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Gautam K, Paudel K, Ahmed A, Dhakal M, Wickersham JA, Poudel KC, Pagoto S, Acharya B, Deuba K, Valente PK, Shrestha R. High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal. J Community Health 2024; 49:575-587. [PMID: 38281283 PMCID: PMC11283576 DOI: 10.1007/s10900-024-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/30/2024]
Abstract
Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.
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Affiliation(s)
- Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Kiran Paudel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
- Nepal Health Frontiers, Tokha-5, Kathmandu, 44600, Nepal
| | - Ali Ahmed
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Manisha Dhakal
- Blue Diamond Society, Dhumbarahi Marg, Kathmandu, 44600, Nepal
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, 06510, USA
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Bibhav Acharya
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, School of Medicine, 675 18th Street, San Francisco, CA, 94107, USA
- Possible, a non-profit organization, Bhim Plaza, Kathmandu, Nepal
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pablo K Valente
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA.
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, 06510, USA.
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Shawon MSR, Hossain FB, Ahmed R, Poly IJ, Hasan M, Rahman MR. Role of women empowerment on mental health problems and care-seeking behavior among married women in Nepal: secondary analysis of nationally representative data. Arch Womens Ment Health 2024; 27:527-536. [PMID: 38315185 PMCID: PMC11230993 DOI: 10.1007/s00737-024-01433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study investigates the associations between women empowerment and the prevalence of mental health symptoms and care-seeking behavior among ever-married Nepalese women aged 15-49 years. METHODS We utilized 2022 Nepal Demographic and Health Survey data to measure women empowerment, employing the Survey-Based Women's Empowerment (SWPER) index. The index focuses on the domains of social independence, decision-making, and attitudes towards violence. Symptoms of anxiety and depression were measured using the Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), respectively. Multiple logistic regression was performed to estimate adjusted odds ratio (aOR) for associations of women empowerment domains and mental health problems and care-seeking behavior. RESULTS Among 5556 women, the prevalence of symptoms of anxiety and depression was 23.1% and 6.1%, respectively. Among those with any symptoms of anxiety or depression, 18.3% sought care. Compared to women with low level of empowerment in the "social independence" domain, those with high level of empowerment were less likely to suffer from symptoms of anxiety (aOR = 0.68; 95%CI, 0.57-0.82) and depression (aOR = 0.69; 95%CI, 0.50-0.94). However, high empowerment in "decision-making" domain was associated with higher likelihood of anxiety (aOR = 1.67; 95%CI, 1.33-2.10) and depression (aOR = 1.80; 95%CI, 1.26-2.58). There was evidence of positive association between high empowerment in "decision-making" and care-seeking (aOR = 1.28; 95%CI, 0.96-1.71). CONCLUSIONS This study underscores important roles of women empowerment on mental health symptoms and care-seeking behavior, suggesting the need to integrate empowerment initiatives into strategies to promote mental health among women in Nepal and similar low- and middle-income settings.
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Affiliation(s)
- Md Shajedur Rahman Shawon
- Centre for Big Data Research in Health, University of New South Wales, Level 2, AGSM Building (G27), Sydney, Australia.
| | | | - Robin Ahmed
- Sir Salimullah Medical College, Dhaka, Bangladesh
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van Heerden A, Poudyal A, Hagaman A, Maharjan SM, Byanjankar P, Bemme D, Thapa A, Kohrt BA. Integration of passive sensing technology to enhance delivery of psychological interventions for mothers with depression: the StandStrong study. Sci Rep 2024; 14:13535. [PMID: 38866839 PMCID: PMC11169515 DOI: 10.1038/s41598-024-63232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
Psychological interventions delivered by non-specialist providers have shown mixed results for treating maternal depression. mHealth solutions hold the possibility for unobtrusive behavioural data collection to identify challenges and reinforce change in psychological interventions. We conducted a proof-of-concept study using passive sensing integrated into a depression intervention delivered by non-specialists to twenty-four adolescents and young mothers (30% 15-17 years old; 70% 18-25 years old) with infants (< 12 months old) in rural Nepal. All mothers showed a reduction in depression symptoms as measured with the Beck Depression Inventory. There were trends toward increased movement away from the house (greater distance measured through GPS data) and more time spent away from the infant (less time in proximity measured with the Bluetooth beacon) as the depression symptoms improved. There was considerable heterogeneity in these changes and other passively collected data (speech, physical activity) throughout the intervention. This proof-of-concept demonstrated that passive sensing can be feasibly used in low-resource settings and can personalize psychological interventions. Care must be taken when implementing such an approach to ensure confidentiality, data protection, and meaningful interpretation of data to enhance psychological interventions.
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Affiliation(s)
- Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa.
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
- Department of Psychiatry and Behavioral Sciences, Center for Global Mental Health Equity, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Methods in Implementation and Prevention Science, Yale University, New Haven, CT, USA
| | | | | | - Dörte Bemme
- Department for Global Health and Social Medicine, Kings College London, London, UK
| | - Ada Thapa
- Division of Global Health Equity, Brigham and Women's Hospital Boston, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, Center for Global Mental Health Equity, George Washington School of Medicine and Health Sciences, Washington, DC, USA
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Thanh HN, Sutrisni IA, Rijal S, Pandey A, Tran TP, Dien R, Thi Hong YN, Timoria D, Friska D, Kekalih A, Bogh C, Karkey A, Hamers RL, Chambers M, Lewycka S, Van Nuil JI. Social cohesion among healthcare workers during COVID-19: Qualitative research in Indonesia, Nepal, and Vietnam. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100404. [PMID: 38911289 PMCID: PMC11190837 DOI: 10.1016/j.ssmqr.2024.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 06/25/2024]
Abstract
Existing literature has portrayed numerous challenges that healthcare workers (HCWs) faced during the COVID-19 pandemic, such as heightened risks of transmission against the scarcity of protective equipment, burgeoning workload, and emotional distress, to name a few. However, most studies explored HCWs' experiences at the individual level rather than examining the collective responses. Exploring these experiences could reveal the social-cultural locality of the pandemic while identifying the system constraints in public health emergencies. As part of a mixed-method study on COVID-19 pandemic impacts, we analysed qualitative interview data with 129 HCWs and health-related staff to explore their experiences during the pandemic between 2020 and 2021 in Vietnam, Indonesia, and Nepal. Using Bahers' sociological framework, Community of Fate, we describe five themes reflecting the formation of a community of HCWs and the social cohesion underlying their efforts to survive hardship. The first three themes characterise the HCW community of fate, including (1) Recognition of extreme work-related danger, (2) physical and figurative closures where HCWs restrict themselves from the outside world, (3) chronic ordeals with overwhelming workload and responsibilities, encompassing recurrent mental health challenges. Against such extreme hardship, cohesive bonding and social resilience are reflected through two additional themes: (4) a mutual sense of moral and professional duty to protect communities, (5) the vertical and horizontal convergence among HCWs across levels and among government departments. We discuss these HCWs' challenges in relation to systemic vulnerabilities while advocating for increasing investment in public health and collaboration across government sectors to prepare for emergency situations.
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Affiliation(s)
- Ha Nguyen Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Ida Ayu Sutrisni
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Samita Rijal
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Aakriti Pandey
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | | | - Ragil Dien
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Diana Timoria
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Sumba Foundation, Sumba, Indonesia
| | - Dewi Friska
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Aria Kekalih
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Raph L. Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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Shawon MSR, Hossain FB, Hasan M, Rahman MR. Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: Analysis of nationally representative survey data. Glob Ment Health (Camb) 2024; 11:e46. [PMID: 38690568 PMCID: PMC11058515 DOI: 10.1017/gmh.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Background Assessing gender disparity in mental health is crucial for targeted interventions. This study aims to quantify gender disparities in mental health burdens, specifically anxiety and depression, and related care-seeking behaviors across various sociodemographic factors in Nepal, highlighting the importance of gender-specific mental health interventions. Methods Data from the 2022 Nepal Demographic and Health Survey was utilized, employing the Generalized Anxiety Disorder 7 scale (GAD-7) and Patient Health Questionnaire (PHQ-9) scales for anxiety and depression symptoms, respectively. Multiple logistic regression models assessed gender associations with these conditions and care-seeking behaviors. Results Women had a higher point prevalence of anxiety (21.9% vs. 11.3%) and depression (5.4% vs. 1.7%) than men. Large variations were noted in gender disparities in the prevalence of anxiety and depression, influenced by age, geographical areas, level of education and household wealth. After adjustment for sociodemographic factors, women were more likely to experience anxiety (adjusted odds ratio (aOR) = 2.18, 95% confidence interval [CI]: 1.96-2.43) and depression (aOR = 3.21, 95% CI: 2.53-4.07). However, no difference was observed in the rates of seeking care for anxiety or depression (aOR = 1.13, 95% CI: 0.91-1.40). Conclusions Our findings show a higher point prevalence of mental health issues among women than men, influenced by sociodemographic factors, underscoring the need for gender-focused mental health interventions in Nepal and globally.
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Lemon CA, Svob C, Bonomo Y, Dhungana S, Supanya S, Sittanomai N, Diatri H, Haider II, Javed A, Chandra P, Herrman H, Hoven CW, Sartorius N. Priorities for research promoting mental health in the south and east of Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100287. [PMID: 38404519 PMCID: PMC10884971 DOI: 10.1016/j.lansea.2023.100287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 02/27/2024]
Abstract
Progress in promoting mental health, preventing mental illness, and improving care for people affected by mental illness is unlikely to occur if efforts remain separated from existing public health programs and the principles of public health action. Experts met recently to discuss integrating public health and mental health strategies in the south and east of Asia, especially in low- and middle-income countries. Areas of research identified as high priority were: 1) integrating mental health into perinatal care; 2) providing culturally-adjusted support for carers of people with mental and physical disorders; 3) using digital health technologies for mental health care in areas with limited resources and 4) building local research capacity. Selection of these areas was informed by their relative novelty in the region, ease of implementation, likely widespread benefit, and potential low costs. In this article, we summarise available evidence, highlight gaps and call for collaborations with research centres, leaders and persons with lived experience within and beyond the region.
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Affiliation(s)
- Christopher A. Lemon
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Connie Svob
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Yvonne Bonomo
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia
- Department of Addiction Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Saraswati Dhungana
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Nepal
| | - Suttha Supanya
- Somdet Chaopraya Institute of Psychiatry, Department of Mental Health, Bangkok, Thailand
| | - Napat Sittanomai
- Division of Child and Adolescent Psychiatry, Department of Paediatrics, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Hervita Diatri
- Department of Psychiatry, Faculty Medicine Universitas Indonesia and Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christina W. Hoven
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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Pedersen GA, Elnasseh A, Bhattacharya B, Moran L, Neupane V, Galea JT, Contreras C, Pfeffer KA, Brown A, Sangraula M, Luitel N, Kohrt BA. Practitioners' perspectives on preparing for and delivering remote psychological support in Nepal, Perú and the United States during COVID-19. Psychol Psychother 2023; 96:849-867. [PMID: 37294035 PMCID: PMC10709530 DOI: 10.1111/papt.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has propelled a global paradigm shift in how psychological support is delivered. Remote delivery, through phone and video calls, is now commonplace around the world. However, most adoption of remote delivery methods is occurring without any formal training to ensure safe and effective care. OBJECTIVE The purpose of this applied qualitative study was to determine practitioners' experiences of rapidly adapting to deliver psychological support remotely during COVID-19. DESIGN We used a pragmatic paradigm and applied approach to gain perspectives related to the feasibility and perceived usefulness of synchronous remote psychological support, including views on how practitioners can be prepared. METHODS Key informant interviews were conducted remotely with 27 specialist and non-specialist practitioners in Nepal, Perú and the USA. Interviewees were identified through purposeful sampling. Data were analysed using framework analysis. RESULTS Respondents revealed three key themes: (i) Remote delivery of psychological support raises unique safety concerns and interference with care, (ii) Remote delivery enhances skills and expands opportunities for delivery of psychological support to new populations, and (iii) New training approaches are needed to prepare specialist and non-specialist practitioners to deliver psychological support remotely. CONCLUSIONS Remote psychological support is feasible and useful for practitioners, including non-specialists, in diverse global settings. Simulated remote role plays may be a scalable method for ensuring competency in safe and effective remotely-delivered care.
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Affiliation(s)
- Gloria A. Pedersen
- The Center for Global Mental Health Equity, The George Washington University
| | - Abdelrhman Elnasseh
- The Center for Global Mental Health Equity, The George Washington University
| | - Bani Bhattacharya
- Milken Institute School of Public Health, The George Washington University
| | | | | | - Jerome T. Galea
- School of Social Work, University of South Florida
- Department of Global Health and Social Medicine, Harvard Medical School
| | - Carmen Contreras
- Socios En Salud Sucursal Perú
- Harvard Global Health Institute, Harvard University
| | | | - Adam Brown
- Department of Psychology, The New School for Social Research
- Department of Psychiatry, New York University School of Medicine
| | | | | | - Brandon A. Kohrt
- The Center for Global Mental Health Equity, The George Washington University
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Gupta AK, Sharma R, Sah RP, Sharma S, Jha A, Chapagai M, Saeed F, Shoib S. Cross-cultural adaptation of Nepalese literacy and stigma of suicide scales (LOSS-SF-Nep and SOSS-SF-Nep) among Nepalese medical and nursing students. Brain Behav 2023; 13:e3344. [PMID: 38010105 PMCID: PMC10726846 DOI: 10.1002/brb3.3344] [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: 03/08/2023] [Revised: 09/13/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Nepal is a country in South-east Asia with high suicide. There is ongoing trend of emerging research on suicide from Nepal but there is lack of validated scale in measuring literacy or stigma. In the view of poor media reporting and large treatment gap, this study was conducted. All previous validation studies were done in non-Hindu populations. METHODS A cross-sectional study was planned where the short forms of Nepalese literacy of suicide scale (LOSS-SF-Nep) and Stigma of Suicide Scale (SOSS-SF-Nep) were validated using standard procedure at a medical college in southern Nepal. Medical and nursing students of all batches were approached offline after successful pretesting. The psychometric properties of the scales were tested, and the statuses of literacy and stigma were assessed. Patient Health Questionnaire-9 and General Anxiety Disorder Scale-7 were used for revealing depression and generalized anxiety. RESULTS Three hundred and nineteen Nepalese students participated and most of them were males, belonged to nuclear family, upper-middle socioeconomic status and represented 46 out of 77 districts of Nepal. The mean score of LOSS-SF-Nep was 6.36 ± 1.92 and literacy ranged from 37.9% to 89.7%. The deeper exposure to suicidal patients was associated with better literacy. Factor analysis of SOSS-SF-Nep revealed three subscales: stigmatization, isolation/depression, and normalization/glorification and had acceptable psychometric properties. Gender, occupation of head of the family, region and years of education, using mental health services, and depression were associated with variable literacy or stigma. CONCLUSION Literacy and stigma scales were validated in Nepali, and SOSS factor structures were revealed with modified descriptors. The literacy and stigma levels in medical students were calculated for the first time in Nepal and Hindu majority population.
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Affiliation(s)
| | - Rakhi Sharma
- Department of PsychiatryNational Medical CollegeBirgunjNepal
| | - Ram Prakash Sah
- Department of PsychiatryNational Medical CollegeBirgunjNepal
| | - Subodh Sharma
- Department of PsychiatryNational Medical CollegeBirgunjNepal
| | - Ashish Jha
- Department of PsychiatryNational Medical CollegeBirgunjNepal
| | | | - Fahimeh Saeed
- Psychosis Research CenterUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Sheikh Shoib
- Department of PsychiatryJawaharlal Nehru Memorial HospitalKashmirIndia
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Luitel NP, Pudasaini K, Pokhrel P, Lamichhane B, Gautam K, Adhikari S, Makhmud A, Taylor Salisbury T, Votruba N, Green E, Chowdhary N, Jordans MJ, Kohrt BA, Dua T, Thornicroft G, Carswell K. Development and functioning of the mobile app-based mh-GAP intervention guide in detection and treatment of people with mental health conditions in primary healthcare settings in Nepal. Glob Ment Health (Camb) 2023; 10:e90. [PMID: 38161752 PMCID: PMC10755379 DOI: 10.1017/gmh.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024] Open
Abstract
This paper describes the development process of a mobile app-based version of the World Health Organization mental health Gap Action Programme Intervention Guide, testing of the app prototypes, and its functionality in the assessment and management of people with mental health conditions in Nepal. Health workers' perception of feasibility and acceptability of using mobile technology in mental health care was assessed during the inspiration phase (N = 43); the ideation phase involved the creation of prototypes; and prototype testing was conducted over multiple rounds with 15 healthcare providers. The app provides provisional diagnoses and treatment options based on reported symptoms. Participants found the app prototype useful in reminding them of the process of assessment and management of mental disorders. Some challenges were noted, these included a slow app prototype with multiple technical problems, including difficulty in navigating 'yes'/'no' options, and there were challenges reviewing detailed symptoms of a particular disorder using a "more information" icon. The initial feasibility work suggests that if the technical issues are addressed, the e-mhGAP warrants further research to understand if it is a useful method in improving the detection of people with mental health conditions and initiation of evidence-based treatment in primary healthcare facilities.
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Affiliation(s)
- Nagendra P. Luitel
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Kriti Pudasaini
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Pooja Pokhrel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Bishnu Lamichhane
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Kamal Gautam
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Sandarba Adhikari
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Eric Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark J.D. Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Khanal G, Selvamani Y, Sapkota P. Insights on historical milestones of mental health in Nepal: Country profile. Indian J Psychiatry 2023; 65:1122-1128. [PMID: 38249153 PMCID: PMC10795665 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_197_23] [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: 03/19/2023] [Revised: 05/12/2023] [Accepted: 11/11/2023] [Indexed: 01/23/2024] Open
Abstract
The present paper has highlighted the mental health development in Nepal. It covers the current state of mental health system and services and a throwback on the significant changes over a period of time. This review grabs a sneak into mental health plan/policies, prevalence; health facilities and human resources, monitoring and supervision, budget allocation, nongovernmental sector involvement, and international agreements. Every description in this paper is substantially based on the progression made at the different time frames, which provides clear understanding of the mental health situation in Nepal. Furthermore, this article throws insights on the main challenges to overcome the current situation on mental health and the associated treatment gap due to stigma toward mental illness, lack of appropriate budget allocation, shortage of human resources, and fear of discrimination.
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Affiliation(s)
- Gayatri Khanal
- School of Public Health, SRM Institute of Science and Technology, Tamil Nadu, India
| | - Y. Selvamani
- School of Public Health, SRM Institute of Science and Technology, Tamil Nadu, India
| | - Prabhat Sapkota
- Department of Psychiatry, Nisarga Hospital and Research Centre Pvt. Ltd., Kailali, Nepal
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Shrestha R, Sapkota D, Mehra D, Ekström AM, Deuba K. Feasibility and Effectiveness of an Intervention to Reduce Intimate Partner Violence and Psychological Distress Among Women in Nepal: Protocol for the Domestic Violence Intervention (DeVI) Cluster-Randomized Trial. JMIR Res Protoc 2023; 12:e45917. [PMID: 37581909 PMCID: PMC10466145 DOI: 10.2196/45917] [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: 01/22/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component. OBJECTIVE This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV. METHODS A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80% power and α<.05 statistical significance level to detect a 15% absolute risk reduction in the IPV frequency and a 50% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline. RESULTS This study received funding in 2019. As of December 29, 2022, over 50% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin. CONCLUSIONS If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV. TRIAL REGISTRATION ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45917.
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Affiliation(s)
- Rachana Shrestha
- Public Health and Environment Research Center, Lalitpur, Nepal
- Knowledge to Action, Lalitpur, Nepal
| | | | - Devika Mehra
- Mamta Health Institute for Mother and Child, New Delhi, India
- Medeon Science Park, Malmo, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Devkota HR, Baral YR, Khanal B, Adhikary P. How effectively are social accountability mechanisms being applied in mental health services within the newly federalized health system of Nepal? A multi-stakeholder qualitative study. BMC Health Serv Res 2023; 23:762. [PMID: 37461026 DOI: 10.1186/s12913-023-09765-1] [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: 10/12/2022] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The burden of mental health problems and inequalities in healthcare has emerged as critical issues, in Nepal. Strengthened citizen-driven social accountability (SA) is an effective strategy for building equitable health systems and providing quality healthcare services to all, yet SA in mental health is an under-researched area in Nepal. OBJECTIVE This study explores changes in mental health service delivery in the re-configured federal health system and discusses the functioning and effectiveness of SA in the federalized context of Nepal. METHOD This case study research used a qualitative approach to data collection. We conducted Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with local stakeholders including people with experience of mental health problems. The audio-recorded interviews and discussions were transcribed and analyzed using a thematic content method. RESULTS A total of 49 participants were recruited, and 17 participated in interviews and 32 participated in six focus group discussions. From the data, eight themes emerged: Policy challenges in mental health, Governance and service delivery, Tokenism in the application of social accountability processes, Weak role of key actors in promoting accountability, Complaints and response, Discriminatory health and welfare system, Public attitudes and commitment towards mental health, and No differences experienced by the change to a federal system. It was found that existing health policies in Nepal inadequately cover mental health issues and needs. The prevailing laws and policies related to mental health were poorly implemented. There is a lack of clarity at different levels of government about the roles and responsibilities in the delivery of mental health services. Poor intra- and inter-governmental coordination, and delays in law-making processes negatively impacted on mental health service delivery. SA mechanisms such as social audits and public hearings exist within government health systems, however, application of these in mental health services was found poor. Rights-holders with mental health problems had not experienced any change in the provision of healthcare services for them even after the federalization. CONCLUSION Mental health is insufficiently addressed by the health policies in Nepal, and SA mechanisms appeared to be rarely institutionalized to promote good governance and provide effective healthcare services to vulnerable populations. The provision of more equitable services and honest implementation of SA tools may foster greater accountability and thereby better service delivery for people with mental health problems.
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Affiliation(s)
- Hridaya Raj Devkota
- Institute for Social and Environmental Research Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal.
| | - Yuba Raj Baral
- Manamohan Memorial Institute of Health Science (MMIHS), Kathmandu, Nepal
| | - Bindu Khanal
- Padmakanya Campus, Tribhuvan University, Kathmandu, Nepal
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Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal. BMC Pregnancy Childbirth 2023; 23:145. [PMID: 36870950 PMCID: PMC9985076 DOI: 10.1186/s12884-023-05457-0] [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: 04/28/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal. METHODS A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression. RESULT In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant. CONCLUSION Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.
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Jackson J, Dangal R, Dangal B, Gupta T, Jirel S, Khadka S, Rimal P, Acharya B. Implementing Collaborative Care in Low-Resource Government, Research, and Academic Settings in Rural Nepal. Psychiatr Serv 2022; 73:1073-1076. [PMID: 35172595 DOI: 10.1176/appi.ps.202100421] [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: 11/30/2022]
Abstract
The collaborative care model (CoCM) is a strategy of integrating behavioral health into primary care to expand access to high-quality mental health services in areas with few psychiatrists. CoCM is multifaceted, and its implementation is accelerating in high-resource settings. However, in low-resource settings, it may not be feasible to implement all CoCM components. Guidance is lacking on CoCM implementation when only some of its components are feasible. In this column, the authors used a cost-benefit approach to refine strategies for addressing common implementation challenges, incorporating the authors' experiences in what was gained and what was lost at each implementation step in three CoCM programs in diverse clinical settings in rural Nepal.
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Affiliation(s)
- James Jackson
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Rajkumar Dangal
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Binod Dangal
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Tula Gupta
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Sunita Jirel
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Sangeeta Khadka
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Pragya Rimal
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Bibhav Acharya
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
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Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
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Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
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Singh R, Gupta AK, Singh B, Basnet P, Arafat SMY. History of psychiatry in Nepal. BJPsych Int 2022; 19:7-9. [PMID: 36622643 PMCID: PMC9811379 DOI: 10.1192/bji.2021.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 01/11/2023] Open
Abstract
The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.
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Affiliation(s)
- Rakesh Singh
- Independent Mental Health Researcher, and Visiting Faculty Member, Department of Public Health, KIST Medical College, Tribhuvan University, Kathmandu, Nepal.
| | - Anoop Krishna Gupta
- Lecturer, Department of Psychiatry, National Medical College, Birgunj, Nepal
| | - Babita Singh
- Professor and Vice-Principal, Department of Psychiatric Nursing, National Medical College, Birgunj, Nepal
| | - Pragyan Basnet
- Medical Student, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - S. M. Yasir Arafat
- Assistant Professor, Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
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Gupta AK, Joshi S, Kafle B, Thapa R, Chapagai M, Nepal S, Niraula A, Paudyal S, Sapkota P, Poudel R, Gurung BS, Pokhrel P, Jha R, Pandit S, Thapaliya S, Shrestha S, Volpe U, Sartorius N. Pathways to mental health care in Nepal: a 14-center nationwide study. Int J Ment Health Syst 2021; 15:85. [PMID: 34930398 PMCID: PMC8685796 DOI: 10.1186/s13033-021-00509-4] [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] [Received: 04/22/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. METHODS This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. RESULTS Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. CONCLUSIONS Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.
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Affiliation(s)
| | - Sulochana Joshi
- Department of Psychiatry, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Bikram Kafle
- Department of Psychiatry, Devdaha Medical College, Devdaha, Nepal
| | - Ranjan Thapa
- Neuro Cardio and Multi-Specialty Hospital, Biratnagar, Nepal
| | - Manisha Chapagai
- Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Suraj Nepal
- Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abhash Niraula
- P.T. Birta City Hospital and Research Centre, Birtamode, Nepal
| | - Sreya Paudyal
- Universal College of Medical Sciences, Siddharthanagar, Nepal
| | | | - Reet Poudel
- Department of Psychiatry, Nepalgunj Medical College, Kohalpur, Nepal
| | | | - Prabhakar Pokhrel
- Department of Psychiatry, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Robin Jha
- Department of Psychiatry, Janakpur Provincial Hospital, Janakpur, Nepal
| | - Sanjib Pandit
- Present Address: Department of Psychiatry, Rapti Academy of Health Sciences, Ghorahi, Nepal
- Department of Psychiatry, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Suresh Thapaliya
- Department of Psychiatry, National Medical College, Birgunj, Nepal
- Present Address: Kent and Medway NHS and Social Care Partnership Trust, Kent, UK
| | - Shuva Shrestha
- Department of Psychiatry, National Medical College, Birgunj, Nepal
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Head, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica Delle Marche, Via Tronto 10/A, 60126 Ancona, Italy
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), 20 chemin Colladon, 1209 Geneva, Switzerland
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Kallivayalil RA, Enara A. Education and training in psychiatry in South Asian countries. Asia Pac Psychiatry 2021; 13:e12494. [PMID: 34873853 DOI: 10.1111/appy.12494] [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: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
"Show me a sane man and I will cure him for you."-Carl Jung. Essentially, Jung was saying that a sane man does not exist. Emotional problems and difficulties are present in a benign form in the vast majority of people. Therefore, psychiatric education should focus on the very common nature of mental and emotional problems. Training of psychiatrists to provide the best quality care and conduct the highest quality research continues to remain a priority across the globe. The treatment and training gaps in many countries continue despite the sustained efforts at improving these, especially in low- and middle-income (LAMI) countries. Although many LAMI countries have improved curricula for undergraduate and postgraduate training, yet the treatment and training gap continues. This article will look to explore education and training in psychiatry in some of the South Asian countries with a special focus on India.
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Affiliation(s)
- Roy Abraham Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Arun Enara
- Department of Psychiatry, Hertfordshire Partnership Foundation NHS Trust, Hertfordshire, UK
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Gupta AK, Grover S, Thapaliya S, Shrestha S, Sawant S, Shoib S. Pathways to care and supernatural beliefs among patients with psychotic disorders in Nepal. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00143-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Longer pathways to care worsen the course of psychotic illness as well. The study aimed to assess the pathways to care, supernatural beliefs, and impact on the duration of untreated psychosis in patients with schizophrenia. It was a cross-sectional, observational study that involved 133 patients and their caregivers. Supernatural Attitude Questionnaire and World Health Organization Encounter form for Pathways to care were used to evaluate the pathways to care, supernatural beliefs in caregivers, and duration of untreated psychosis. SPSS descriptive and non-parametric tests were used for analysis.
Results
Overall, 59.4% of the participants had a non-medical person as the first treatment contact. Duration of untreated psychosis (DUP) for the whole study sample was 6.04 (SD 15.14) months and when it was compared among the first contact with a medical person (mean 4.43; SD 14.39) and non-medical person (mean 7.15; SD 15.63), the later had significantly longer (Mann-Whitney U = 1278; p < 0.001) DUP. More than half of the patients had one or more supernatural beliefs. Having supernatural beliefs and carryout rituals related to these beliefs is associated with a higher number of visits to different professionals before reaching a psychiatrist.
Conclusions
Patients with psychosis and their caregivers seek first help from non-medical persons, especially faith healers. This is associated with a longer duration of untreated psychosis and supernatural beliefs in caregivers. Thus, there is a need to improve mental health literacy and have public awareness programs to address the belief systems and clarify the prevailing myths in society.
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