. Multivariate logistic regression demonstrated low maternal educational attainment (adjustedOR = 1.92; 95% Confidence Interval = 1.24-2.97), the inadequate consumption of iron tablets during pregnancy (adjustedOR = 1.56; 95% Confidence Interval = 1.08-2.24), and no extended family (adjustedOR = 1.55; 95% Confidence Interval = 1.07-2.26) as being significantly associated with stunting. According to these findings, sociodemographic and healthcare factors are associated with stunting in urban Bali. Improving women's education, ensuring sufficient iron tablets are consumed during pregnancy, and encouraging the involvement of the extended family in childcare are recommended.
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Affiliation(s)
| | - Rofingatul Mubasyiroh
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta 10340, Indonesia
- Correspondence:
| | - Sudikno Sudikno
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta 10340, Indonesia
| | - Olwin Nainggolan
- Health Development Policy Agency, Ministry of Health, Jakarta 10560, Indonesia
| | | | - Ni Ketut Sutiari
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
| | - Kadek Tresna Adhi
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
| | - I Made Suarjana
- Health Polytechnic, Ministry of Health, Denpasar 80224, Indonesia
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
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Co-Benefits of Largescale Organic farming On huMan health (BLOOM): Protocol for a cluster-randomised controlled evaluation of the Andhra Pradesh Community-managed Natural Farming programme in India. PLoS One 2023; 18:e0281677. [PMID: 36862623 PMCID: PMC9980745 DOI: 10.1371/journal.pone.0281677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/29/2023] [Indexed: 03/03/2023] Open
Abstract
The BLOOM study (co-Benefits of Largescale Organic farming On huMan health) aims to determine if a government-implemented agroecology programme reduces pesticide exposure and improves dietary diversity in agricultural households. To achieve this aim, a community-based, cluster-randomised controlled evaluation of the Andhra Pradesh Community-managed Natural Farming (APCNF) programme will be conducted in 80 clusters (40 intervention and 40 control) across four districts of Andhra Pradesh state in south India. Approximately 34 households per cluster will be randomly selected for screening and enrolment into the evaluation at baseline. The two primary outcomes, measured 12 months post-baseline assessment, are urinary pesticide metabolites in a 15% random subsample of participants and dietary diversity in all participants. Both primary outcomes will be measured in (1) adult men ≥18 years old, (2) adult women ≥18 years old, and (3) children <38 months old at enrolment. Secondary outcomes measured in the same households include crop yields, household income, adult anthropometry, anaemia, glycaemia, kidney function, musculoskeletal pain, clinical symptoms, depressive symptoms, women's empowerment, and child growth and development. Analysis will be on an intention-to-treat basis with an a priori secondary analysis to estimate the per-protocol effect of APCNF on the outcomes. The BLOOM study will provide robust evidence of the impact of a large-scale, transformational government-implemented agroecology programme on pesticide exposure and dietary diversity in agricultural households. It will also provide the first evidence of the nutritional, developmental, and health co-benefits of adopting agroecology, inclusive of malnourishment as well as common chronic diseases. Trial registration: Study registration: ISRCTN 11819073 (https://doi.org/10.1186/ISRCTN11819073). Clinical Trial Registry of India CTRI/2021/08/035434.
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12
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Ram D, Bheemaraju SP, Alammar MA. Explanatory Models and their Relationship with Drug Attitude in Patients with Depression in South India. Indian J Psychol Med 2023; 45:53-58. [PMID: 36778620 PMCID: PMC9896122 DOI: 10.1177/02537176221098329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The patient's understanding of the illness may mediate beliefs towards its treatment. There is a paucity of studies examining the relationships between these variables in depression. This study was conducted to know the relationships between explanatory models and attitude to medication in depression. METHODS 494 patients with depression in remission were assessed with sociodemographic proforma, Drug Attitude Inventory, and Mental Distress Explanatory Model Questionnaire. RESULTS A favorable attitude toward medication was observed in 57.49% of participants. Mean scores on MDEMQ subscales Stress, Western Physiology, Non-Western Physiology, and Supernatural were 32.96, 21.87, 10.06, and 47.55, respectively. Statistically significant associations were found between attitude towards medication and the patient's marital status (more negative attitude with single status, χ2 = 11.72, df = 3, P = 0.008) and occupation (more negative attitude among unemployed patients, χ2 = 4.17, df = 1, P = 0.041). The scores of explanatory models did not differ based on positive or negative drug attitude. CONCLUSION Though explanatory models are not linked to patient attitudes toward medication, patients who are single or unemployed have a negative attitude toward medications. Such negative attitude may impair compliance and worsen patient outcomes.
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Affiliation(s)
- Dushad Ram
- Dept. of Medicine(Psychiatry), College of Medicine, Shaqra University, Shaqra, Riyadh Province, Saudi Arabia
| | | | - Muath A Alammar
- Dept. of Medicine (Family Medicine), Shaqra College of Medicine, Shaqra University, Shaqra, Riyadh Province, Saudi Arabia
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13
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Scott HR, Stevelink SAM, Gafoor R, Lamb D, Carr E, Bakolis I, Bhundia R, Docherty MJ, Dorrington S, Gnanapragasam S, Hegarty S, Hotopf M, Madan I, McManus S, Moran P, Souliou E, Raine R, Razavi R, Weston D, Greenberg N, Wessely S. Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study. Lancet Psychiatry 2023; 10:40-49. [PMID: 36502817 PMCID: PMC9731576 DOI: 10.1016/s2215-0366(22)00375-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. METHODS We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. FINDINGS The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1). INTERPRETATION The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. FUNDING UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.
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Affiliation(s)
- Hannah R Scott
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rafael Gafoor
- Department of Applied Health Research, University College London, London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Gnanapragasam
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sally McManus
- NatCen Social Research, London, UK; Violence and Society Centre City, University of London, London, UK
| | - Paul Moran
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emilia Souliou
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Reza Razavi
- Wellcome/EPSRC Centre For Medical Engineering, London, UK
| | - Danny Weston
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Fontes Leite CC, Passos TO, Cavalcante Neto JL. Common mental disorders and associated factors in healthcare workers during the COVID-19 pandemic: A cross-sectional study. Work 2022; 75:19-27. [PMID: 36591673 DOI: 10.3233/wor-211387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic changed the way people live. As a result, workload and mental health problems increased, especially in healthcare workers. OBJECTIVE To verify the prevalence of common mental disorders (CMD) and its association with sociodemographic and work variables in healthcare workers of a Family Health Support Center in the Primary Health Care context (NASF-AB) in Brazil during the COVID-19 pandemic. METHODS This cross-sectional study was conducted with 68 healthcare workers, both sex (55 female/13 male), from the Primary Health Care context in Brazil, particularly NASF-AB of Salvador Bahia. NASF-AB is part of a policy to consolidate Primary Health Care in Brazil. NASF-AB of Salvador has twelve multidisciplinary teams distributed in twelve health districts. The data collection was performed from May to August 2021. The self-reporting questionnaire - 20 (SRQ-20), that assessed the prevalence of CMD, and a sociodemographic questionnaire assessed sociodemographic and work variables via Google forms. RESULTS The prevalence of CMD was 39.71%. On SRQ-20, 70, 59% of participants felt nervous; 54, 41% felt tired all the time and 51, 47% felt tired easily. CMD was also significantly associated with females (p < 0.001). CONCLUSION The prevalence of CMD was high (39, 71%), with females (n = 27/55) being more susceptible to CMD than males (n = 0/13). Feel nervous, tired all the time and easily tired were the most frequent symptoms reported by the participants, indicating depressive/anxious mood, and reduced vital energy. Our findings highlight the need for specific measures to improve health and quality of life of healthcare workers.
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Affiliation(s)
| | | | - Jorge Lopes Cavalcante Neto
- Department of Life Sciences, State University of Bahia, Salvador, Brazil.,Department of Human Sciences, State University of Bahia, Jacobina, Brazil
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Gratão LHA, Pessoa MC, Rocha LL, da Silva TPR, Santos Freitas ED, de Oliveira TRPR, de Freitas Cunha C, Mendes LL. Living with parents, lifestyle pattern and common mental disorders in adolescents: a school-based study in Brazil. BMC Public Health 2022; 22:1862. [PMID: 36199052 PMCID: PMC9535856 DOI: 10.1186/s12889-022-14241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Mental health conditions represent 16% of the global burden of disease and injury in adolescents. Promotion, protection, and restoring the mental health must be considered indispensable, especially in adolescence. This study aims to verify the association of lifestyle pattern, living with parents and the presence of Common Mental Disorders (CMD) in Brazilian adolescents. Methods Cross-sectional study that analyzed data from 71,553 adolescents aged 12–17 years, from the Study on Cardiovascular Risks in Adolescents (ERICA), between 2013 and 2014. Principal Component Analysis (PCA) was performed to identify lifestyle pattern, and Logistic Regression Models were performed to identify the associations between lifestyle pattern, living with parents, and presence of CMD. Results To construct the Common Mental Disorders (CMD) variable, the Goldberg General Health Questionnaire was used. The Pattern of Healthy Lifestyle Practices found was characterized by higher water consumption, lower consumption of ultra-processed foods, the habit of eating breakfast, less exposure time to screens, habit of physical activity, and longer mean sleep time in hours. Adolescents belonging to the second (OR: 0.73; 95% CI 0.65–0.82) and third (OR: 0.44; 95% CI 0.39–0.50) terciles of the pattern, that is, those who had higher belonging to the pattern had lower chances of having CMD. Adolescents who lived with neither parent (OR: 1.44; 95% CI 1.16–1.78) were associated with a higher chance to present CMD. Conclusion Living with parents can contribute to better mental health among adolescents. In addition, the adoption of a healthy lifestyle, encouraged by parents and the community, can reduce the chances of CMD in Brazilian adolescents.
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Affiliation(s)
- Lucia Helena Almeida Gratão
- School of Medicine, Pediatrics Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- School of Nursing, Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luana Lara Rocha
- Medicine School, Departament of Preventive and Social Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Eloar Dos Santos Freitas
- School of Nursing, Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Cristiane de Freitas Cunha
- School of Medicine, Pediatrics Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Loures Mendes
- School of Nursing, Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Masiano SP, Yu X, Tembo T, Wetzel E, Mphande M, Khama I, Mkandawire A, Chitani M, Liwimbi O, Udedi M, Mazenga A, Nyasulu P, Abrams E, Ahmed S, Kim MH. The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi. J Affect Disord 2022; 312:159-168. [PMID: 35752220 PMCID: PMC9892657 DOI: 10.1016/j.jad.2022.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting. METHODS This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. RESULTS The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. LIMITATIONS Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. CONCLUSIONS ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.
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Affiliation(s)
- Steven P Masiano
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public Health and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Tapiwa Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Olive Liwimbi
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | - Michael Udedi
- Ministry of Health, NCDs and Mental Health Unit, Lilongwe, Malawi; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Phoebe Nyasulu
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Srinivasan K, Heylen E, Johnson Pradeep R, Mony PK, Ekstrand ML. Collaborative care compared to enhanced standard treatment of depression with co-morbid medical conditions among patients from rural South India: a cluster randomized controlled trial (HOPE Study). BMC Psychiatry 2022; 22:394. [PMID: 35698087 PMCID: PMC9195442 DOI: 10.1186/s12888-022-04000-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression is common among primary care patients in LMIC but treatments are largely ineffective. In this cluster-randomized controlled trial, we tested whether depression outcomes are different among recipients of a collaborative care model compared to enhanced standard treatment in patients with co-morbid chronic medical conditions. METHODS We conducted a cluster randomized controlled trial among participants 30 years or older seeking care at 49 primary health centers (PHCs) in rural Karnataka, diagnosed with major depressive disorder, dysthymia, generalized anxiety disorder, or panic disorder on the MINI-International Neuropsychiatric Interview plus either hypertension, diabetes, or ischemic heart disease. From a list of all PHCs in the district, 24 PHCs were randomized a priori to deliver collaborative care and 25 PHCs enhanced standard treatment. The collaborative care model consisted of a clinic-based and a community-based component. Study assessment staff was blinded to treatment arm allocation. The primary outcome was the individual-level PHQ-9 score over time. RESULTS Between May 2015 and Nov 2018, 2486 participants were enrolled, 1264 in the control arm, and 1222 in the intervention arm. They were assessed at baseline, 3, 6 and 12 months. The mean PHQ-9 depression score was around 8.5 at baseline. At each follow-up PHQ-9 scores were significantly lower in the intervention (5.24, 4.81 and 4.22 at respective follow-ups) than in the control group (6.69, 6.13, 5.23, respectively). A significant time-by-treatment interaction (p < 0.001) in a multi-level model over all waves, nested within individuals who were nested within PHCs, confirmed that the decrease in depression score from baseline was larger for collaborative care than enhanced standard care throughout follow-up. CONCLUSIONS The collaborative care intervention resulted in significantly lower depression scores compared to enhanced standard care among participants with co-morbid physical conditions. The findings have potential implications for integrating mental health and chronic disease treatment in resource constrained settings. TRIAL REGISTRATION ClinicalTrials.gov NCT02310932 , registered on December 8, 2014, and Clinical Trials Registry India CTRI/2018/04/013001 , registered on April 4, 2018. Retrospectively registered.
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Affiliation(s)
- Krishnamachari Srinivasan
- grid.418280.70000 0004 1794 3160Division of Mental Health & Neurosciences, St John’s Research Institute, Bangalore, India ,grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Bangalore, India
| | - Elsa Heylen
- grid.266102.10000 0001 2297 6811Division of Prevention Sciences, University of California, San Francisco, USA
| | - R. Johnson Pradeep
- grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Bangalore, India
| | - Prem K. Mony
- grid.416432.60000 0004 1770 8558Division of Epidemiology and Community Health, St John’s Medical College & Research Institute, Bangalore, India
| | - Maria L. Ekstrand
- grid.418280.70000 0004 1794 3160Division of Mental Health & Neurosciences, St John’s Research Institute, Bangalore, India ,grid.266102.10000 0001 2297 6811Division of Prevention Sciences, University of California, San Francisco, USA
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Bau N, Khanna G, Low C, Shah M, Sharmin S, Voena A. Women's well-being during a pandemic and its containment. JOURNAL OF DEVELOPMENT ECONOMICS 2022; 156:102839. [PMID: 35221446 PMCID: PMC8860469 DOI: 10.1016/j.jdeveco.2022.102839] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic brought the dual crises of disease and the containment policies designed to mitigate it. Yet, there is little evidence on the impacts of these policies on women in lower-income countries, where there may be limited social safety nets to absorb these shocks. We conduct a large phone survey and leverage India's geographically varied containment policies to estimate the association between the pandemic and containment policies and measures of women's well-being, including mental health and food security. On aggregate, the pandemic resulted in dramatic income losses, increases in food insecurity, and declines in female mental health. While potentially crucial to stem the spread of COVID-19, the greater prevalence of containment policies is associated with increased food insecurity, particularly for women, and reduced female mental health. For surveyed women, moving from zero to average containment levels is associated with a 38% increase in the likelihood of reporting more depression, a 73% increase in reporting more exhaustion, and a 44% increase in reporting more anxiety. Women whose social position may make them more vulnerable - those with daughters and those living in female-headed households - experience even larger declines in mental health.
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Affiliation(s)
- Natalie Bau
- UCLA, United States of America
- NBER, United States of America
- CEPR, United Kingdom
- BREAD, United States of America
| | | | - Corinne Low
- UPenn, United States of America
- NBER, United States of America
| | - Manisha Shah
- UCLA, United States of America
- NBER, United States of America
- BREAD, United States of America
| | | | - Alessandra Voena
- Stanford, United States of America
- NBER, United States of America
- CEPR, United Kingdom
- BREAD, United States of America
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19
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Andersen AG, Kotsadam A, Somville V. Material resources and well-being - Evidence from an Ethiopian housing lottery. JOURNAL OF HEALTH ECONOMICS 2022; 83:102619. [PMID: 35436664 DOI: 10.1016/j.jhealeco.2022.102619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
Do better material conditions improve well-being and mental health? Or does any positive relationship merely reflect that well-being promotes economic success? We compare winners and losers from a large Ethiopian housing lottery in a preregistered analysis. Winners gain access to better housing, experience a substantial increase in wealth, and report higher levels of overall life satisfaction and lower levels of financial distress. However, we find no average effects of winning on psychological distress. Our results suggest that not all aspects of well-being and mental health are equally sensitive to economic conditions.
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Affiliation(s)
| | - Andreas Kotsadam
- Ragnar Frisch Centre for Economic Research, Norway; PROMENTA Research Center Department of Psychology, University of Oslo, Norway
| | - Vincent Somville
- NHH Norwegian School of Economics, Norway; Chr. Michelsen Institute, Norway.
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20
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Srinivasan M, Premarajan KC, Reddy MM, Menon V, Kumar SG. Prevalence of psychological morbidity and its correlates among school-going adolescents of urban Puducherry, India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:88-92. [PMID: 36461851 DOI: 10.25259/nmji_396_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Background Experiencing poor mental health during adolescence predisposes an individual to psychiatric morbid conditions in adulthood. We estimated the prevalence of psychological morbidity and its associated factors, among school-going adolescents in higher secondary schools of urban Puducherry. Methods We did this cross-sectional study among adolescents studying in classes 11 and 12 from selected schools of urban Puducherry, including one government and three private schools. Study tools used were the General Health Questionnaire-12 and Perceived Stress Scale-10 to assess psychological morbidity and perceived psychological stress in adolescents, respectively. Risk factors in academic, environmental, personal and health-related domains were captured using a structured questionnaire. Study questionnaires were self-administered by the participants in classrooms. Bivariate and multivariate analyses were done to identify risk factors for psychological morbidity. Results Of the 820 adolescents surveyed, the prevalence of psychological morbidity was 25.4% (95% CI 22.4- 28.5). Academic factors such as reporting peer pressure for academic performance and lack of extracurricular activities at school were associated with psychological morbidity. Among health-related factors, adolescents who reported having difficulty in coping with pubertal changes, being worried about their physical appearance, reporting substance abuse and experiencing sleep disturbances had greater chances of having screened with psychological morbidity. Of note, adolescents with psychological stress had 2.5 times higher chances of having psychological morbidity. Conclusions We estimated that 1 in 4 school-going adolescents in urban Puducherry suffered psychological morbidity. Reducing the academic burden and advocating health promotion through a life skills approach may improve mental wellness in Indian adolescents.
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Affiliation(s)
- Manikandan Srinivasan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - K C Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Mahendra M Reddy
- Department of Community Medicine, Sri Devraj Urs Medical College, Kolar, Karnataka 563101, India
| | - Vikas Menon
- Department of Psychiatry, Sri Devraj Urs Medical College, Kolar, Karnataka 563101, India
| | - S Ganesh Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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Choi SH, McClintock CHY, Lau E, Miller L. The impact of perceived relationship to ancestors on the association between self-transcendence and psychopathology: A cross-cultural examination. Transcult Psychiatry 2022:13634615211049072. [PMID: 34986065 DOI: 10.1177/13634615211049072] [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: 11/16/2022]
Abstract
Self-transcendence has been associated with lower levels of psychopathology. Most studies of self-transcendence have focused on samples of Western participants, and used scales addressing such concepts as self-awareness and feelings of oneness with the larger universe. However, a common Eastern notion of transcendence-perception of ongoing relationships with ancestors-has not been studied. We conducted a cross-cultural investigation of the association between self-transcendence, perceived degree of relationship to ancestors and depression and anxiety in the United States (N = 1499), China (N = 3,150), and India (N = 863). Degrees of perceived relationship to ancestors differed across countries, with the highest rates in India and China, and lowest rates in the United States. Self-transcendence was negatively associated with risks for depression and anxiety in the United States. In India, self-transcendence was also negatively associated with risks for depression and anxiety, and a strong perceived relationship with ancestors had further protective benefit. In China, those with a high level of perceived relationship to ancestors and a high level of self-transcendence exhibited lower levels of psychopathology. Results suggest that measures of relationship to ancestors might be included in future cross-cultural studies of transcendence.
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22
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Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study. Glob Ment Health (Camb) 2022; 9:26-36. [PMID: 36618733 PMCID: PMC9806979 DOI: 10.1017/gmh.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. METHODS Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. RESULTS The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92-39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61-25.57, p = 0.008)]. CONCLUSION Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings.
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Varghese JS, Hall RW, Adair LS, Patel SA, Martorell R, Belleza DE, Kroker-Lobos MF, Lee NR, Nyati LH, Ramirez-Zea M, Richter LM, Stein AD. Subjective social status is associated with happiness but not weight status or psychological distress: An analysis of three prospective birth cohorts from low- and middle-income countries. WELLBEING, SPACE AND SOCIETY 2022; 3:None. [PMID: 36518911 PMCID: PMC9732742 DOI: 10.1016/j.wss.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Subjective social status (SSS, perception of social position relative to a frame of reference) has been associated with physical, mental and socio-emotional wellbeing. However, these associations may be susceptible to unmeasured confounding by life course objective socio-economic position (SEP; such as wealth, education and employment) and life satisfaction. PURPOSE To estimate the association of position on ladders of perceived community respect and perceived economic status with weight, distress and wellbeing, independent of objective SEP in cohorts from three low and middle-income countries. METHODS We used data from birth cohorts in Guatemala (n = 1258), Philippines (n = 1323) and South Africa (n = 1393). We estimated the association of perceived community respect and perceived economic status with body mass index (kg/m2), the World Health Organization's Self-Reported Questionnaire-20 (SRQ-20) for psychological distress, and Lyubomirsky's Subjective Happiness Scale. We estimated these associations using robust linear regression models adjusting for indicators of life course objective SEP, early life characteristics, adult covariates, and life satisfaction. RESULTS Participants in South Africa (age 27-28y) rated themselves higher on average for both the respect (7 vs 5 in Guatemala and 6 in Philippines) and economic (5 vs 3 in Guatemala and 4 in Philippines) ladder measures. Position on neither community respect nor economic ladders were associated with BMI or psychological distress. Higher position on community respect (Guatemala: 0.03, 95%CI: 0.01, 0.04; Philippines: 0.03, 95% CI: 0.02, 0.05; South Africa: 0.07, 95%CI: 0.04, 0.09) and economic (Guatemala: 0.02, 95%CI: 0, 0.04; Philippines: 0.04, 95%CI: 0.02, 0.07; South Africa: 0.07, 95%CI: 0.04, 0.10) ladders were associated with greater happiness. CONCLUSIONS Subjective social status showed small but consistent associations with happiness in birth cohorts independent of life-course SEP.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Waford Hall
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Delia E. Belleza
- Department of Psychology, University of San Carlos, Cebu City, Philippines
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Lukhanyo H. Nyati
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D. Stein
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Sathe H, Thakre M, Talapalliwar M. Psychometric properties of Kessler's Psychological Distress Scale (K10) in cancer patients. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Saini RK, Chaudhury S, Singh N, Chadha DS, Kapoor R. Depression, anxiety, and quality of life after percuataneous coronary interventions. Ind Psychiatry J 2022; 31:6-18. [PMID: 35800859 PMCID: PMC9255611 DOI: 10.4103/ipj.ipj_126_21] [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] [Received: 05/31/2021] [Revised: 07/25/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. However, some fascinating advances in the field of cardiology have not only added years to people's life but life to years as well. Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a nonsurgical procedure used to treat stenotic coronary arteries. In recent years, PCI has become the preferred modality of treatment for occluded coronary arteries. However, there has been growing interest in the quality of life (QOL) issues for those who undergo such procedures. Depression, anxiety, vital exhaustion, hostility, anger, and acute mental stress have been evaluated as risk factors for the development and progression of CAD. Further, they also have strong bearing toward recovery from an acute coronary event. The current article discusses the role of depression, anxiety, and QOL of patients undergoing PCI.
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Affiliation(s)
- Rajiv Kumar Saini
- Department of Psychiatry, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - Navreet Singh
- Department of Cardiology, CH (WC) Chandimandir, Panchkula, India
| | - D S Chadha
- Department of Cardiology, CH (IAF), Bengaluru, Karnataka, India
| | - Rajneesh Kapoor
- Department of Interventional Cardiology, Medanta Medicity, Gurgaon, Haryana, India
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Deshmukh P, Sujiv A, Kalaiselvi S, Tiwari M. Social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic: A cross-sectional study from central India. Indian J Public Health 2022; 66:451-457. [PMID: 37039173 DOI: 10.4103/ijph.ijph_482_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background In the present COVID-19 pandemic, social distancing measures have been advised to protect elderly from infection which might have led to poor mental health state. Objective A cross-sectional study was carried out to assess the magnitude of social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic in Central India. Methods The estimated sample size was 1535. The sample was equally distributed among rural, semiurban, and urban strata of districts. Social isolation was measured using Lubben's Social Network Scale-Revised, and psychological distress was assessed using Kessler K10 Psychological Distress Scale. Other parameters such as a history of COVID-19 illness and COVID-19 vaccination were assessed. Results The prevalence of social isolation was higher at 23.6% during the COVID-19 pandemic compared to before the pandemic period (15.0%). The majority perceived a high level of social support during the pandemic (55.3%) and 39.9% received moderate support. Overall, 18.4% of the respondents had psychological distress. Out of them, 56.2% had mild distress, 20.1% had moderate distress, and 23.7% had severe distress. Significant predictors of psychological distress were female gender, lower socioeconomic status, history of COVID-19 disease among the participants, social isolation, and lack of social support. Conclusion Social isolation and lack of social support were significant predictors of psychological distress among the elderly during the pandemic.
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Andersen LS, Saal W, Joska JA, Safren SA, Bantjes J, O'Cleirigh C, Witten JA, Lee JS, Kagee A. Improving Detection of Depression in People Living with HIV: Psychometric Properties of the South African Depression Scale (SADS). AIDS Behav 2021; 25:3630-3637. [PMID: 34143340 PMCID: PMC8563384 DOI: 10.1007/s10461-021-03305-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/26/2022]
Abstract
Most measures developed in high income countries to screen for major depressive disorder (MDD) among people living with HIV (PWH) demonstrate suboptimal psychometric properties when utilized in non-western, resource limited settings due to their high false positive rates. For standardized MDD screening to be implementable in local settings, a measure is needed that reduces diagnostic burden by being highly sensitive while limiting false positives. This study sought to evaluate the ability of the locally developed South African Depression Scale (SADS) to screen for MDD in PWH in Cape Town. The SADS was administered along with the SCID-5-RV as gold standard to 236 PWH. It demonstrated good discriminating ability in detecting MDD with an area under the curve of 0.85. A cut-off of 27 yielded 78.2% sensitivity and 54.4% PPV. Given its robust psychometric properties, routine use of the SADS in community clinics to screen at-risk PWH, combined with evidence-based depression treatment, could improve the health outcomes and well-being of PWH in South Africa.ResumenLa mayoría de las medidas desarrolladas en países de ingresos altos para detectar el trastorno depresivo mayor (TDM) entre las personas que viven con el VIH (PVV) demuestran propiedades psicométricas subóptimas cuando se utilizan en entornos no occidentales de recursos limitados debido a sus altas tasas de falsos positivos. Para que la detección de TDM estandarizada sea implementable en entornos locales, se necesita una medida que reduzca la carga diagnóstica al ser altamente sensible mientras limita los falsos positivos. Este estudio trató de evaluar la capacidad de la Escala de Depresión Sudafricana (SADS, por sus siglas en inglés) desarrollada localmente para detectar TDM en PVV en Ciudad del Cabo. El SADS se administró junto con el SCID-5-RV como el test de referencia a 236 PWH. Demostró una buena capacidad discriminatoria en la detección de TDM con un área bajo la curva de 0,85. Un corte de 27 produjo un 78,2% de sensibilidad y un 54,4% de VPP. Dadas sus sólidas propiedades psicométricas, el uso rutinario del SADS en clínicas comunitarias para detectar las PVV en riesgo, combinado con un tratamiento de depresión basado en la evidencia, podría mejorar los resultados de salud y el bienestar de las PVV en Sudáfrica.
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Affiliation(s)
- Lena Skovgaard Andersen
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa.
- Department of Public Health, Section of Global Health, University of Copenhagen,, Copenhagen, Denmark.
| | - Wylene Saal
- Centre for Social Science Research, University of Cape Town & Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jason Bantjes
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Conall O'Cleirigh
- Department of Psychiatry, Behavioral Medicine Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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Li N, Li S, Fan L. Risk Factors of Psychological Disorders After the COVID-19 Outbreak: The Mediating Role of Social Support and Emotional Intelligence. J Adolesc Health 2021; 69:696-704. [PMID: 34420819 PMCID: PMC8453612 DOI: 10.1016/j.jadohealth.2021.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The present study examined the risk factors of psychological disorders after COVID-19 outbreak and tested the possible mediating role of social support and emotional intelligence on the relationship between COVID-19 pandemic exposure and psychological disorders. METHODS We conducted an online survey from May 25, 2020 until June 10, 2020 among Chinese university students who had been quarantined at home due to the COVID-19 pandemic. Social support was assessed using the Social Support Rating Scale. Self-perceived emotional competency was measured using a Chinese version of the self-report Wong Law Emotional Intelligence Scale. The 10-item Kessler Psychological Distress Scale was used to assess nonspecific symptoms of psychological disorders. RESULTS A total of 6,027 college students participated in the survey, of whom 2,732 (45.3%) reported mental health issues. Men and people in a relationship showed higher frequencies of psychological disorders. Social support and emotional intelligence were both negatively associated with psychological disorders. Stepwise linear regression revealed that the most important predictors of psychological disorders were self-emotion appraisal, family relationships, and showing panic about COVID-19 on the social media. Path analysis suggested that the association between pandemic exposure and psychological disorders was partially mediated by emotional intelligence, but not by social support. CONCLUSIONS Emotional intelligence may mediate the relationship between COVID-19 pandemic exposure and psychological disorders. Psychological interventions fostering emotional intelligence and social support should be implemented among university students to reduce the psychological harm caused by the COVID-19 pandemic.
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Affiliation(s)
- Na Li
- Mental Health Education Center, Chengdu Normal University, Chengdu, PR China
| | - Shuyue Li
- Business School, Sichuan University, Chengdu, Sichuan, PR China
| | - Lurong Fan
- Business School, Sichuan University, Chengdu, Sichuan, PR China; Institute of Emergency Management and Reconstruction in Post-Disaster, Sichuan University, Chengdu, PR China.
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Monsalve SD, Vargas-Monroy AM, Ariza JE, Oñate Cuello AM, Ropero Vera AR, Bermudez Cuello JC, Arzuaga Zuleta L, Cubillos Novella AF, Peñaloza Quintero E, Fernández Ortiz YN, Carrillo MA, Kroeger A. Mental health among displaced and non-displaced populations in Valledupar, Colombia: do inequalities continue? Pathog Glob Health 2021; 116:305-318. [PMID: 34689701 DOI: 10.1080/20477724.2021.1989186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
During the long-lasting civil war in Colombia, thousands of people were displaced mainly from rural to urban areas, causing social disruption and prolonged poverty. This study aimed at analyzing the traumatic experience many years ago on the current psycho-emotional status of displaced families as well as the ongoing inequalities regarding displaced and non-displaced communities in one of the most affected areas by the armed conflict. An interview survey was conducted among 211 displaced families and 181 non-displaced families in 2 adjacent compounds in Valledupar, Colombia. The questionnaire used questions from the validated national survey and was revised and applied by staff members of the departmental secretary of health who conducted additional in-depth interviews. The study showed that the living conditions of the displaced community were precarious. The past traumatic events many years ago and the current difficult living conditions are associated with psychological problems being more frequent among the displaced people. The displaced people had experienced more violent acts and subsequently had a larger number of emotional symptoms (fright, headache, nervousness, depression, and sleeplessness). Other stress factors like economic problems, severe disease or death of family members and unemployment prevailed among displaced persons. The non-displaced lived in a more protected environment with less exposure to violence and stress, although belonging to a similarly low socio-economic stratum. It is recommended to take measures for a better protection of the displaced community, improve their access to the job market, offer different leisure activities and facilitate public transport.
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Affiliation(s)
- Sonia Diaz Monsalve
- Albert-Ludwigs Universitaet Freiburg, Centre for Medicine and Society, Freiburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Axel Kroeger
- Albert-Ludwigs Universitaet Freiburg, Centre for Medicine and Society, Freiburg, Germany
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Synowski J, Weiss HA, Velleman R, Patel V, Nadkarni A. A lay-counsellor delivered brief psychological treatment for men with comorbid Alcohol Use Disorder and depression in primary care: Secondary analysis of data from a randomized controlled trial. Drug Alcohol Depend 2021; 227:108961. [PMID: 34428630 PMCID: PMC8504199 DOI: 10.1016/j.drugalcdep.2021.108961] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/14/2021] [Accepted: 07/10/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND We investigated the feasibility, acceptability, safety, and preliminary effectiveness of the Counselling for Alcohol Problems (CAP) psychological intervention delivered by non-specialist health workers (NSHW) to participants with alcohol use disorder (AUD) and comorbid depression in primary care. METHODS We used data from a single blind randomised controlled trial conducted in ten primary health care centres in Goa, India. Adult male harmful or dependent drinkers with or without depression were randomized (1:1) to receive either CAP & enhanced usual care (EUC) or EUC only. Process indicators such as the number of completed counselling sessions were assessed and compared between comorbid and non-comorbid participants. Remission from AUD and depression along with abstinence were measured at 3 and 12 months post randomisation. Analyses were on an intention-to-treat basis, employing multivariable regression analyses. RESULTS 271 participants had symptoms of comorbid depression; 241 did not. Both groups completed a similar number of counselling sessions (adjusted Mean Difference 0.05, 95 %CI -0.24-0.34;p = 0.72). Among comorbid participants, CAP did not lead to more frequent adverse events compared to EUC only (adjusted Odds Ratio [aOR] 0.84, 0.43-1.64;p = 0.62), and there was no evidence for an effect of CAP on remission from AUD or depression at 3 months (aOR 1.51, 0.84-2.74;p = 0.17 and aOR 0.74, 0.43-1.27;p = 0.28) and 12 months follow-up, respectively (aOR 1.69, 0.96-3.01;p = 0.08 and aOR 1.08, 0.62-1.87;p = 0.79). CONCLUSIONS Brief therapies like CAP can be safely delivered by NSHWs to patients with comorbid AUD and depression, but their effectiveness may be limited and requires further investigation.
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Affiliation(s)
- Jasper Synowski
- Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India,Charité – Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany
| | - Helen A. Weiss
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Richard Velleman
- Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India,Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Vikram Patel
- Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India,London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Abhijit Nadkarni
- Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India; London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Behere PB, Nagdive AB, Behere AP, Yadav R, Fernandes R. Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India. J Neurosci Rural Pract 2021; 12:623-629. [PMID: 34737494 PMCID: PMC8559082 DOI: 10.1055/s-0041-1735242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.
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Affiliation(s)
- Prakash B. Behere
- Department of Psychiatry, Dnyandeo Yashwantrao Patil University, Kolhapur, Maharashtra, India
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi, Wardha, Maharashtra, India
| | - Amit B. Nagdive
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi, Wardha, Maharashtra, India
| | - Aniruddh P. Behere
- Department of Pediatrics and Human Development, Helen Devos Children's Hospital, Michigan State University College of Human Medicine Grand Rapids, Grand Rapids, Michigan, United States
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, Maharashtra, India
| | - Richa Yadav
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, Maharashtra, India
- Department of Psychiatry and Behavioural Sciences, OU College of Medicine, Oklahoma City, Oklahoma, United States
| | - Rouchelle Fernandes
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi, Wardha, Maharashtra, India
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Huded CB, Rasquinha SL, Rao P. Psychological impact of COVID-19 on medical interns - Findings from a nationwide survey. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:336. [PMID: 34761022 PMCID: PMC8552284 DOI: 10.4103/jehp.jehp_33_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic has negatively impacted the mental health of health-care workers worldwide. This study aimed to estimate the prevalence of psychological distress in medical interns during the pandemic and examine the factors influencing it. MATERIALS AND METHODS A cross-sectional online survey was conducted using snowball sampling among 764 medical interns across India, who were evaluated using the Kessler Psychological Distress Scale, Fear of COVID-19 Scale, and semi-structured questionnaires. Univariate analysis was done using Chi-square test, unpaired t-test, and ANOVA, while multivariate analysis was conducted using binary logistic regression. RESULTS 57.5% of the interns reported psychological distress, with 39.8% having moderate-to-severe distress. Past consultation with a mental health professional (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.42-3.26) and perceived lack of support from friends (OR: 2.33; 95% CI: 1.33-3.99) and faculty (OR: 2.15; 95% CI: 1.41-3.28) were the most significant predictors of distress. Fear of COVID-19 was higher in interns who were female, were medically ill, were dissatisfied with the pandemic preparedness at the hospital, and perceived the faculty to be less approachable and supportive. Majority of the interns felt that the pandemic had hampered their learning and were worried about an extension to their internship and their performance in the postgraduate entrance examinations. CONCLUSIONS Psychological distress was highly prevalent among interns, with several workplaces and personal factors affecting the distress levels. Most interns perceived a negative impact of the pandemic on their learning and career. Addressing these issues could help alleviate the distress and bolster the mental health of interns.
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Affiliation(s)
- Chandrashekar B. Huded
- Department of Psychiatry, Gulbarga Institute of Medical Sciences, Kalaburgi, Karnataka, India
| | | | - Pradyumna Rao
- Department of Psychiatry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India
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Prabhu S, Mehta SH, McFall AM, Srikrishnan AK, Vasudevan CK, Lucas GM, Celentano DD, Solomon SS. Role of geospatial mapping in the planning of HIV programs: A case study from Southern India. Medicine (Baltimore) 2021; 100:e27092. [PMID: 34449513 PMCID: PMC8389960 DOI: 10.1097/md.0000000000027092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 01/04/2023] Open
Abstract
Geographic information systems (GIS) tools can be used to understand the spatial distribution of local HIV epidemics but are often underutilized, especially in low-middle income countries. We present characteristics of an HIV epidemic within Hyderabad, a large city in southern India, as a case study to highlight the utility of such data in program planning.Cross-sectional sample recruited using respondent-driven sampling in a cluster-randomized trial.We analyzed data from 2 cross-sectional respondent-driven sampling surveys of MSM in Hyderabad, which were conducted as part of a cluster-randomized trial. All participants were tested for HIV and those positive underwent viral load quantification. ArcGIS was used to create heat maps of MSM distribution using self-reported postal code of residence and combined into larger zones containing at least 200 MSM.Postal code data was available for 661 MSM (66.2%) in the baseline and 978 MSM (97.8%) in the follow-up survey. The proportion of HIV-positive MSM (12.7-15.7%) and prevalence of virally suppressed persons (2.6-8.2%) increased between the 2 surveys. The distribution of all MSM, HIV-positive MSM, and HIV-viremic MSM differed significantly by geographic zone with several zones having higher numbers of HIV-positive and viremic individuals than would be expected based on the distribution of all MSM.The prevalence of HIV and HIV viremia among MSM differed by geographic zones within a city and evolved over time. Such data could be critical to improving program implementation efficiency by accurately targeting resources to population characteristics.
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Affiliation(s)
- Sandeep Prabhu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- University of Washington, Seattle, WA
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Aylur K. Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India
| | | | | | | | - Sunil S. Solomon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India
- Johns Hopkins University School of Medicine, Baltimore, MD
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults. SSM Popul Health 2021; 15:100880. [PMID: 34377763 PMCID: PMC8327130 DOI: 10.1016/j.ssmph.2021.100880] [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: 04/20/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Objective We study how life course objective socioeconomic position (SEP) predicts subjective social status (SSS) and the extent to which SSS mediates the association of objective SEP with nutritional status and mental health outcomes. Methods We use data from participants of the INCAP Longitudinal Study 1969–2018 (n = 1258) from Guatemala. We use the MacArthur ladder for two measures of SSS - perceived community respect and perceived economic status. We estimate the association of SSS with health outcomes after adjusting for early life characteristics and life course objective SEP (wealth, schooling, employment) using linear regression. We use path analysis to study the extent of mediation by SSS on the health outcomes of body mass index (BMI; kg/m2), psychological distress (using the WHO Self-Reported Questionnaire; SRQ-20) and happiness, using the Subjective Happiness Scale (SHS). Results Median participant rating was 5 [IQR: 3–8] for the perceived community respect and 3 [IQR: 1–5] for the perceived economic status, with no differences by sex. Objective SEP in early life and adulthood were predictive of both measures of SSS in middle adulthood as well as health outcomes (BMI, SRQ-20 and SHS). Perceived community respect (z-scores; 1 z = 3.1 units) was positively associated with happiness (0.13, 95 % CI: 0.07, 0.19). Perceived economic status (z-scores; 1 z = 2.3 units) was inversely associated with psychological distress (−0.28, 95 % CI: −0.47, −0.09). Neither measure of SSS was associated with BMI. Neither perceived community respect nor perceived economic status attenuated associations of objective SEP with health outcomes on inclusion as a mediator. Conclusions Subjective social status was independently associated with happiness and psychological distress in middle adulthood after adjusting for objective SEP. Moreover, association of objective SEP with health was not mediated by SSS, suggesting potentially independent pathways. Subjective social status (SSS) is a self-appraisal of one's objective measures of socio-economic position (SEP; such as education and wealth) and social identity relative to their community. Perceived community respect and perceived economic status were positively associated with happiness and inversely associated with psychological distress respectively. Neither measure of SSS were associated with body mass index. The associations of objective SEP measures with health outcomes were not attenuated after adjusting for SSS, suggesting independent pathways.
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Key Words
- BMI, Body mass index
- FIML, Full Information Maximum Likelihood
- Happiness
- INCAP, Institute of Nutrition of Central America and Panama
- IQR, Interquartile Range
- LMIC, Low- and middle-income country
- MAR, Missing at Random
- MI, Multiple imputation
- MacArthur ladder
- Perceived social status
- Psychological distress
- Psychosocial framework
- Relative deprivation
- SEP, socio-economic position
- SRQ-20, World Health Organization Self-Reported Questionnaire-20
- SSS, Subjective social status
- Subjective status
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Coffey D, Hathi P, Khalid N, Thorat A. Measurement of population mental health: evidence from a mobile phone survey in India. Health Policy Plan 2021; 36:594-605. [PMID: 33693616 PMCID: PMC8173664 DOI: 10.1093/heapol/czab023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/26/2022] Open
Abstract
In high-income countries, population health surveys often measure mental health. This is less common in low- and middle-income countries (LMICs), including in India, where mental health is under-researched relative to its disease burden. The objective of this study is to assess the performance of two questionnaires for measuring population mental health in a mobile phone survey. We adapt the Kessler-6 screening questionnaire and the World Health Organization's Self-Reporting Questionnaire (SRQ) for a mobile phone survey in the Indian states of Bihar, Jharkhand and Maharashtra. The questionnaires differ in the symptoms they measure and in the number of response options offered. Questionnaires are randomly assigned to respondents. We consider a questionnaire to perform well if it identifies geographic and demographic disparities in mental health that are consistent with the literature and does not suffer from selective non-response. Both questionnaires measured less mental distress in Maharashtra than in Bihar and Jharkhand, which is consistent with Maharashtra's higher human development indicators. The adapted SRQ, but not the adapted Kessler-6, identified women as having worse mental health than men in all three states. Conclusions about population mental health based on the adapted Kessler-6 are likely to be influenced by low response rates (about 82% across the three samples). Respondents were different from non-respondents: non-respondents were less educated and more likely to be female. The SRQ's higher response rate (about 94% across the three states) may reflect the fact that it was developed for use in LMICs and that it focuses on physical, rather than emotional, symptoms, which may be less stigmatized.
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Affiliation(s)
- Diane Coffey
- Department of Sociology & Population Research Center, University of Texas at Austin, 305 E 23rd St, RLP 2.602, Austin, TX 78712, USA
- r.i.c.e., a research institute for compassionate economics, Delhi, India
- Indian Statistical Institute, Delhi Centre, Delhi, India
| | - Payal Hathi
- r.i.c.e., a research institute for compassionate economics, Delhi, India
- Department of Sociology, University of California, Berkeley, CA, USA
- Department of Demography, University of California, Berkeley, CA, USA
| | - Nazar Khalid
- r.i.c.e., a research institute for compassionate economics, Delhi, India
- Department of Demography, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Thorat
- r.i.c.e., a research institute for compassionate economics, Delhi, India
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
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Tilahun MM, Yibekal BT, Kerebih H, Ayele FA. Prevalence of common mental disorders and associated factors among adults with Glaucoma attending University of Gondar comprehensive specialized hospital tertiary eye care and training center, Northwest, Ethiopia 2020. PLoS One 2021; 16:e0252064. [PMID: 34015012 PMCID: PMC8136648 DOI: 10.1371/journal.pone.0252064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to assess the prevalence of common mental disorders and associated factors among adults with glaucoma at Gondar university comprehensive specialized hospital tertiary eye care and training center. Glaucoma predisposes patients to common mental problems and leads to wasteful, costly and inefficient use of medical services and complications of the diagnoses. So, determining the level and factors associated with common mental disorders among glaucoma patient would help to improve and integrate comprehensive ophthalmic services which address common mental disorder in a follow-up visit. METHODS An institution-based cross-sectional study was conducted on 495 glaucoma patients selected by using systematic random sampling. Data were collected through face-to-face interview and chart review. Self-reported questionnaire (SRQ-20) was used to assess the presence of common mental disorders. Binary logistic regression analysis was done to identify factors associated with common mental disorders. Variables with P<0.05 were considered as factors significantly associated with common mental disorders. RESULT Four hundred sixty-eight patients were included in this study with a response rate of 94.54%. The mean age of the participant was 58 ± 14.11 years. The prevalence of common mental disorders was found to be 29.5% (95% CI 25.4-33.3). Female sex (AOR = 3.79, 95% CI: 1.66-8.62) (p-value = 0.001), average monthly income of less than 1200 birr (AOR = 6.05 95% CI: 2.26-16.22) (p-value = 0.001), poor level of social support (AOR = 17.39 95% CI: 7.79-38.82) (p-value = 0.001), moderate and high risk of alcohol use (AOR = 10.42 95%CI: 2.74-39.54) (p-value = 0.001), presence of chronic medical illness (AOR = 3.85 95% CI: 2.07-7.16) (p-value = 0.001), receiving both drug and surgical treatment (AOR = 2.50, 95%CI: 1.30-4.83) (p-value = 0.006) and presence of systemic carbonic anhydrase inhibitors use (AOR = 3.16, 95%CI: 1.65-6.06) (p-value = 0.001) were significantly associated with increased level of common mental disorders. CONCLUSION Significant numbers of glaucoma patients have CMD and found significantly associated with socio-economic, ocular and systemic clinical factors. Therefore, the integration of psychosocial care into the current treatment of patients with glaucoma would have a significant advantage to help these patients.
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Affiliation(s)
- Mikias Mered Tilahun
- Department of Optometry, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive specialized hospital, Gondar Town, Ethiopia
| | - Betelhem Temesgen Yibekal
- Department of Optometry, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive specialized hospital, Gondar Town, Ethiopia
| | - Habtamu Kerebih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive Specialized Hospital, Gondar Town, Ethiopia
| | - Fisseha Ademassu Ayele
- Department of Ophthalmology, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive Specialized Hospital, Gondar Town, Ethiopia
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Pillai A, Keyes KM, Susser E. Antidepressant prescriptions and adherence in primary care in India: Insights from a cluster randomized control trial. PLoS One 2021; 16:e0248641. [PMID: 33739982 PMCID: PMC7978355 DOI: 10.1371/journal.pone.0248641] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The World Health Organization recommends that treatment of depression in low and middle-income countries with a scarcity of psychiatrists could be done in primary care and should include prescription of antidepressant medications for moderate and severe depression. Little is known, however, about the actual practices of antidepressant prescription by primary care physicians in low and middle-income countries, nor about adherence by people receiving such prescriptions. In a large study of primary care clinics in Goa, India, we examined the relationship of actual to recommended prescribing practices for depression, among all patients who screened positive for common mental disorder. We also examined other patient and clinic characteristics associated with antidepressant prescription, and self-reported adherence over a one-month period. METHODS Patients attending 24 primary care clinics were screened for common mental disorders. Those who screened positive were eligible to enroll in a trial to assess the effectiveness of a collaborative stepped care (CSC) intervention for mental disorders. Physicians in the 12 intervention and 12 control clinics (usual care) were free to prescribe antidepressants and follow-up interviews were conducted at 2, 6 and 12 months. Screening results were shared with the physician, but they were blinded to the diagnosis generated later using a standardized diagnostic interview administered by a health counsellor. We categorized these later diagnoses as "moderate/severe depression", "mild depression or non-depression diagnosis", and "no diagnosis". We used a two-level hierarchical logistic regression model to examine diagnostic and other factors associated with antidepressant prescription and one-month adherence. RESULTS Overall, about 47% of screened positive patients (n = 1320) received an antidepressant prescription: 60% of those with moderate/severe depression, 48% of those with mild depression or non-depression diagnosis, and 31% with no diagnosis. Women (OR 1.29; 95%CI 1.04-1.60) and older adults (OR 1.80; 95%CI 1.32-2.47) were more likely to receive an antidepressant prescription. While the overall rate of antidepressant prescription was similar in clinics with and without CSC, patients without any diagnosis were more likely to receive a prescription (OR 2.20 95% CI 1.03-4.70) in the usual care clinics. About 47% of patients adhered to antidepressant treatment for one month or more and adherence was significantly better among older adults (OR 3.92; 95% CI 1.70-8.93) and those who received antidepressant as part of the CSC treatment model (OR 6.10 95% CI 3.67-10.14) compared with those attending the usual care clinic. CONCLUSION Antidepressants were widely prescribed following screening in primary care, but prescription patterns were in poor accord with WHO recommendations. The data suggest under-prescription for people with moderate/severe depression; over-prescription for people with mild depression or non-depression diagnoses; and over-prescription for people with no disorders. For all diagnoses adherence was low, especially in usual care clinics. To address these concerns, there is an urgent need to study and develop strategies in primary care practices to limit unnecessary antidepressant prescriptions, target prescription for those patients who clearly benefit, and to improve adherence to antidepressant treatment. ClinicalTrials.gov Identifier: NCT00446407.
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Affiliation(s)
- Aravind Pillai
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Ezra Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
- New York State Psychiatric Institute, New York, New York, United States of America
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Merson F, Newby J, Shires A, Millard M, Mahoney A. The temporal stability of the Kessler Psychological Distress Scale. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1893603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Francis Merson
- Graduate School of Health, University of Technology, Ultimo, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, Australia
- Prince of Wales Hospital, Black Dog Institute, Randwick, Australia
| | - Alice Shires
- Graduate School of Health, University of Technology, Ultimo, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital and School of Psychiatry, University of New South Wales, Darlinghurst, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital and School of Psychiatry, University of New South Wales, Darlinghurst, Australia
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Psychological Distress among Caregivers of Children with Neurodevelopmental Disorders in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052460. [PMID: 33801567 PMCID: PMC7967590 DOI: 10.3390/ijerph18052460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Parenting a child with neurodevelopmental disorder (NDD) is related to a higher rate of anxiety and depression, increased stress, and reduced quality of life. Although there is reason to believe that parenting children with NDD in low- and middle-income countries (LMIC) can be challenging, there is a lack of knowledge on the psychological distress among these caregivers, especially in rural areas. The aim of the study was to examine the psychological distress among caregivers having children with NDD in rural Nepal. Sixty-three caregivers were visited in their homes and interviewed by experienced mental health professionals. This study examined demographic information, severity of disability, perceived caregiver burden, and psychological distress, measured by the General Health Questionnaire-12 (GHQ-12). The study found a high level of psychological distress in the caregivers (M = 5.38, SD = 2.8). A majority (90.5%) scored two or higher, indicating the presence of a common mental disorder (CMD). Almost half (46%) scored six or higher, indicating a high level of distress. A majority of the caregivers reported that caring for their disabled child had a negative effect on the caregiver’s economy (70%), physical health (65%), social life (64%), and dreams and expectations for the future (81%). There was a significant relationship between the caregiver’s psychological distress (GHQ-12) and degree of disability in the child (Gross Motor Function Classification System), degree of caregiver burden, feeding problems, having health workers as a possible source of help, receiving incentive from the government, having somebody to confide in, and caregiver illiteracy. A forward regression analysis entering the significant factors indicated that caregiver burden, having someone to confide in, and having health workers as a possible source of help were significant related to psychological distress. The final step of the model explained 42.4% of the variance in psychological distress among the caregivers. The study indicates a high level of psychological distress and high overall burden in caregivers of children with NDD in rural Nepal. Further implications for research and service development are discussed.
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Singla DR, MacKinnon DP, Fuhr DC, Sikander S, Rahman A, Patel V. Multiple mediation analysis of the peer-delivered Thinking Healthy Programme for perinatal depression: findings from two parallel, randomised controlled trials. Br J Psychiatry 2021; 218:143-150. [PMID: 31362799 DOI: 10.1192/bjp.2019.184] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low-intensity psychosocial interventions have been effective in targeting perinatal depression, but relevant mechanisms of change remain unknown. AIMS To examine three theoretically informed mediators of the Thinking Healthy Programme Peer-delivered (THPP), an evidence-based psychosocial intervention for perinatal depression, on symptom severity in two parallel, randomised controlled trials in Goa, India and Rawalpindi, Pakistan. METHOD Participants included pregnant women aged ≥18 years with moderate to severe depression, as defined by a Patient Health Questionnaire 9 (PHQ-9) score ≥10, and were randomised to either THPP or enhanced usual care. We examine whether three prespecified variables (patient activation, social support and mother-child attachment) at 3 months post-childbirth mediated the effects of THPP interventions of perinatal depressive symptom severity (PHQ-9) at the primary end-point of 6 months post-childbirth. We first examined individual mediation within each trial (n = 280 in India and n = 570 in Pakistan), followed by a pooled analysis across both trials (N = 850). RESULTS In both site-specific and pooled analyses, patient activation and support at 3 months independently mediated the intervention effects on depressive symptom severity at 6 months, accounting for 23.6 and 18.2% of the total effect of THPP, respectively. The intervention had no effect on mother-child attachment scores, thus there was no evidence that this factor mediated the intervention effect. CONCLUSIONS The effects of the psychosocial intervention on depression outcomes in mothers were mediated by the same two factors in both contexts, suggesting that such interventions seeking to alleviate perinatal depression should target both social support and patient activation levels. DECLARATION OF INTEREST None.
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Affiliation(s)
- Daisy R Singla
- Assistant Professor and Clinician Scientist, Department of Psychiatry, Sinai Health System, University of Toronto, Canada
| | | | - Daniela C Fuhr
- Assistant Professor, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Siham Sikander
- Assistant Professor, Health Services Academy, Pakistan; and Human Development Research Foundation, Pakistan
| | - Atif Rahman
- Professor, Institute of Psychology Health and Society, University of Liverpool, UK
| | - Vikram Patel
- Professor, Sangath, India; Department of Global Health and Social Medicine, Harvard Medical School; and Department of Global Health and Population, Harvard TH Chan School of Public Health, Massachusetts, USA
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Rajendran KP, Govindarajulu S, Adaikalam JM, Srinivasan V, Seshayyan S, Ramalingam S, Elangovan AR. An insight into the mental health needs of the common public of Tamil Nadu, India, subjected to COVID-19 lockdown, a rare unprecedented crisis. ANNALES MEDICO-PSYCHOLOGIQUES 2021; 180:543-550. [PMID: 33612846 PMCID: PMC7888250 DOI: 10.1016/j.amp.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
Purpose COVID-19, a major “Public Health Emergencies of International Concern”, had sought greater attention among researchers to study its pathogenesis, associated complications and management. However, there are only few studies that had studied its potential impact on mental health of general public, who are subjected to social distancing, community lockdown and restrictions in their routine activities. Objectives The aim of this study is to assess the prevalence of psychological distress and mental health needs among general public in Tamil Nadu subjected to lockdown, social distancing amidst COVID-19 crisis. Tamil Nadu is one of the worst affected states of southern India. Methods A self-administered, web-based application study using “WHO-Self Reported Questionnaire-20”, in bilingual version, both English and Tamil, is used to screen the public for the level of distress. The study is done while the state is under extended lockdown and restricted movement. Key findings A total of 918 respondents participated in the survey and it is found that about more than one third of the respondents (∼35%) are under psychological distress. A significant association between younger age group, female gender, unmarried, people with children are found to be under distress. The lockdown had increased the frequency of smoking and quantity of cigarettes among smokers, also has increased the frequency of drinking among alcohol consumers. Of the SRQ-20 items recorded, stress related neurotic symptoms (> 70%) was observed more than the depressive mood. About 33% of those scored > 7, had suicidal tendency. The districts declared red zones had significantly reported a greater number of respondents under distress. Conclusion Besides effectively mitigating the COVID-19 crisis, in terms of prevention, control and treatment strategies, it is prerogative to effectively manage fear, distress due to the COVID-19 and associated anxiety and depression among the public.
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Affiliation(s)
| | - Srinivas Govindarajulu
- Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, 69, Anna-Salai, Guindy, 600032 Chennai, Tamil Nadu, India
| | - Joseph Maria Adaikalam
- Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, 69, Anna-Salai, Guindy, 600032 Chennai, Tamil Nadu, India
| | - Valarmathi Srinivasan
- Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, 69, Anna-Salai, Guindy, 600032 Chennai, Tamil Nadu, India
| | - Sudha Seshayyan
- The Tamil Nadu Dr MGR Medical University, 69, Anna-Salai, Guindy, 600032 Chennai, Tamil Nadu, India
| | - Suresh Ramalingam
- Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, 69, Anna-Salai, Guindy, 600032 Chennai, Tamil Nadu, India
| | - Arvind Raj Elangovan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), 560029 Bangalore, Karnataka, India
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Prabhu S, McFall AM, Mehta SH, Srikrishnan AK, Kumar MS, Anand S, Shanmugam S, Celentano DD, Lucas GM, Solomon SS. Psychosocial Barriers to Viral Suppression in a Community-based Sample of Human Immunodeficiency Virus-infected Men Who Have Sex With Men and People Who Inject Drugs in India. Clin Infect Dis 2021; 70:304-313. [PMID: 30840989 DOI: 10.1093/cid/ciz175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/26/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Little is known about the impact of psychosocial factors and substance use on viral suppression among human immunodeficiency virus (HIV)-infected key populations in resource-limited settings. Accordingly, we examined the association and interactions between depression, alcohol use, and recreational drug use on viral suppression among men who have sex with men (MSM) and people who inject drugs (PWID) in India. METHODS MSM and PWID were recruited across India using respondent-driven sampling (RDS). Correlates of viral suppression were determined using Poisson regression models incorporating RDS-II weights. Two-way multiplicative interactions were assessed with separate models of all combinations of the 3 variables of interest using interaction terms; 3-way interactions were evaluated by stratifying 2-way interactions by the third variable. RESULTS Among 1454 treatment-eligible HIV-infected MSM and 1939 PWID, older age (adjusted prevalence ratio [aPR], 1.14 for MSM; 1.41 for PWID) and higher HIV treatment literacy (aPR, 1.58 for MSM; 3.04 for PWID) were positively associated with viral suppression. Among MSM, there was evidence of a synergistic negative association between severe depression and recreational drug use (aPR, 0.37 [95% confidence interval {CI}, .16-.84]), alcohol dependence and recreational drug use (aPR, 0.45 [95% CI, .20-.99]), and severe depression, alcohol dependence, and recreational drug use (aPR, 0.23 [95% CI, .09-.57]). Among PWID, daily injection (aPR, 0.51 [95% CI, .31-.82]) was the primary barrier to suppression. CONCLUSIONS Incorporating psychosocial and harm-reduction services into differentiated care models targeting MSM and PWID in low-resource settings is critical to achieving the 90-90-90 HIV/AIDS targets.
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Affiliation(s)
- Sandeep Prabhu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,School of Medicine, University of California, San Diego
| | - Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Santhanam Anand
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - David D Celentano
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunil S Solomon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland
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Khan R, Waqas A, Mustehsan ZH, Khan AS, Sikander S, Ahmad I, Jamil A, Sharif M, Bilal S, Zulfiqar S, Bibi A, Rahman A. Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan. Front Psychiatry 2021; 12:584287. [PMID: 34566707 PMCID: PMC8461022 DOI: 10.3389/fpsyt.2021.584287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan. Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using "Patient health questionnaire" (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on "Women's Health and Domestic Violence against Women." Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p < 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p < 0.01, OR 6.9, CI 1.77-26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p < 0.001, OR 3.2, CI 1.68-5.98) than in women with 1-2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p < 0.01, OR 0.9, CI 0.85-0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p < 0.05 CI 1.12-2.51). Odds of having depression was also high in women who had less mean score of MSSI (p < 0.05, OR 1.1, CI 1.01-1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p < 0.05, OR 0.5, CI 0.27-0.92). Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables.
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Affiliation(s)
- Rukhsana Khan
- Department of Community Medicine Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom.,Human Development Research Foundation, Islamabad, Pakistan
| | - Zille Huma Mustehsan
- Department of Community Medicine Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Amna Saeed Khan
- Department of Community Medicine Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan.,Health Services Academy, Islamabad, Pakistan
| | - Ikhlaq Ahmad
- Human Development Research Foundation, Islamabad, Pakistan.,Health Services Academy, Islamabad, Pakistan
| | - Anam Jamil
- Human Development Research Foundation, Islamabad, Pakistan
| | - Maria Sharif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Samina Bilal
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Amina Bibi
- Human Development Research Foundation, Islamabad, Pakistan
| | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Scoppetta O, Cassiani-Miranda CA, Arocha-Díaz KN, Cabanzo-Arenas DF, Campo-Arias A. Validity of the patient health questionnaire-2 (PHQ-2) for the detection of depression in primary care in Colombia. J Affect Disord 2021; 278:576-582. [PMID: 33032028 DOI: 10.1016/j.jad.2020.09.096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 08/01/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The PHQ-2 is a screening test for major depressive disorder (MDD) derived from PHQ-9, which has shown to be useful in the detection of cases of clinical significance in previous studies. The psychometric properties of PHQ-2 in the Colombian population are unknown. METHODS PHQ-2 were assessed in 243 patients in general medical consultations using the Mini-International Neuropsychiatric Interview (MINI) as the gold standard. Internal consistency, convergent validity and criterion validity were calculated by analyzing the Receptor Operating Characteristics (ROC) and the area under the curve (AUC). RESULTS Cronbach's alpha and McDonald's omega coefficients were 0.71. Spearman's rho coefficients for correlations with PHQ-9 and HADS-D scores were 0.63 and 0.59 (p<0.01). AUC was 0.89. The optimal cut point was ≥2 with the following indicators: sensitivity 0.87 specificity 0.74; Youden index 0.60; PPV 0.47; NPV 0.95; (LR+) 3.24; (LR-) 0.18 (95% CI 0.09-0.37). Kappa coefficient between PHQ-2 and MINI for depression was .458 and 0.46 for HADS-D. LIMITATIONS Since this study was done with people attending hospital, which could has implications for the prevalence of depression, affecting the validity indicators of the instrument. CONCLUSIONS PHQ-2 show an acceptable test performance in the context of the study. However, the test could yield a considerable amount of false positives that would require specialized evaluation to establish a reliable diagnosis.
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Affiliation(s)
- Orlando Scoppetta
- Universidad Católica de Colombia, Faculty of Psychology, GAEM Group (Research methods applied to behavioral sciences), Bogotá, Colombia
| | - Carlos Arturo Cassiani-Miranda
- Universidad de Santander, Faculty of Health Sciences, medicine program, Neurosciences Research Group, Bucaramanga, Colombia.
| | - Karen Nicolle Arocha-Díaz
- Universidad de Santander, Faculty of Health Sciences, medicine program, Neurosciences Research Group, Bucaramanga, Colombia
| | - Diego Fernando Cabanzo-Arenas
- Universidad de Santander, Faculty of Health Sciences, medicine program, Neurosciences Research Group, Bucaramanga, Colombia
| | - Adalberto Campo-Arias
- Universidad del Magdalena, Faculty of Health Sciences, Health Psychology and Psychiatry Research Group, Santa Marta, Colombia
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Ridley M, Rao G, Schilbach F, Patel V. Poverty, depression, and anxiety: Causal evidence and mechanisms. Science 2020; 370:eaay0214. [PMID: 33303583 DOI: 10.1126/science.aay0214] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/27/2020] [Indexed: 03/23/2024]
Abstract
Why are people who live in poverty disproportionately affected by mental illness? We review the interdisciplinary evidence of the bidirectional causal relationship between poverty and common mental illnesses-depression and anxiety-and the underlying mechanisms. Research shows that mental illness reduces employment and therefore income, and that psychological interventions generate economic gains. Similarly, negative economic shocks cause mental illness, and antipoverty programs such as cash transfers improve mental health. A crucial step toward the design of effective policies is to better understand the mechanisms underlying these causal effects.
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Affiliation(s)
- Matthew Ridley
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Gautam Rao
- Department of Economics, Harvard University, Cambridge, MA 02138, USA
| | - Frank Schilbach
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Vikram Patel
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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Patra S, Patro BK, Mangaraj M, Sahoo SS. Screening for depression in diabetes in an Indian primary care setting: Is depression related to perceived quality of life? Prim Care Diabetes 2020; 14:709-713. [PMID: 32345555 DOI: 10.1016/j.pcd.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 11/28/2022]
Abstract
AIMS To screen for depression in diabetes and evaluate the contributing factors in a primary care setting in India. To evaluate the relationship of depression with perceived quality of life. METHODS We used convenience sampling method in this cross-sectional study. 388 consecutive patients with type 2 diabetes mellitus were enrolled over a period of one year. 50.3% patients screened positive on Patient Health Questionnaire (PHQ-9) out of which 21.4% reported moderate to severe depression. Male gender, middle age and poor glycaemic control were associated with depression. In stepwise linear regression analysis when depression category was included as an independent variable, significant difference in regression equations were found. Other independent variables which were included in regression equation were age, education, gender, income lifestyle, glycosylated haemoglobin and Body Mass Index whereas dependent variables were transformed domains of World Health Organization Quality of Life questionnaire. RESULTS There is high prevalence of depression in primary care in type 2 diabetes patients in this Indian setting. Depression was strongly associated with all four domains of quality of life. Highest association with depression was seen in Physical domain (β -0.385, p = 0.000) followed by Social domain (β -0.372, p = 0.000). CONCLUSIONS High prevalence of depression and its association with poor quality of life indicates need for improved recognition of depression for improving diabetes outcomes in this centre.
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Affiliation(s)
- Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Odisha, India.
| | - Binod Kumar Patro
- Department of Community & Family Medicine, All India Institute of Medical Sciences Bhubaneswar, Odisha, India.
| | - Manaswini Mangaraj
- Department of Biochemistry, All India Institute of Medical Sciences Bhubaneswar, Odisha, India.
| | - Soumya Swaroop Sahoo
- Department of Community & Family Medicine, All India Institute of Medical Sciences Bhubaneswar, Odisha, India.
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Balaji M, Vijayakumar L, Phillips M, Panse S, Santre M, Pathare S, Patel V. The Young Lives Matter study protocol: A case-control study of the determinants of suicide attempts in young people in India. Wellcome Open Res 2020; 5:262. [PMID: 33884310 PMCID: PMC8042515 DOI: 10.12688/wellcomeopenres.16364.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/20/2022] Open
Abstract
Suicide is the second leading cause of death among young people in India. Over 40% of all suicides occur in people between 15 and 29 years of age. Suicide attempts are estimated to be 15 times more common than suicides and substantially increase the risk of subsequent death. However, there has been little systematic study of the determinants for suicide attempts in young people, which makes it difficult to design contextually appropriate and comprehensive suicide prevention strategies for this population. The proposed case-control study seeks to address this knowledge gap by studying a range of risk and protective factors for suicide attempts in young people in India. Field work will be in
Yashwantrao Chavan Memorial Hospital (YCMH) hospital, in Pimpri-Chinchwad, Pune, India. Cases will be 15-29-year-old individuals admitted to the hospital with self-inflicted non-lethal injuries and poisoning. They will be matched for age and gender with those presenting at the General Medicine outpatient department with other health complaints. In each group, 150 persons will be recruited from YCMH from October 2019 to September 2022 and will undergo a comprehensive semi-structured interview. The primary exposure variable is negative life events over the past 12 months. Secondary exposure variables considered include: demographic characteristics, psychological factors, addictive behaviours, personal resources, adverse experiences over their lifetime, social support, suicidal behaviours in the family and social environment, and exposure to suicide-related information. Data will be analysed using conditional logistic regression. Following completion of the study, workshops will be held with young people, mental health professionals and policy makers to develop a theory of change that will be used to promote suicide prevention. Results will be disseminated via peer-reviewed publications, reports to young people and mental health organisations, and news articles. The study was approved by the Institutional Review Board at Sangath.
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Affiliation(s)
- Madhumitha Balaji
- Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa, 403501, India.,Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Shivajinagar, Pune, 411004, India
| | - Lakshmi Vijayakumar
- Sneha Suicide Prevention Centre, 11, Park View Rd, Bishop Garden, Raja Annamalai Puram, Chennai, 600028, India
| | - Michael Phillips
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 3210 Humin Road, Min Hang District, Shanghai, 201108, China
| | - Smita Panse
- Department of Psychiatry, PCMC's Post Graduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, 411018, India
| | - Manjeet Santre
- Department of Psychiatry, PCMC's Post Graduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, 411018, India
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Shivajinagar, Pune, 411004, India
| | - Vikram Patel
- Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa, 403501, India.,Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts, 02115, USA
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49
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Ransing R, Deshpande SN, Shete SR, Patil I, Kukreti P, Raghuveer P, Mahadevaiah M, Bhosale N, Ramesh VO, Puri M, Bantwal P. Assessing antenatal depression in primary care with the PHQ-2 and PHQ-9: Can It Be carried Out by auxiliary nurse midwife (ANM)? Asian J Psychiatr 2020; 53:102109. [PMID: 32474343 PMCID: PMC10035069 DOI: 10.1016/j.ajp.2020.102109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
Antenatal Depression (AD) is prevalent in India but remains unidentified and untreated in primary care settings. The Auxiliary Nursing Midwife (ANM), a non-specialist health care worker at antenatal care (ANC) clinic or at a primary care centre can improve the detection of women with AD. In this study, we aimed to estimate the inter-rater reliability of the Patient Health Questionnaire (PHQ-9) and PHQ-2, administered by ANMs, with mental health professionals, that is, Clinical Psychologists(CP). The prospective, blind, observational study was conducted in an antenatal clinic of tertiary care rural hospital of India. PHQ-2 and PHQ-9(Marathi) valid and translated versions were administered to consecutive antenatal women (n = 108) aged 18-45 years by two raters (CP, ANM) independently. Raters and data analyst were blinded to each other's scores. Kappa Coefficient, weighted kappa, Intra-class correlation coefficients (ICC) were used to assess Inter-rater reliability. The mean age of the study participants was 25.91 ± 4.39 years. Inter-rater reliability for PHQ-2 (Screen -Positive or Negative for depression) and PHQ-9 (Severity of depression) was (k = 0.675) and (kw = 0.732) respectively, which suggested the 'substantial' agreement between ANMs and CP. Among raters, the ICC (95 % confidence interval) was 0.90 (0.85, 0.93) for the PHQ-9 score and for the PHQ-2 was 0.873 (0.819-0.911), which was suggestive of excellent and good reliability respectively. The 'substantial' agreement and 'good to excellent' inter-rater reliability among ANM and CP suggest that these two scales can be used to screen and assess the severity of AD by either qualified or minimally trained, community health workers.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India.
| | - Smita N Deshpande
- Dept. of Psychiatry, De-Addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.
| | - Shreya R Shete
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India.
| | - Ishwar Patil
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India.
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, 110001, India.
| | - Pracheth Raghuveer
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, 575018, India.
| | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad institute of Mental Health and Neurosciences (DIMHANS), Dharwad, 580008, India.
| | - Nandkumar Bhosale
- Department of Obstetrics and gynecology, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India
| | | | - Manju Puri
- Department of Obstetrics & Gynecology, Lady Hardinge Medical College, New Delhi, 110001, India.
| | - Priyanka Bantwal
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, 575018, India.
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50
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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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