What are young Indians saying about mental health? A content analysis of blogs on the It's Ok To Talk website

Mental health of young adults pursuing higher education in Tier-1 cities of India: A cross-sectional study

India, with its vast youth population, grapples with significant mental health issues among young adults in higher education, due to factors such as academic pressure, social isolation, stigma, economic uncertainty, screen time, sedentary lifestyles, and pandemic-related stresses. Though the issue has garnered attention, there's a gap in post-pandemic mental health research for Indian students. This study aims to address this by investigating anxiety, depression, and overall mental well-being among students aged 18-29 in higher educational institutions across eight major Indian cities, categorized by gender, zone, city, and institution type. Using a cross-sectional design and multi-stage sampling, we surveyed 1628 students (47.1 % males, 52.9 % females) using the Mental Health Inventory (MHI-38). Female students reported higher distress levels than males. Students from the Western and Southern zones showed higher positivity and well-being. Kolkata students reported low positivity but superior well-being. Hyderabad students reported low depression levels. Central University students reported more depression, while government arts and science college students reported lower life satisfaction. The majority exhibited moderate to high levels of anxiety (69.9 %), depression (59.9 %), loss of behavioral/emotional control (65.1 %), and distress (70.3 %). These statistics underscore the burden of mental health issues faced by this demographic. Despite the prevalence, a minimal number of young adults accessed mental health services, often due to stigma and cultural biases. This study highlights how the post-pandemic context has exacerbated these barriers, revealing significant mental health issues among participants and underscoring the urgent need for targeted interventions in educational institutions amidst rising suicide rates in this demographic.

Co-design of "Baatcheet," a peer-supported, web-based storytelling intervention for young people with common mental health problems in India

Background

Engaging with personal mental health stories has the potential to help people with mental health difficulties by normalizing distressing experiences, imparting coping strategies and building hope. However, evidence-based mental health storytelling platforms are scarce, especially for young people in low-resource settings.

Objective

This paper presents an account of the co-design of 'Baatcheet' ('conversation' in Hindi), a peer-supported, web-based storytelling intervention aimed at 16-24-year-olds with depression and anxiety in New Delhi, India.

Methods

Development comprised three stages: (1) establishing a logic model through consultations with a Young People's Advisory Group (N = 11) and a stakeholder reference group (N = 20); (2) elaborating intervention guiding principles and components through focus group discussions and co-design workshops (N = 42); and (3) user-testing of prototypes.

Results

The developmental process identified key stakeholder preferences for an online, youth-focused mental health storytelling intervention. Baatcheet uses an interactive storytelling website containing a repository of personal stories about young people's experiences of depression and anxiety. This is offered alongside brief support from a peer.

Conclusions

There are few story-based interventions addressing depression and anxiety for young people, especially in low-resource settings. Baatcheet has the potential to deliver engaging, accessible and timely mental health support to young people. A pilot evaluation is underway.

Personal Narratives of Mental Illness: From Hostage to Survivor

This study has delved into personal narratives extracted from online blogs to build a systematic view of mental illness trajectory through the portrayal offered by bloggers. One hundred and thirty-three blogs were reviewed and narrative analysis was used to interpret a final sample of 12 blogs. The results offer two main narratives-the hostage and the survivor-which illustrate, within the context of social and self-stigma, the need for an identity reformulation in order to reach recovery. The two narratives also led to the design of a model for mental illness trajectory (MMIT). The breaking down of mental illness trajectory into phases could be advantageous to promoting tailored interventions for specific stages of recovery. The importance of referring to lived experience when trying to understand and develop better treatments for mental illness has been well established. This study contributes to the growing body of research that includes the voice of the person with mental illness offering not only a vivid portrayal of life with mental health issues but also an understanding of the trajectory to recovery.

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

AIMS

Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs).

METHODS

MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results.

RESULTS

Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations.

CONCLUSIONS

ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

Addressing Mental Health Stigma in Low-Income and Middle-Income Countries: A New Frontier for Digital Mental Health

BACKGROUND

Mental health stigma is a major barrier to seeking help, and leads to poor quality of life and social withdrawal for individuals living with mental illness. These concerns are especially severe in low-income and middle-income countries (LMICs) that face a disproportionate share of the global burden of mental illnesses. With growing access to digital technologies in LMICs, there may be new opportunities to address mental health stigma. This review considers the potential for emerging digital technologies to advance efforts to challenge mental health stigma in LMICs.

METHODS

Promising digital strategies to reduce mental health stigma were identified through searching the peer-reviewed literature. Drawing from the Mental Illness Stigma Framework, these studies of digital strategies were grouped into three categories: 1) protest; 2) education, and 3) contact.

RESULTS

These three categories align with established stigma reduction programs. Digital strategies could expand the reach of or complement existing efforts. There are challenges with digital stigma reduction strategies, including the need for cultural adaptation of these programs to diverse contexts and settings, consideration of reliable measurement of mental health related stigma, and risks that digital media could perpetuate the spread of misinformation and exacerbate concerns pertaining to mental health stigma.

CONCLUSION

This review highlights the promise of technology for addressing mental health stigma in LMICs. This is imperative in the face of growing demand for mental health services owing to the economic and social impacts of the COVID-19 pandemic, and the increasing reliance on digital platforms among individuals in most countries.

Design process and protocol description for a multi-problem mental health intervention within a stepped care approach for adolescents in India

This paper documents the collaborative design of a mental health intervention for adolescents in India with anxiety, depression, or anger-related concerns. The process was characterized by three phases of formative activities: (1) an intensive review of the service context, (2) selection of an overall design strategy (e.g., whether to choose existing evidence-based treatments or build new treatments in context), and (3) a period of prototyping, testing, and refining. Each phase resulted in specific outputs, which were, respectively, (1) a detailed articulation of values and preferences (setting expectations for what the ideal protocol should be), (2) a set of build parameters representing a blueprint that managed strategic compromises for this context, and (3) a working protocol. We outline the steps of this design process, summarize data from an open-trial clinical case series, and illustrate the resulting working protocol, which will be tested in a future larger trial. We conclude with insights and observations likely to be relevant to protocol design activity in a variety of contexts, most particularly those in low-and-middle-income countries such as India.

Digital Innovations for Global Mental Health: Opportunities for Data Science, Task Sharing, and Early Intervention

PURPOSE

Globally, individuals living with mental disorders are more likely to have access to a mobile phone than mental health care. In this commentary, we highlight opportunities for expanding access to and use of digital technologies to advance research and intervention in mental health, with emphasis on the potential impact in lower resource settings.

RECENT FINDINGS

Drawing from empirical evidence, largely from higher income settings, we considered three emerging areas where digital technology will potentially play a prominent role: supporting methods in data science to further our understanding of mental health and inform interventions, task sharing for building workforce capacity by training and supervising non-specialist health workers, and facilitating new opportunities for early intervention for young people in lower resource settings. Challenges were identified related to inequities in access, threats of bias in big data analyses, risks to users, and need for user involvement to support engagement and sustained use of digital interventions.

SUMMARY

For digital technology to achieve its potential to transform the ways we detect, treat, and prevent mental disorders, there is a clear need for continued research involving multiple stakeholders, and rigorous studies showing that these technologies can successfully drive measurable improvements in mental health outcomes.

Suicide prevention: Putting the person at the center

In September's Editorial, Vikram Patel and Pattie Gonsalves discuss suicide prevention, the focus of World Mental Health Day, 2019.