Burden of mental illness: a review in an Indian context

Psychological Distress in Low-Income and Economically Marginalized Populations in India: Protective and Risk Factors

Studies at the juncture of development economics and public health take on considerable responsibility in addressing inequality and related mental health distress. Mental healthcare in economically marginalized populations requires depicting the linkages between socioeconomic status and psychological distress. In the present work, a sequential mixed-methods design was used to study 190 people in such communities in India. Gender-dependent psychological distress was found according to the Kessler Psychological Distress Scale (K-10) with moderate distress in women (M = 26.30, SD = 9.15) and mild distress in men (M = 21.04, SD = 8.35). Regression analysis indicated that gender significantly predicted psychological distress, followed by age, marital status, and the level of education of the head of the family. The Interpretative Phenomenological Analysis of semi-structured interviews of the six women who scored the highest on the distress scale unveiled three master themes: (1) manifestation of psychological distress, (2) contextual challenges, and (3) sources of strength and resilience. Overall, participants reported a lack of resources, community violence, gender discrimination, and widespread substance use as major contributors to the ongoing distress. These findings can pave the way for future studies to expand beyond independent economic indicators and curate clinical interventions for culturally competent mental healthcare.

Stigma and mental health problems in an Indian context. Perceptions of people with mental disorders in urban, rural and tribal areas of Kerala

BACKGROUND

The concept of stigma has been widely used to understand patterns of discrimination and negative ideas surrounding people with mental health problems, yet we know little of the specific nuances of how this might operate beyond the 'Global North'.

AIM

This paper aims to explore the notion of stigma in an Indian context by considering the lived experience of patients, carers and community members.

METHODS

A sample of 204 participants, representing mental health patients, informal carers and community members was recruited from urban and rural areas in Kerala, India. Participants took part in interviews where they were encouraged to talk about their experiences of mental ill health, attitudes towards these problems, barriers encountered and sources of support.

RESULTS

Experiences akin to the experience of stigma in Europe and the United States were elicited but there were important local dimensions specific to the Indian context. The difficulties faced by people with diagnoses of mental disorders in finding marriage partners was seen as an important problem, leading to marriage proposals being refused in some cases, and secrecy on the part of those with mental health problems. Rather than the 'self-stigma' identified in the US, participants were more likely to see this as a collective problem in that it could reflect badly on the family group as a whole rather than just the sufferer.

CONCLUSIONS

In the Indian context, the idioms of stigma emphasised impairments in marriage eligibility and the implications for the family group rather than just the self.

Prevalence, service use and clinical correlates of hallucinations and delusions in an out-patient population from India

BACKGROUND

Despite the persistent public health problem of positive psychotic symptoms, understanding of symptom specific prevalence rates, clinical correlates and service utilisation are sparse.

AIMS

The current study aimed to establish prevalence, clinical and service utilisation correlates of hallucinations and delusions in people accessing outpatient clinics in Tamil Nadu, India.

METHODS

Secondary patient data from outpatient clinics, over a 12-month period, in 2016, was used for analysis (N = 917). Based on the presence of positive psychotic symptoms (PPSx), the sample was divided into four groups for analysis- hallucinations-only (H), delusions-only (D), both hallucinations and delusions (HD) and neither PPSx (N-PPSx).

RESULTS

Findings indicate that the most prevalent PPSx were hallucinations (10.7%) however, barriers to service utilisation and clinical correlates were associated predominantly with the D and the HD group; as was severe work impairment. Yet, this group was most likely to remain with psychiatric services. Lastly, diagnostic challenges were apparent within the sample.

CONCLUSIONS

The study revealed that despite more barriers to service utilisation, persons with PPSx remain in contact with services. Yet prognosis remains only moderate at best, indicating other mediating and underlying factors impeding recovery may be interplaying and, therefore, a need for enhanced biopsychosocial approaches.

Psychosocial inventory for caregivers (PIC) of persons with mental illness: Content validity and cognitive interviewing process

BACKGROUND

Content validity and cognitive interview plays a vital role in tool construction and contributes significantly in determining the psychometric properties of a tool.

AIM

The study aimed to present the content validation process, using expert judgment and to illustrate the use of a cognitive interviewing method for gathering validity evidence on the response process of psychosocial inventory for caregivers (PIC) of persons with mental illness.

METHODOLOGY

This is a descriptive, psychometric study on content validity through expert judgment which was conducted at the LGB Regional Institute of mental health, Assam, India. Convenience and intentional sampling were used for the selection of the field expert. In this study, the psychosocial inventory for caregivers (PIC) of persons with mental illness was validated by 10 mental health professionals from India. The present study proceeded in three phases. Phase-1, an item pool (150 items) was generated. Phase-2, content validity was calculated based on the content validity index (CVI) and content validity ratio (CVR). Phase-3, cognitive interview (CI) was done. The study was approved by the institute ethics committee (IEC) of LGBRIMH, Tezpur.

RESULTS

Through content validity procedure, 39 items out of 150 were discarded, whereas, through cognitive interview 27 out of 111 items were deleted. So, altogether 84 items were retained for the final scale 'psychosocial inventory for caregivers (PIC) of persons with mental illness. Universal agreement (UA) was 0.6.

CONCLUSION

In present study, content validity was found to be satisfactory. Yet, further studies are needed to evaluate its reliability and validity.

Family matters! - The caregivers' perspective of Mental Healthcare Act 2017

Mental health continues to fight for acceptance in health care all over the world. The need for a separate act for mental illnesses proves this fact even more. The very nature of the mental illness has necessitated legislation to aid the service providers and service users. The Mental Healthcare Act 2017 has taken great initiatives in terms of protection of human rights for people with mental illness such as the inclusion of mental illness in health insurance, stress on informed consent, decriminalization of suicide, and introduction of advance directives (ADs) and punishment to those who violate the law. However, in a country like India where the family as a unit has more significance than personal autonomy, the new act emphasizes the patient's rights and, in doing so, may make the doctors more defensive and fearful in making clinical decisions, thus shifting the burden to the shoulders of the family members. There is a need for suitable amendments to include the family's concerns as well; otherwise, the present act would stand as an alien Western law enforced on Indian cohesive family dynamics. Qualitative studies are required from the family's perspective to illustrate the hindrances that the patients' families are facing. In the context of Indian family structure and dynamics and working in the Indian community, we feel that without suitable amendments to include the family's concerns, the present act would stand as an alien Western law enforced on Indian cohesive family dynamics.