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Primasari I, Hoeboer CM, Bakker A, Olff M. Adaptation and validation study of the Indonesian version of the Global Psychotrauma Screen in an undergraduate student population. Compr Psychiatry 2024; 132:152485. [PMID: 38653061 DOI: 10.1016/j.comppsych.2024.152485] [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: 05/31/2023] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The high incidence of potentially traumatic events (PTEs) in Indonesia warrants early identification of those with probable trauma-related disorders in order to tailor prevention and intervention for trauma-related symptoms. OBJECTIVES This study aims to adapt and validate a novel brief transdiagnostic screener, the Global Psychotrauma Screen (GPS), in Indonesian undergraduate students. METHODS An online survey was administered among Indonesian undergraduate students (N = 322). Exploratory factor analysis, reliability analyses, clinical validity analyses, and correlational analyses were performed to evaluate the construct validity, reliability, clinical validity, and convergent-divergent validity of the Indonesian GPS. Hierarchical multiple regression was conducted to assess the relationship between risk factors and trauma-related symptoms. The relationship between four categories of trauma-related symptom severity and social/work functioning was measured using Analysis of Covariance. RESULTS Exploratory factor analysis yielded a single-factor solution. The Indonesian GPS demonstrated good internal consistency, test-retest correlation, and absolute agreement, indicating good reliability. The Indonesian GPS also had an acceptable area under the curve, sensitivity, and specificity for a probable diagnosis of Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (CPTSD), depression, and generalized anxiety disorder (GAD). We also established evidence for the convergent and divergent validity of GPS. The GPS risk factors (low psychological resilience, other stressful events, history of mental illness, and low social support) contributed to predicting trauma-related symptoms after controlling for gender, age, employment status, and faculty background. Additionally, in comparison to participants from the mild and low categories of GPS symptoms scores, participants from the severe and moderate category reported impaired lowered social/work functioning. CONCLUSION The current findings indicate that the Indonesian GPS is a valid and reliable transdiagnostic trauma screener for Indonesian undergraduate students. This first comprehensive validation of the GPS in Indonesia calls for more research in Lower-middle Income Countries (LMICs) as a way towards prevention and early intervention for trauma-related symptoms.
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Affiliation(s)
- Indira Primasari
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; Faculty of Psychology, Universitas Indonesia, Depok, Indonesia.
| | - Chris M Hoeboer
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Anne Bakker
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; Department of Trauma Care, OLVG, Amsterdam, the Netherlands
| | - Miranda Olff
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
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Contractor AA, Almeida IM, Fentem A, Griffith EL, Kaur G, Slavish DC. Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1468-1483. [PMID: 37427484 DOI: 10.1177/15248380231184207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Substantial comorbidity exists between posttraumatic stress disorder and sleep disturbances/disorders. Such comorbidities are understudied in minority groups, including Asian Indians residing in countries outside India. Thus, we synthesized the existing literature specific to this group of Asian Indians to determine (a) prevalence estimates of posttraumatic stress disorder (PTSD) and sleep disturbances/disorders; and (b) PTSD-sleep comorbidity estimates. For this systematic review, we searched four databases (PubMed, PsycInfo, PTSDpubs, Web of Science) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3,796 screened articles, 9 articles (10 studies) met inclusion criteria. Study sample sizes ranged from 11 to 2,112 Asian Indians; studies were conducted in Singapore or Malaysia. No reviewed study examined PTSD. All studies examined sleep disturbances/disorders among Asian Indians; prevalence estimates were: 8.3% to 70.4% for short sleep duration, 2.0% to 22.9% for long sleep duration, 25.9% to 56.3% for poor sleep quality, 3.4% to 67.5% for insomnia diagnosis or probable insomnia, 7.7% for excessive daytime sleepiness, 3.8% to 54.6% for obstructive sleep apnea (OSA) diagnosis or high OSA risk, and 5.1% to 11.1% for sleep-disordered breathing. Specific to Asian Indians residing in countries outside India, this review advances PTSD-sleep literature by (a) suggesting substantial prevalence of sleep disturbances/disorders; (b) highlighting the need for culturally relevant sleep interventions; and (c) highlighting research gaps (e.g., no PTSD-focused research).
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Andualem F, Melkam M, Takelle GM, Nakie G, Tinsae T, Fentahun S, Rtbey G, Begashaw TD, Seid J, Tegegn LF, Gedef GM, Bitew DA, Godana TN. Prevalence of posttraumatic stress disorder and associated factors among displaced people in Africa: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1336665. [PMID: 38516263 PMCID: PMC10956696 DOI: 10.3389/fpsyt.2024.1336665] [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: 11/11/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Background The number of people who have been displaced from their homes due to violence, conflict, and natural disasters. The displaced persons are vulnerable to PTSD; however, being women, individuals with lower socio-economic status and intense exposure to physical assault are more vulnerable. The reviews stated that the pooled prevalence of PTSD among refugees in high-income countries was higher than the general population. However, there has been no review done on PTSD among displaced persons in Africa. Therefore, the aim of this review was to summarise the most recent data evidence on the pooled prevalence of posttraumatic stress disorder and the pooled effect of associated factors on adult displaced people in Africa. Methods We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023411371). The publications were identified from PubMed/Medline, EMBASE, the Cochrane Library, Scopus databases, and other grey searches of Google Scholar and World Health Organisation (WHO) reports. The data was extracted in Microsoft Excel, and then it will be imported into STATA 11.0 for analysis. Results We have included 10 studies conducted in African countries with 5287 study participants. In this meta-analysis, the pooled prevalence of PTSD among displaced people in Africa was 55.64 (95% CI: 42.76-68.41%). Further, in subgroup analysis regarding the study participants, the pooled prevalence of PTSD among internally displaced people and refugees was 56.35% and 54.04%, respectively. Among the associated factors, being female, unemployed, and depression were significantly related to PTSD among displaced people. Conclusions In this review, the pooled prevalence of PTSD among displaced people in Africa was high. Demographic characteristics (female, single, and unemployed), substance use disorder, and depression were risk factors for PTSD among displaced people. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address the prevention, early screening, and management of PTSD among displaced people and to give attention to more vulnerable bodies. Systematic review registration PROSPERO, identifier CRD42023411371.
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Affiliation(s)
- Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Derbie Begashaw
- Department of Psychiatry College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Jemal Seid
- Department of Psychiatry College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Lidiya Fasil Tegegn
- Department of Nursing, College of Medicine and Health Science, Arsi University, Asella, Ethiopia
| | - Getachew Muluye Gedef
- Department of General Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tilahun Nega Godana
- Department of Internal Medicine, University of Gondar College of Medicine and Health Science, Comprehensive Specialized Hospital, Gondar, Ethiopia
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Karagiorga VE, Schafer JL, Marchionatti LE, Caye A, Serdari A, Kotsis K, Basta M, Balikou P, Kapsimalli E, Mitropoulou A, Klavdianou N, Zeleni D, Mitroulaki S, Botzaki A, Gerostergios G, Samiotakis G, Simioni A, Georgiades K, Salum GA, Koumoula A. Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece. J Patient Rep Outcomes 2024; 8:18. [PMID: 38345660 PMCID: PMC10861406 DOI: 10.1186/s41687-024-00693-0] [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: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale. METHODS This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes. RESULTS A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified). CONCLUSION A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.
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Affiliation(s)
- Vasiliki Eirini Karagiorga
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
| | - Julia Luiza Schafer
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lauro Estivalete Marchionatti
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Arthur Caye
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aspasia Serdari
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Kotsis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Basta
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Panagiota Balikou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Efstathia Kapsimalli
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Andromachi Mitropoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Nikanthi Klavdianou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Domna Zeleni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Sotiria Mitroulaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Anna Botzaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Giorgos Gerostergios
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Giorgos Samiotakis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - André Simioni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences and Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Giovanni Abrahão Salum
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA.
- Child Mind Institute, New York, USA.
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Anastasia Koumoula
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA.
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Victims of armed conflict in India: psychosocial impact and available support. Eur J Psychotraumatol 2023; 14:2178375. [PMID: 37052093 PMCID: PMC9970191 DOI: 10.1080/20008066.2023.2178375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
India has been a part of 5 major wars since its independence in 1947 and hosts over 212,413 refugees from Sri Lanka, Tibet and Bangladesh. So, a wide spectrum of trauma survivors, both civilian and military, live in this country and require mental healthcare. We discuss the psychological impact of armed conflict and how the country and culture tint it uniquely. We not only explore the current scene but the resources available and what can be done to make such vulnerable parts of the Indian population feel safer.
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Chandna AS, Suhas S, Patley R, Dinakaran D, Manjunatha N, Rao GN, Gururaj G, Varghese M, Benegal V. Exploring the enigma of low prevalence of post-traumatic stress disorder in India. Indian J Psychiatry 2023; 65:1254-1260. [PMID: 38298881 PMCID: PMC10826864 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_830_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: 10/31/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition associated with significant distress and dysfunction. While worldwide estimates of prevalence range from 3.9% to 24%, little research has been conducted to identify the prevalence of PTSD in the general population of India. This study analyzes data from the National Mental Health Survey 2015-2016, a comprehensive epidemiological study of mental health disorders in India, to explore the unique characteristics and prevalence of PTSD in the Indian population. Materials and Methods The National Mental Health Survey 2015-2016 employed a multiple-stage, stratified, cluster-sampling methodology, covering 39,532 individuals in 12 states of India. The Mini-International Neuropsychiatric Interview (MINI) version 6.0.0 was used to diagnose psychiatric disorders, including PTSD. A detailed analysis of sociodemographic profiles, prevalence patterns, comorbidities, economic and social impact, and treatment-seeking behavior was conducted. Firth penalized logistic regression was employed to identify associated sociodemographic factors. Results The study revealed a low prevalence of PTSD in India at 0.2%, significantly lower than global averages. Factors associated with PTSD included female gender, middle age (40-49 years), and urban residence. The study also highlighted a high rate of comorbid mood and anxiety disorders, substantial disability, poor treatment-seeking behavior, and significant suicidal risk among individuals with PTSD. Conclusion Our findings underscore the need for culturally informed diagnostic and management programs to accurately identify and address PTSD in the Indian population. Cultural nuances, stigma, and the use of Western-derived diagnostic instruments likely contribute to the underidentification and undertreatment of PTSD in India. The study emphasizes the importance of recognizing and addressing these challenges to improve mental health outcomes in India.
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Affiliation(s)
- Ateev S. Chandna
- Department of Psychiatry National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Damodharan Dinakaran
- Department of Psychosocial Support in Disaster Management, NIMHANS, Bengaluru, Karnataka, India
| | | | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Vidyasagaran AL, McDaid D, Faisal MR, Nasir M, Muliyala KP, Thekkumkara S, Wright J, Huque R, Benkalkar S, Siddiqi N. Prevalence of mental disorders in South Asia: A systematic review of reviews. Glob Ment Health (Camb) 2023; 10:e78. [PMID: 38161740 PMCID: PMC10755414 DOI: 10.1017/gmh.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/24/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.
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Affiliation(s)
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Muhammad Nasir
- Department of Economics, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Krishna P. Muliyala
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | | | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Najma Siddiqi
- Department of Health Sciences, University of York, Heslington, UK
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Jin L, Compton SE, Sameen DE, Cornish MV, Contractor AA. Mental Health Symptom Profiles and Treatment Parameters Among Asian Indians: Latent Profile Analyses. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Krishnakumari K, Munivenkatappa M, Hegde S, Muralidharan K. A Systematic Chart Review of Adults with Post-Traumatic Stress Disorder: Data from a Tertiary Care Psychiatry Center in India. Indian J Psychol Med 2022; 44:378-383. [PMID: 35910407 PMCID: PMC9301746 DOI: 10.1177/02537176211035074] [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: 11/15/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is an understudied construct in the psychiatric setting. The majority of existing Indian studies on PTSD focus on the general population or disaster-stricken communities. Here, we present data from a five-year retrospective chart review from a tertiary care psychiatric center in India. METHODS Medical records of adult patients (≥18 years) who had attended psychiatry outpatient services between April 1, 2015 and March 31, 2020 (five years) and were diagnosed with PTSD, as per ICD-10 criteria, were reviewed (n = 113). The relevant sociodemographic and clinical details were extracted using a semistructured pro-forma. RESULTS The percentage of adult patients with PTSD diagnosis in the five years was 0.22%. PTSD was more common in females (n = 65, 57.5%). Most patients had interpersonal trauma (n = 85, 75.2%), specifically sexual abuse (n = 47, 41.6%). The median age of onset was 22 years. All the patients had re-experiencing symptoms, with an equally high rate of avoidance (n = 109, 96.5%) and arousal symptoms (n = 110, 97.3%). 82%(93) had a comorbid psychiatric disorder, with mood disorder being the most common (n = 44, 38.9%). Males had a higher rate of comorbid substance use disorder (n = 14, 29.2%) and depression (n = 20,42%), and females had a higher rate of comorbid dissociative disorder (n = 13,20%). Most of the patients received non-trauma-focused psychological interventions, and only 18% (20) received evidence-based trauma-focused psychological interventions. CONCLUSION Interpersonal trauma, specifically sexual abuse, largely contributes to PTSD among adults attending psychiatric services. The need for trauma-focused psychological interventions is underscored.
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Affiliation(s)
- K Krishnakumari
- Dept. of Clinical Psychology, M.V. Govindaswamy Centre, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manjula Munivenkatappa
- Dept. of Clinical Psychology, M.V. Govindaswamy Centre, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shantala Hegde
- Dept. of Clinical Psychology, M.V. Govindaswamy Centre, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kesavan Muralidharan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Patel AR, Newman E, Richardson J. A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence. BMC Womens Health 2022; 22:22. [PMID: 35090450 PMCID: PMC8795349 DOI: 10.1186/s12905-022-01595-3] [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] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background Despite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. Similarly, the PTSD checklist-5 (PCL-5) has not yet been validated in India. This study describes the adaptation, validation, and results from the adapted HTQ, and embedded PCL-5, for Indian women from slums reporting GBV. Method This study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-15). Results The majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha = .88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha = .80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 and .80, ps < .05). Discussion This is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant trauma reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01595-3.
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Affiliation(s)
- Anushka R Patel
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA. .,Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California San Francisco, 2727 Mariposa St, San Francisco, CA, 94110, USA.
| | - Elana Newman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
| | - Julia Richardson
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
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11
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Aye WT, Lien L, Stigum H, Bjertness E. Childhood abuse and its association with adults' mental health problems: a cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open 2021; 11:e045870. [PMID: 34824104 PMCID: PMC8627399 DOI: 10.1136/bmjopen-2020-045870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms. DESIGN A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale-Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively. SETTING Urban and rural areas of the Yangon Region, Myanmar. PARTICIPANTS A total of 2377 men and women aged 18-49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. RESULTS Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men. CONCLUSIONS Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.
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Affiliation(s)
- Win Thuzar Aye
- Community Medicine and Global Health, University of Oslo Faculty of Medicine, Oslo, Norway
- Preventive and Social Medicine Department, University of Medicine 2, Yangon, Myanmar
| | - Lars Lien
- National Norwegian Advisory Board for Concurrent Addiction and Mental Health Problems, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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12
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Potluri S, R Patel A. Using a Continuous Traumatic Stress Framework to Examine Ongoing Adversity Among Indian Women from Slums: A Mixed-Methods Exploration. J Trauma Stress 2021; 34:917-928. [PMID: 34462969 DOI: 10.1002/jts.22699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023]
Abstract
Gender-based violence (GBV) is pervasive among Indian women. Although posttraumatic stress disorder (PTSD) is a psychological outcome of GBV, it might not accurately capture the experiences of Indian women from slums, who face continued stressors (i.e., ongoing adversity). Continuous traumatic stress (CTS) is a framework used to characterize experiences of ongoing adversity. This mixed-method study investigated the applicability of the CTS framework for characterizing ongoing adversity and the psychological impacts of ongoing adversity among GBV-exposed Indian women from slums. Indian women from slums (N = 100) completed all study measures; a subset (n = 47) completed qualitative interviews analyzed using deductive coding and thematic analysis to identify core CTS characteristics. To examine the impact of ongoing adversity on participants' psychological symptom severity in the full sample, we performed an ANCOVA on PTSD symptom severity and an ANOVA on anxiety and depression symptom severity. Interviewed participants described the context of stressor conditions as pervasive, reported stressor conditions existed in the present or future rather than the past, had difficulty discriminating between real versus imagined threat, and demonstrated absent external protective systems. Results indicated that ongoing adversity was associated with significantly more severe PTSD, F(1, 96) = 9.86, p < .001; anxiety, F(1, 98) = 20.31, p < .001; and depression, F(1, 98) = 25.24, p < .001. The CTS framework is valuable for characterizing ongoing adversity and its related mental health impacts among GBV-exposed Indian women from slums. Assessment and intervention in slum communities must account for ongoing adversity.
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Affiliation(s)
- Sriramya Potluri
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Anushka R Patel
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma, USA.,Trauma Recovery Center, University of California San Francisco, San Francisco, California, USA
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13
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TRIVEDI GUNJANY, PILLAI NISHITHA, TRIVEDI RIRIG. Adverse Childhood Experiences & mental health - the urgent need for public health intervention in India. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E728-E735. [PMID: 34909501 PMCID: PMC8639107 DOI: 10.15167/2421-4248/jpmh2021.62.3.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Global evidence has demonstrated that Adverse Childhood Experiences (ACEs) up to age 18 significantly increases the risk of mental and physical health for an adult. The research linking ACE with health and well-being has confirmed a dose-response relationship between the number of ACEs experienced and the extent of the impact on wellbeing. The source of ACE is the family, community, and the immediate environment, and it causes long-term risk for mental health with the potential to carry it over beyond the present generation. The findings are consistent across the developed and developing countries, and the evidence highlights the need for new elements beyond the 10 ACE elements in the pathbreaking original study. India needs urgent intervention on ACE prevention and management with 0.4 billion children and adolescents, with one out of seven Indians with mental health issues. Firstly, this commentary reviews global research and summarizes the limited evidence available in India on ACE elements' impact on mental health. And, secondly, it proposes a multi-pronged approach to identify, manage and prevent the mental health implications of ACE in India to preempt a significant public health challenge.
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Affiliation(s)
- GUNJAN Y. TRIVEDI
- Cofounder, Society for Energy & Emotions, Wellness Space, Ahmedabad, India
| | - NISHITHA PILLAI
- Interning Psychologist, Society for Energy & Emotions, Wellness Space, Ahmedabad, India
| | - RIRI G. TRIVEDI
- Cofounder, Society for Energy & Emotions, Wellness Space, Ahmedabad, India
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14
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Astill Wright L, Roberts NP, Barawi K, Simon N, Zammit S, McElroy E, Bisson JI. Disturbed Sleep Connects Symptoms of Posttraumatic Stress Disorder and Somatization: A Network Analysis Approach. J Trauma Stress 2021; 34:375-383. [PMID: 33170989 PMCID: PMC9943267 DOI: 10.1002/jts.22619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/04/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress disorder (PTSD) and physical health problems, particularly somatic symptom disorder, are highly comorbid. Studies have only examined this co-occurrence at the disorder level rather than assessing the associations between specific symptoms. Using network analysis to identify symptoms that act as bridges between these disorders may allow for the development of interventions to specifically target this comorbidity. We examined the association between somatization and PTSD symptoms via network analysis. This included 349 trauma-exposed individuals recruited through the National Centre for Mental Health PTSD cohort who completed the Clinician-Administered PTSD Scale for DSM-5 and the Patient Health Questionnaire-15. A total of 215 (61.6%) individuals met the DSM-5 diagnostic criteria for PTSD. An exploratory graph analysis identified four clusters of densely connected symptoms within the overall network: PTSD, chronic pain, gastrointestinal issues, and more general somatic complaints. Sleep difficulties played a key role in bridging PTSD and somatic symptoms. Our network analysis demonstrates the distinct nature of PTSD and somatization symptoms, with this association connected by disturbed sleep.
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Affiliation(s)
- Laurence Astill Wright
- Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Neil P. Roberts
- Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom,Directorate of Psychology and Psychological TherapiesCardiff & Vale University Health BoardCardiffUnited Kingdom
| | - Kali Barawi
- Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Natalie Simon
- Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom,Centre for Academic Mental HealthPopulation Health SciencesUniversity of BristolBristolUnited Kingdom
| | - Eoin McElroy
- Department of NeurosciencePsychology and BehaviourUniversity of LeicesterLeicesterUnited Kingdom
| | - Jonathan I. Bisson
- Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
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15
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Di Crosta A, Palumbo R, Marchetti D, Ceccato I, La Malva P, Maiella R, Cipi M, Roma P, Mammarella N, Verrocchio MC, Di Domenico A. Individual Differences, Economic Stability, and Fear of Contagion as Risk Factors for PTSD Symptoms in the COVID-19 Emergency. Front Psychol 2020; 11:567367. [PMID: 33013604 PMCID: PMC7506146 DOI: 10.3389/fpsyg.2020.567367] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
On January 30th 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency of International Concern (PHEIC). Italy has been one of the most affected countries in the world. To contain further spread of the virus, the Italian government has imposed an unprecedented long-period lockdown for the entire country. This dramatic scenario may have caused a strong psychological distress, with potential negative long-term mental health consequences. The aim of the present study is to report the prevalence of high psychological distress due to the COVID-19 pandemic on the general population, especially considering that this aspect is consistently associated with PTSD symptoms. Furthermore, the present study aims to identify the risk factors for high PTSD symptoms, including individual differences and subjective perception of both economic and psychological aspects. We administered an online survey to 1253 participants during the peak period of the contagion in Italy. A logistic regression on the Impact of Event Scale - Revised (IES-R) scores was used to test the risk factors that predict the possibility to develop PTSD symptoms due to the COVID-19 pandemic. Gender (female), lower perceived economic stability, higher neuroticism, and fear and consequences of contagion were predictors of high PTSD symptomatology. The results, highlighted in the present study, extend our understanding of the COVID-19 pandemic's impact on the population's mental health, by identifying individuals at high-risk of developing PTSD. This may help with the implementation of specific protocols to prevent the possibility of developing symptoms of PTSD in target populations.
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Affiliation(s)
- Adolfo Di Crosta
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Daniela Marchetti
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Irene Ceccato
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Pasquale La Malva
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Roberta Maiella
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Mario Cipi
- Department of Business Studies, Grenon School of Business, Assumption University, Worcester, MA, United States
| | - Paolo Roma
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Nicola Mammarella
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Alberto Di Domenico
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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16
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Ostergaard LS, Wallach-Kildemoes H, Thøgersen MH, Dragsted UB, Oxholm A, Hartling O, Norredam M. Prevalence of torture and trauma history among immigrants in primary care in Denmark: do general practitioners ask? Eur J Public Health 2020; 30:1163-1168. [DOI: 10.1093/eurpub/ckaa138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Torture survivors typically present with varied and complex symptoms, which may challenge assessment by general practitioners (GPs). This study explored the prevalence of torture and trauma history among immigrants born in non-Western countries presenting to GPs in Denmark and the extent to which GPs ask this population about torture or trauma history.
Methods
Based on a self-reported questionnaire among non-western immigrant patients, we used bivariate analyses to determine the prevalence of torture and trauma history and the proportion of patients being asked by their GP about this. Data were analysed using multivariate logistic regression.
Results
From 46 GP clinics, 300 questionnaires were finalized by immigrant patients. Twenty-eight percent of the patients had a history of torture. Of these, significantly more were men (70%) than women (29%). About half of the torture survivors (55%) had been asked by their GP about torture history. The odds ratio (OR, 95% confidence interval) for being asked about torture history by the GP was 1.28 (0.46–3.53) among women compared with men. Compared with Southeast Europe, OR for being a torture survivor among male immigrants from Middle East-North African region and South and East Asia was 1.83 (0.81–4.15) and 0.25 (0.08–0.82), respectively.
Conclusions
Our results suggest that torture and trauma are widespread among immigrants presenting to GPs. In our study, the GPs had managed to detect half of the torture survivors. A more systematic approach to detection in General Practice is advisable, and more knowledge on how and when to ask is needed.
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Affiliation(s)
- Liv Stubbe Ostergaard
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Danish Research Center on Migration, Ethnicity and Health, Section of Health Services Research, Copenhagen, Denmark
| | - Helle Wallach-Kildemoes
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Section for Social and Clinical Pharmacy, Copenhagen, Denmark
| | - Marie H Thøgersen
- Department of Rehabilitation, Dignity – Danish Institute Against Torture, København, Denmark
| | - Ulrik B Dragsted
- Amnesty Internationals Danish Medical Group, Amnesty International Denmark, The Medical Group, Copenhagen, Denmark
| | - Annemette Oxholm
- Amnesty Internationals Danish Medical Group, Amnesty International Denmark, The Medical Group, Copenhagen, Denmark
| | - Ole Hartling
- Amnesty Internationals Danish Medical Group, Amnesty International Denmark, The Medical Group, Copenhagen, Denmark
| | - Marie Norredam
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Danish Research Center on Migration, Ethnicity and Health, Section of Health Services Research, Copenhagen, Denmark
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17
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Tripathy S, Acharya SP, Singh S, Patra S, Mishra BR, Kar N. Post traumatic stress symptoms, anxiety, and depression in patients after intensive care unit discharge - a longitudinal cohort study from a LMIC tertiary care centre. BMC Psychiatry 2020; 20:220. [PMID: 32398018 PMCID: PMC7216410 DOI: 10.1186/s12888-020-02632-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Data on intensive care unit (ICU) related psychiatric morbidity from Low Middle-Income Countries are sparse. We studied the ICU related posttraumatic stress symptoms (PTSS), anxiety, and depression symptoms in a cohort of patients from Eastern India. METHODS We included adults admitted more than 24 h to a mixed ICU. PTSS, anxiety, and depression symptoms were assessed by telephonic or face to face interviews by using the Impact of Events-r (IES-r) and Hospital anxiety and depression (HADS), respectively, at 0, 7,14, 30, 90 and 180 days from ICU discharge. The loss to follow up was minimal. Demographic, socioeconomic, quality of life (QOL), and critical care related variables were studied. RESULTS Of 527 patients, 322 (59.4%) completed 6 months' follow up. The majority were male (60%), mechanically ventilated > 48 h (59.4%), mean age of 48 (+/- 16), mean acute physiology and chronic health evaluation II (APACHE II) at admission 9.4 (+/- 4.6), median length of stay 3 (2-28 days). The rates of ICU related clinical PTSS was < 1 and < 3% for anxiety/depression at any point of follow up. Data were analyzed by linear mixed (random effects) models. There was a significant drop in all scores and association with repeated measures over time. Poor QOL at discharge from the ICU showed significant association with PTSS, anxiety, and depression (β = - 2.94, - 1.34, - 0.7 respectively) when corrected for gender and education levels. Younger age, greater severity of illness, and prior stressful life experiences predicted worse PTSS (β = - 0.02, 0.08, 3.82, respectively). Benzodiazepines and lower sedation scores (better alertness) predicted lower depression symptoms. (β = - 0.43, 0.37 respectively). CONCLUSION ICU related psychiatric morbidity rates in our population are low compared with reported rates in the literature. Poor QOL at ICU discharge may predict worse long-term mental health outcomes. Further research on the impact of ICU and sociocultural factors on mental health outcomes in patients from different backgrounds is needed. The study was registered at CTRI/2017/07/008959.
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Affiliation(s)
- Swagata Tripathy
- Department Anesthesia & Intensive Care, Bhubaneswar, India
- All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Santosh Singh
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suravi Patra
- All India Institute of Medical Sciences, Bhubaneswar, India
- Department of Psychiatry, Bhubaneswar, India
| | | | - Nilamadhab Kar
- Black County Partnership NHS Foundation Trust, Wolverhampton, UK
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18
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Padmakar A, de Wit EE, Mary S, Regeer E, Bunders-Aelen J, Regeer B. Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: Learning from an innovative de-hospitalization process. PLoS One 2020; 15:e0230074. [PMID: 32271784 PMCID: PMC7144972 DOI: 10.1371/journal.pone.0230074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/20/2020] [Indexed: 12/16/2022] Open
Abstract
Individuals with severe mental illness have long been segregated from living in communities and participating in socio- cultural life. In recent years, owing to progressive legislations and declarations (in India and globally), there has been a growing movement towards promoting social inclusion and community participation, with emphasis on the need to develop alternative and inclusive care paradigms for persons with severe mental illness. However, transitions from inpatient care to community settings is a complex process involving implications at multiple levels involving diverse stakeholders such as mental health service users, care providers, local communities and policy makers. This article studies how the transition from a hospital setting to a community-based recovery model for personals with severe mental illness can be facilitated. It reflects on the innovative process of creating a Supported Housing model in South India, where 11 MH Service users transitioned from a psychiatric ECRC to independent living facilities. Experiences in various phases of the project development, including care provider- and community level responses and feedback were scrutinised to understand the strategies that were employed in enabling the transition. Qualitative methods (including in-depth interviews and naturalistic observations) were used with residents and staff members to explore the challenges they encountered in stabilizing the model, as well as the psychosocial benefits experienced by residents in the last phase. These were complemented with a Brief Psychiatric Rating Scale (BPRS) and WHO Quality of Life scale to compare baseline and post-assessment results and an increase of quality of life. Results display a significant reduction of psychiatric symptoms in patients (p< 0.5). It also describes the challenges encountered in the current context, and strategies that were used to respond and adapt the model to address these concerns effectively. Positive behavioural and psycho-emotional changes were observed amongst the residents, significant amongst those being enhanced in their mobility and participation. The article concludes by discussing the implications of this study for the development of innovative community-based models in wider contexts.
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Affiliation(s)
- Archana Padmakar
- The Banyan Academy of Leadership in Mental Health (BALM), Chennai, India
| | - Emma Emily de Wit
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
- * E-mail:
| | - Sagaya Mary
- The Banyan Academy of Leadership in Mental Health (BALM), Chennai, India
| | - Eline Regeer
- Altrecht, Mental Health Care, Utrecht, Netherlands
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
| | - Barbara Regeer
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
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