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Debnath A, Salve HR, Sagar R, Krishnan A, Kumar R, Kant S. Mapping of mental health care facilities and psychiatrists in a North Indian district of India. Indian J Psychiatry 2023; 65:1078-1082. [PMID: 38108055 PMCID: PMC10725207 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_168_23] [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: 03/14/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Since 1990, the proportional contribution of mental disorders to India's total disease burden has nearly doubled, but the number of psychiatrists has not increased proportionately. Even after two decades of District Mental Health Programme (DMHP) launch, a considerable treatment gap still exists for mental illness. The present study aimed to map all health facilities providing mental health services and all psychiatrists in district Faridabad, Haryana. Methods The starting point was the information available with the DMHP and district health office. This was supplemented by web search and snowball sampling. All identified facilities were visited to map the mental health services provided. All the mental health care providers and health care facilities were mapped using "Google my Maps". 2011 census data on population were used. Results In Faridabad, 0.88 psychiatrists per lakh population were present. Most psychiatrists were concentrated in the urban area. The number of psychiatrists per lakh population was 1.1 in urban, compared to 0.54 in rural Faridabad. Clustering of mental health facilities was also observed more in urban areas (8.7 per 100 Sq Km) compared to rural areas (0.95 per 100 Sq Km) of district Faridabad. Conclusion There was a scarcity of psychiatric manpower and facilities in the district with a distinct urban skew.
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Affiliation(s)
- Aninda Debnath
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Harshal Ramesh Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Vishwakarma D, Gaidhane A, Bhoi SR. Depression and Its Associated Factors Among the Elderly Population in India: A Review. Cureus 2023; 15:e41013. [PMID: 37519597 PMCID: PMC10374168 DOI: 10.7759/cureus.41013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Over the last few decades, life expectancy has increased, particularly for old age people. This has resulted in an increased number of family members at a given time leading to more crowded households and thus causing stress in members of joint or large families. Lack of family support, the death of a loved one, isolation in the community due to poor physical health, and generational and communication gaps within the family, even though they reside under the same roof, are just a few of the things that can cause loneliness. These issues affect the mental health of elderly persons and may occasionally result in depression. Depression's high morbidity and mortality rates, particularly in older people, make it a serious public health concern. This review summarises that elderly persons have a higher prevalence of depression; regarding routine depression screening for the older population and their counselling, no precise guidelines are available. We used Medical Subject Heading (MeSH) phrases to search for published articles/studies/research in the English language in PubMed, Scopus, and Google Scholar. We also searched numerous government websites for recent data on geriatric depression and we analysed 35 articles. Old age is the transition stage where an individual must deal with various physical and mental health problems due to brain ageing that leads to changes in behaviour that affect their social well-being. The existing mental health programme should pay more attention to the problems with senior depression. In order to deal with the problem of depression, they might also involve non-governmental organisations (NGOs).
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Affiliation(s)
- Deepak Vishwakarma
- School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Gaidhane
- Department of Community Medicine and Public Health, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sudha R Bhoi
- School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Gangadhar B, Kumar CN, Sadh K, Manjunatha N, Math SB, Kalaivanan RC, Rao GN, Parthasarathy R, Chand PK, Chandra PS, Thirthalli J, Murthy P, Varghese M, Mathur A, Bairy BK, Kishore C, Gowda GS, Basvaraju V, Harihara SN, Isaac MK, Chaturvedi S. Mental Health Programme in India: Has the tide really turned? Indian J Med Res 2023; 157:387-394. [PMID: 37955215 PMCID: PMC10443714 DOI: 10.4103/ijmr.ijmr_2217_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/14/2023] Open
Abstract
Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.
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Affiliation(s)
- B.N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Kamaldeep Sadh
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rakesh Chander Kalaivanan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health & Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India
| | - Prabhat K. Chand
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mathur
- General of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Bhavya K. Bairy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Chethana Kishore
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basvaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Mohan K. Isaac
- Department of Psychiatry, University of Western Australia, Perth, Australia
| | - S.K. Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
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4
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Devassy SM, Scaria L, Cheguvera N. Task sharing and stepped referral model for community mental health promotion in low- and middle-income countries (LMIC): insights from a feasibility study in India. Pilot Feasibility Stud 2022; 8:192. [PMID: 36042504 PMCID: PMC9426017 DOI: 10.1186/s40814-022-01159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is a low-cost community mental health task-sharing model driven by university students to strengthen the mental health workforce in poor resource settings. This article presents the feasibility of a stepped referral model using the community health workforce and university students. The primary feasibility objective is to detect and refer people with mental illness from the community using a task-sharing approach. METHODS We tested the model using a cross-sectional, one-phase door-knock survey in three geographically defined locations in Kerala, India, between May and July 2019. Students surveyed 549 residents above 18 years of age who consented to participate in the study to detect depressive symptoms and suicidality. The feasibility of the current model was evaluated based on four criteria: (a) identification and deployment of untapped human resources, (b) coordination of community health resources, (c) the acceptability of stepped referral pathways, and (d) identification of implementation challenges. RESULTS The mean age of the participants was 38.8, and more than 62% of the respondents were women. The results showed that 11.29%, 8.38%, and 4.91% of people reported mild, moderate, and severe levels of depression, respectively, and suicidal thoughts were found in 6.9% and suicidal ideation in 1.8%. The odds of depression were higher among females compared to males (OR: 1.64 (0.75-2.52), poor people (OR: 2.01 (1.14-2.88), and people with chronic illnesses (OR: 2.03 (1.24-2.81). The agreement of the findings with professional-administered research validated the strategy's efficiency. Twenty-seven patients with severe/extreme degrees of depression were sent for high-intensity interventions led by the mental health team, whereas 135 individuals with mild and above depression were referred for low-intensity interventions. CONCLUSIONS The newly recruited mental health workforce-driven screenings were acceptable and effective in detecting mental illness in the community population. We tested the care coordination systems and processes in creating referral pathways for the detected patients. Further, task-sharing stepped referral model will be tested in five panchayats (the lowest tier of local self-government) before replicating the model across India through Unnat Bharat Abhiyan (UBA) scheme.
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Affiliation(s)
- Saju Madavanakadu Devassy
- Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, Cochin, Kerala, India. .,Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India. .,Honorary Principal Fellow, Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Lorane Scaria
- Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, Cochin, Kerala, India.,Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India
| | - Natania Cheguvera
- Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India
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Singh GP. National Tele-Mental Health Programme formulation: A revolution in 21st century in India. Int J Soc Psychiatry 2022; 69:803-804. [PMID: 35791647 DOI: 10.1177/00207640221109173] [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: 11/17/2022]
Affiliation(s)
- Gurvinder Pal Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
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Chander KR, Moirangthem S, Patley R, Philip S, Varshney P, Basavaraju V, Parthasarathy R, Krishna PVM, Manjunatha N, Channaveerachari NK, Math SB. A camp approach of community psychiatry in India: Past, present, and the future. Ind Psychiatry J 2022; 31:191-196. [PMID: 36419705 PMCID: PMC9678157 DOI: 10.4103/ipj.ipj_195_21] [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: 09/08/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022] Open
Abstract
Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.
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Affiliation(s)
- K Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Mental Health, Government of Karnataka, Bengaluru, Karnataka, India
| | - P V Mohan Krishna
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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7
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Lakshmana G, Sangeetha V, Pandey V. Community perception of accessibility and barriers to utilizing mental health services. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:56. [PMID: 35372598 PMCID: PMC8974990 DOI: 10.4103/jehp.jehp_342_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Government of India and State Government authorities are trying their best to provide adequate mental health services through various mental health policies and programs. To reduce the burden in psychiatric hospitals, Government has decentralized mental health services. Although Government has provided mental health services, the utilization has always been low due to many reasons. In the present study, an attempt was made to assess the accessibility and the barriers to utilizing mental health services with various community stakeholders. MATERIALS AND METHODS This is a qualitative study wherein data was collected from youth, women, geriatric groups, community key leaders, and Anganwadi workers. The primary data were collected through focused group discussions and interview methods. The collected data were analyzed using thematic coding. RESULTS A total of twenty-five factors have been identified in the study, which were categorized under eight themes. (a) Lack of awareness and misinformation on mental health, illness, and available services, (b) Perceived causes for mental illness, (c) Reasons for not approaching health professionals, (d) Treatment adherence-related issues, (e) No multidisciplinary team in private hospitals and lack of involvement in government sector (f) Manpower issues, (g) Quality of service issues and building confidence among community people, and (h) Belief system and stigma. CONCLUSIONS Inadequate mental health services, lack of awareness of mental health, and illness are still persist. The District Mental Health Program and other service providers need to reach communities, especially in remote areas. Periodical evaluation should be carried out to improve the utilization of mental health services.
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Affiliation(s)
- Govindappa Lakshmana
- Department of Social Work, Central University of Karnataka, Kalaburagi, Karnataka, India
| | | | - Vijyendra Pandey
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
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Chaudhury S, Davis S, Gupta N, Samudra M, Dhamija S, Saldanha D. Evaluation of stigma among patients reporting to a tertiary care psychiatric center. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_920_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Kalaivanan RC, Rahul P, Manjunatha N, Kumar CN, Sivakumar PT, Math SB. Telemedicine in Geriatric Psychiatry: Relevance in India. Indian J Psychol Med 2021; 43:S121-S127. [PMID: 34732964 PMCID: PMC8543607 DOI: 10.1177/02537176211033007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.
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Affiliation(s)
- Rakesh Chander Kalaivanan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Patley Rahul
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Bairy BK, Ganesh A, Kaur S, Chand PK, Kumar CN, Manjunatha N, Math SB, Sinha NK, Arora S. Capacity Building in Mental Health for Bihar: Overview of the 1-Year Blended Training Program for Nonspecialist Medical Officers. J Neurosci Rural Pract 2021; 12:329-334. [PMID: 33927523 PMCID: PMC8064863 DOI: 10.1055/s-0041-1722842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective
The aim of this study is to give an experiential overview of a 1-year blended training program for nonspecialist medical officers (primary care doctors; PCDs) of Bihar State of India. The training program was aimed to enable PCDs identify, diagnose, and treat commonly presenting psychiatric disorders in primary care
Methods
PCDs had a brief onsite orientation program to psychiatric practice at National Institute of Mental Health and Neuro-Sciences (NIMHANS), followed by 10 months of online blended training. The online program followed the NIMHANS Virtual Knowledge- Extension for Community Healthcare Outcomes (ECHO) model, that is, a hub and spokes model of training
Results
Twenty-two PCDs participated in this program. Eleven of them got accredited at the end. The onsite orientation consisted of exposure to various psychiatry facilities at NIMHANS, in addition to learning psychiatric history taking and mental status examination. The ECHO model of online learning consisted of fortnightly sessions, lasting 2 hours each. There were 20 such sessions. Each session consisted of a didactic lecture by the psychiatrist followed by a case discussion. The cases were presented by PCDs, moderated by the hub specialists (NIMHANS). At the end of the training, participants rated an average of 4.5/5 on the mode, content and relevance of training and increase in knowledge due to the training. Around 23,000 patients were cared for during the said 1 year by the trained PCDs.
Conclusion
Training PCDs in a manner that enables retaining the learnt skills is feasible. However, rigorous evaluation protocols are needed in order to test this in a systematic fashion.
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Affiliation(s)
- Bhavya K Bairy
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aurobind Ganesh
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sandeepa Kaur
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabhat Kumar Chand
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Sanjeev Arora
- University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
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Saldanha D, Mujawar S, Chaudhury S, Banerjee A. A community-based study of prevalence and functional status of major depressive disorder in an industrial area. Ind Psychiatry J 2021; 30:96-101. [PMID: 34483531 PMCID: PMC8395567 DOI: 10.4103/ipj.ipj_2_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/09/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Depression is a significant public health issue that needs to be taken care of, as it poses a great economic burden on the society at large. Early identification and treatment of the patients will reduce mental morbidity and disability. AIM The aim is to study the prevalence and functional status of subjects with major depressive disorder in the community. MATERIALS AND METHODS After identification of the sample population, the sociodemographic details were recorded. Subsequently, assessment was carried out by General Health Questionnaire (GHQ), Patient Health Questionnaire-9 (PHQ-9), Functional Status Questionnaire (FSQ), and Mini Mental State examination (MMSE). RESULTS A total of 2000 subjects were screened using the GHQ and PHQ and 544 subjects were selected. These 544 subjects were further assessed with FSQ and MMSE. Out of the 544 subjects, 65.1% had a GHQ score of <14, 22.1% had a score between 15 and 19, and 12.9% had a score of >20. The PHQ-9 score was found to be <5 in 28.9% subjects, 5-14 in 64.3% subjects, and >14 in 6.8% subjects. Majority of the sample population was in the warning zone according to the FSQ. The MMSE scores were ≥23 in 86% and ≤22 in 14% of the patients. Over 65% of the subjects were relatively mentally healthy. Out of the remaining 35%, 22% of the subjects required screening for psychiatric disorders and 13% of them did require active psychiatric intervention. CONCLUSIONS It would be beneficial to the community if a database is created regarding the psychiatric disorders such as depression prevalent in the community and their functional status so that the effective measures can be implemented to minimize the suffering by providing effective psychiatric care at the earliest and follow them up in the long run.
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Affiliation(s)
- Daniel Saldanha
- Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Swaleha Mujawar
- Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Amitav Banerjee
- Department of Community Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
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Mithur R, Kakunje A, Puthran S, Joy A, Shetty S. History of psychiatric rehabilitation in India. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2021. [DOI: 10.4103/amhs.amhs_127_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Bharti A, Singh H, Singh D, Kumar V. Behavior of general population toward mentally ill persons in Digital India: Where are we? Ind Psychiatry J 2021; 30:106-112. [PMID: 34483533 PMCID: PMC8395565 DOI: 10.4103/ipj.ipj_194_20] [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: 10/05/2020] [Revised: 01/15/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We aimed to find out the overall reported and intended behavior of the general population of India toward mentally ill persons. MATERIALS AND METHODS Participants were included in an online survey using a nonprobability snowball sampling technique. After taking informed consent, sociodemographic details were recorded, and the "Reported and Intended Behaviour Scale" was administered. RESULTS Out of 818 responses, 684 responses were eligible for study after exclusion. The mean age (standard deviation) of the study population was 31.01 (7.79) years. Maximum participants reported that they did not live (76.6%), did not work (75.7%), did not live nearby (66.4 %), or have not had a close friend (79.8%) with mental health problems. However, most individuals neither agreed nor disagreed to live (48.5%), work (38%), and live nearby (42.7%) a mentally ill person, but maximum individuals strongly agreed to continue a relationship with a friend having mental health problems (34.5%). There were 77.5% males and 32.2% healthcare workers. Regarding intended behavior, there was a significant difference between healthcare workers and persons other than these as well as between males and females. Participants who had previous interaction with the mentally ill person were more willing to interact with the same. CONCLUSION Most people do not intend to have stigmatized behavior toward mentally ill persons. Healthcare workers and males have less negative social reactions toward mentally ill persons in different domains of life. However, there is still a need to intensify awareness about mental health.
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Affiliation(s)
- Abhishek Bharti
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Harpreet Singh
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepak Singh
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vipin Kumar
- Department of Psychiatry, SHKM Government Medical College, Nuh, Haryana, India
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Deshpande SN, Singh R, Bhatia T, Shah GD, Singh H, Hawk M, Nimgaonkar VL. Protocol for a Coordinated Approach for Building Capacity of Mental Health Researchers in India. Indian J Psychol Med 2020; 42:S5-S14. [PMID: 33487797 PMCID: PMC7802036 DOI: 10.1177/0253717620969063] [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: 11/16/2022] Open
Abstract
INTRODUCTION India's National Mental Health Programme (NMHP) was initiated in 1982. In 2016, the Indian Council of Medical Research (ICMR) organized a Brainstorming Meeting on Prioritization of Mental Health Research. Recognizing the need for improving mental healthcare by building a cadre of mental health researchers based on focus areas of the NMHP, the ICMR organized a research training cum capacity building workshop in collaboration with the Cross-Fertilized Research Training Programme (funded by Fogarty International Centre, NIH, USA) in 2016. The workshop successfully prepared and reviewed 12 single and multicenter research proposals in priority areas of mental health research, which were awarded by the ICMR to middle- and junior-level research faculty and NGO. METHODS A National Coordination Unit (NCU) was set up to mentor investigators and to coordinate, train, and monitor the progress of their projects. Investigators were paired with senior mentors and also participated in four capacity building workshops focusing on proposal-writing, evaluation, and process tracking. RESULTS Following discussions with ICMR program officers, the NCU formulated standard operating procedures for ethical conduct, data collection, data sharing, progress reporting procedures, and manuscript preparation for all research projects. Regularly scheduled long-distance communications with investigators using social media and group communications were planned. NCU partnered with the ICMR Database Management Unit to build a shared online platform for real-time data entry and storage, and organized two project review meetings where it also coordinated with US faculty to organize public workshops on manuscript writing and qualitative research. CONCLUSIONS The NCU will ensure timely completion of research projects, data entry and analysis, and reports and project publications. It is feasible to evaluate progress with the NMHP through coordinated multisite research that also enables research capacity building. Results from these projects will help in formulating policies by the Ministry of Health Government of India for achieving objectives of the NMHP.
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Affiliation(s)
- Smita N Deshpande
- Dept. of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Disease, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Triptish Bhatia
- Indo-US Projects and National Coordination Unit-Indian Council of Medical Research, Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Gyan D Shah
- Indo-US Projects and National Coordination Unit-Indian Council of Medical Research, Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Harpreet Singh
- Data Management Unit, Indian Council for Medical Research, New Delhi, Delhi, India
| | - Mary Hawk
- Evaluation Institute for Public Health, Centre for LGBT Health Research, University of Pittsburgh Graduate School of Public Health Behavioural and Community Health Sciences, Pittsburgh, Pennsylvania, USA
| | - Vishwajit L Nimgaonkar
- Dept. of Psychiatry and Dept. of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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15
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Pal A. Telepsychiatry: The Tool to Revive National Mental Health Program of India? Indian J Psychol Med 2020; 42:586-588. [PMID: 33354093 PMCID: PMC7735250 DOI: 10.1177/0253717620959775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arghya Pal
- Dept. of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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16
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Dalal PK. Changing scenario of addiction psychiatry: Challenges and opportunities. Indian J Psychiatry 2020; 62:235-241. [PMID: 32773864 PMCID: PMC7368435 DOI: 10.4103/psychiatry.indianjpsychiatry_346_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- P K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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17
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Naveen KHS, Goel AD, Dwivedi S, Hassan MA. Adding life to years: Role of gender and social and family engagement in geriatric depression in rural areas of Northern India. J Family Med Prim Care 2020; 9:721-728. [PMID: 32318409 PMCID: PMC7113954 DOI: 10.4103/jfmpc.jfmpc_1019_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Depression among elderly population is a major public health issue affecting nearly 5% to 7% of the world's elderly. In the coming years, a major share will be contributed by developing countries like India. In the rural areas of Allahabad district of Uttar Pradesh, there is scarce data on the depression. Methodology: A community-based cross-sectional study was conducted in rural Allahabad. A total of 411 elderly persons were selected from 2 blocks—Jasra and Bahadurpur—through multistage random sampling method. Short form of geriatric depression scale (GDS) was used to assess depression. Results: The prevalence of depression among elderly was 19.7%. On binary logistic regression, depression had significant association with female sex [aOR = 2.4, 95% CI 1.1–5.1], having less-than-good relationship with family members [aOR = 2.7, 95% CI 1.2–6.0], not being cared for during illness by family members [aOR = 3.9, 95% CI 1.2-12.9], not being involved in leisure time activities [aOR = 2.5, 95% CI 1.3–4.9], and not regularly meeting relatives and friends [aOR = 4.7, 95% CI 1.9–11.6]. Conclusions: The prevalence of depression in elderly was high in rural areas of Allahabad. Female sex and social and family engagement are the important predictors of depression among them.
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Affiliation(s)
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shraddha Dwivedi
- Department of Community Medicine, MLN Medical College, Allahabad, India
| | - Mohd Amirul Hassan
- Department of Community Medicine, Government Medical College, Ambedkarnagar, Uttar Pradesh, India
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18
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Joag K, Ambrosio G, Kestler E, Weijer C, Hemming K, Van der Graaf R. Ethical issues in the design and conduct of stepped-wedge cluster randomized trials in low-resource settings. Trials 2019; 20:703. [PMID: 31852547 PMCID: PMC6921381 DOI: 10.1186/s13063-019-3842-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Stepped-wedge cluster randomized trials (SW-CRTs) are increasingly popular in health-related research in both high- and low-resource settings. There may be specific ethical issues that researchers face when designing and conducting SW-CRTs in low-resource settings. Knowledge of these issues can help to improve the ethical conduct of SW-CRTs in a global health context. Methods We performed an ethical analysis of two studies using SW-CRT designs in low-resource settings: the Que Vivan Las Madres study conducted from 2014 to 2017 in Guatemala and the Atmiyata study conducted from 2017 to 2018 in rural parts of India. For both case studies, we identified and evaluated the classification of the study as research or nonresearch and the ethical issues regarding the justification of the design, including the delayed rollout of an intervention that had a promising effect. Results In our case studies, some minor ethical issues surfaced about the registration and stakeholder pressure on the order of randomization, but both included good justification for the design and delayed rollout. Our analysis did, however, demonstrate that careful consideration of the role of randomization and registration of the trials is important. Discussion SW-CRTs can provide an opportunity for rigorous evaluation of interventions destined to be rolled out on the basis of limited evidence. Furthermore, in SW-CRTs, the underlying objective is often to provide a robust evaluation of the effectiveness for generalized dissemination, and this makes the SW-CRT no less a research study than any other form of cluster randomized trial. Conclusion The design and conduct of stepped-wedge cluster randomized trials raises at least two ethical issues that need special consideration in both high- and low-resource settings: the justification for using the design, specifically the delayed rollout of the intervention to the control group, and the classification of the study as research or nonresearch. In our case studies, these issues did not seem to raise special ethical scrutiny in low-resource settings. Further ethical evaluation will hopefully result in specific ethical guidelines for the use of SW-CRTs in both high- and low-resource settings to contribute to responsible functioning of these trials and adequate protection of participants.
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Affiliation(s)
- Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Guillermo Ambrosio
- Epidemiological Research Center in Sexual and Reproductive Health, Guatemala City, Guatemala
| | - Edgar Kestler
- Epidemiological Research Center in Sexual and Reproductive Health, Guatemala City, Guatemala
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rieke Van der Graaf
- University Medical Center Utrecht, Utrecht University, Julius Center, Utrecht, The Netherlands.
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19
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Abstract
In this article, we trace encounters between humans and phantasmic entities in hospitals in Indian-occupied and Pakistan-controlled Kashmir. In Pakistan, the presence of spectral beings (jinni) in hospitals is linked to state and sectarian violence, which precipitates ruptures between jinni and human worlds. Such breaches permit jinni to manifest in the medical present, where insecure actors harness them to ventriloquize unspoken anxieties. In Indian-occupied Kashmir, jinn-like, chronically mentally ill patients haunt psychiatric modernization projects. In embracing a jinneaological approach to medical crises, we theorize hospitals as multi-temporal and multi-dimensional spaces called "tesseracts," in which human-nonhuman encounters serve existential and political purposes.
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Affiliation(s)
- Emma Varley
- Department of Anthropology, Brandon University, Brandon, Manitoba, Canada
| | - Saiba Varma
- Department of Anthropology, University of California, San Diego, La Jolla, California, USA
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20
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Malhotra S, Chakrabarti S, Shah R, Sharma M, Sharma KP, Malhotra A, Upadhyaya SK, Margoob MA, Maqbool D, Jassal GD. Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module. Indian J Med Res 2018; 146:196-204. [PMID: 29265020 PMCID: PMC5761029 DOI: 10.4103/ijmr.ijmr_757_15] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background & objectives: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. Methods: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. Results: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. Interpretation & conclusions: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.
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Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Minali Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanu Priya Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Akanksha Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Suneet K Upadhyaya
- Department of Psychiatry, Hemwati Nandan Bahuguna Base Hospital, Srinagar, Uttarakhand, India
| | - Mushtaq A Margoob
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
| | - Dar Maqbool
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
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21
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Kumar CN, Thirthalli J, Suresha KK, Venkatesh BK, Arunachala U, Gangadhar BN. Antipsychotic treatment, psychoeducation & regular follow up as a public health strategy for schizophrenia: Results from a prospective study. Indian J Med Res 2018; 146:34-41. [PMID: 29168458 PMCID: PMC5719605 DOI: 10.4103/ijmr.ijmr_838_15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background & objectives: In low- and middle-income countries such as India, a feasible public health strategy could be to ensure continuous antipsychotics and psychoeducation for those with schizophrenia. Whether such a strategy favourably influences its course and outcome is not well-studied. The objectives of this study were to examine these issues in a cohort of patients with schizophrenia in a rural south Indian taluk (an administrative block). This cohort was part of a community intervention programme running in the place since the past one decade. Methods: A total of 201 patients were assessed after an average of four years of follow up. Psychopathology, disability and course of illness were assessed using Positive and Negative Syndrome Scale (PANSS), Indian Disability Evaluation and Assessment Scale (IDEAS) and Psychiatric and Personal History Schedule (PPHS), respectively. Interventions included ensuring continuous antipsychotic treatment and low-intensity psychoeducation. Results: One hundred and forty two [70.6%; 95% confidence interval (CI): 64.35-76.95] of the 201 patients achieved clinical remission by the end of follow up period (four years); 140 (69.6%; 95% CI: 63.29-76.07) had satisfactory outcome (42.3% best outcome and 27.4% intermediate outcome). There was a significant reduction in the proportion of patients with disability [134/201 (66.7%) at baseline; 55/201 (27.3%) at follow up; P< 0.01]. Best course pattern and least disability were seen in patients with best treatment adherence. Interpretation & conclusions: Treatment with antipsychotics and psychoeducation can favourably influence the course of schizophrenia and reduce disability in a substantial proportion of patients. Structured psychosocial interventions may be indicated in the significant minority who show suboptimal outcome with this strategy.
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Affiliation(s)
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India
| | - Kudumallige K Suresha
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India
| | - Basappa K Venkatesh
- Department of Psychiatry & Sleep Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA, USA
| | | | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India
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Affiliation(s)
- B. R. Sahithya
- Department of Psychiatry, St. John’s National Academy of Health Sciences, Bangalore, India
| | - R. P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Abstract
BACKGROUND General hospital psychiatry units (GHPUs) are the major providers of mental health services in India. Unlike in high-income countries, GHPUs in India are also the main training centers for providing postgraduate training in psychiatry and allied disciplines. AIM This paper traces the history of the GHPUs in India from beginning to the present. MATERIAL AND METHODS PubMed, old issues of the Indian Journal of Psychiatry and related sources were searched with key words general hospital and psychiatry both electronically and manually to look for the related literature. RESULTS The history of the development of GHPUs is discussed under 3 phases: beginning to the preindependence period, independence to the year of the launch of the National Mental Health Programme of India, and afterward. Contributions of the GHPUs towards service development, teaching, research, community awareness and reducing stigma, and their future scope are discussed. CONCLUSION GHPUs have been a revolutionary development in India with great contribution in the field of mental heath.
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Affiliation(s)
- Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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24
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Böge K, Zieger A, Mungee A, Tandon A, Fuchs LM, Schomerus G, Tam Ta TM, Dettling M, Bajbouj M, Angermeyer M, Hahn E. Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India. Indian J Psychiatry 2018; 60:24-31. [PMID: 29736059 PMCID: PMC5914258 DOI: 10.4103/psychiatry.indianjpsychiatry_406_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors. MATERIALS AND METHODS Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis. RESULTS Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P < 0.01), with female participants showing higher levels of perceived stigma compared to male counterparts. CONCLUSION Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Abhinav Tandon
- AKT Neuropsychiatric Centre, Allahabad, Uttar Pradesh, India
| | - Lukas Marian Fuchs
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Matthias Angermeyer
- Center for Public Mental Health, Untere 12 Zeile 13, A-3482 Gö-sing am Wagram, Austria
| | - Eric Hahn
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
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25
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Naskar S, Victor R, Das H, Nath K. Telepsychiatry in India - Where Do We Stand? A Comparative Review between Global and Indian Telepsychiatry Programs. Indian J Psychol Med 2017; 39:223-242. [PMID: 28615754 PMCID: PMC5461830 DOI: 10.4103/0253-7176.207329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.
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Affiliation(s)
- Subrata Naskar
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Robin Victor
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Himabrata Das
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kamal Nath
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
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Mugisha J, Abdulmalik J, Hanlon C, Petersen I, Lund C, Upadhaya N, Ahuja S, Shidhaye R, Mntambo N, Alem A, Gureje O, Kigozi F. Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis. Int J Ment Health Syst 2017; 11:7. [PMID: 28070217 PMCID: PMC5217325 DOI: 10.1186/s13033-016-0114-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental, neurological and substance use disorders contribute to a significant proportion of the world's disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. METHODS A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis. RESULTS Three of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental health into PHC in all the study countries were also inadequate. CONCLUSION Integration of mental health into PHC will require addressing the resource limitations that have been identified in this study. There is a need for up to date mental health legislation and policies to engender commitment in allocating resources to mental health services.
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Affiliation(s)
- James Mugisha
- Kyambogo University, Kampala, Uganda
- Butabika Hospital Emerald Project, Kampala, Uganda
- Stellenbosch University, Stellenbosch, South Africa
| | - Jibril Abdulmalik
- Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Neuroscience, University of Ibadan, Ibadan, Nigeria
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Inge Petersen
- EMERALD Project, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Crick Lund
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Nawaraj Upadhaya
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Shalini Ahuja
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Ntokozo Mntambo
- EMERALD Project, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Atalay Alem
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Oye Gureje
- Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Neuroscience, University of Ibadan, Ibadan, Nigeria
| | - Fred Kigozi
- Butabika Hospital Emerald Project, Kampala, Uganda
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Shields-Zeeman L, Pathare S, Walters BH, Kapadia-Kundu N, Joag K. Promoting wellbeing and improving access to mental health care through community champions in rural India: the Atmiyata intervention approach. Int J Ment Health Syst 2017; 11:6. [PMID: 28066505 PMCID: PMC5210275 DOI: 10.1186/s13033-016-0113-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background There are limited accounts of community-based interventions for reducing distress or providing support for people with common mental disorders (CMDs) in low and middle-income countries. The recently implemented Atmiyata programme is one such community-based mental health intervention focused on promoting wellness and reducing distress through community volunteers in a rural area in the state of Maharashtra, India. Case presentation This case study describes the content and the process of implementation of Atmiyata and how community volunteers were trained to become Atmiyata champions and mitras (friends). The Atmiyata programme trained Atmiyata champions to provide support and basic counselling to community members with common mental health disorders, facilitate access to mental health care and social benefits, improve community awareness of mental health issues, and to promote well-being. Challenges to implementation included logistical challenges (difficult terrain and weather conditions at the implementation site), content-related challenges (securing social welfare benefits for people with CMDs), and partnership challenges (turnover of public health workers involved in referral chain, resistance from public sector mental health specialists). Conclusions The case study serves as an example for how such a model can be sustained over time at low cost. The next steps of the programme include evaluation of the impact of the Atmiyata intervention through a pre-post study and adapting the intervention for further scale-up in other settings in India.
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Affiliation(s)
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | | | - Kaustubh Joag
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
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Abstract
In recent years, the Movement for Global Mental Health (MGMH) and the World Health Organization have worked closely with governments across the global South to redress major treatment gaps to improve access to mental health services. In India, recent reforms include transforming public psychiatric institutions from sites of treatment to research and training institutes, known as "Centres of Excellence," to combat acute manpower shortages and modernize psychiatry. Drawing on ethnographic fieldwork at a public psychiatric hospital in Srinagar, Kashmir, one of the institutions selected to be a future "Centre of Excellence," this article focuses on how these reforms have affected psychiatric institutions themselves. Efforts at modernizing and increasing access to mental health care-that is, emphasizing shortened stays, increasing outpatient treatment, and providing care in the "community"-depend on quarantining stigmatized, chronically ill, long-term patients who reside in custodial conditions with fewer resources and limited attention from providers. Psychiatrists have a radically different vision for redressing manpower shortages than the MGMH and Indian state, revealing contradictions in the reform process. This paper demonstrates how modernizing mental health care splits mental institutions spatially, ontologically, temporally, and epistemologically, so that the process of modernizing the institution is neither seamless nor complete.
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Zieger A, Mungee A, Schomerus G, Ta TMT, Dettling M, Angermeyer MC, Hahn E. Perceived stigma of mental illness: A comparison between two metropolitan cities in India. Indian J Psychiatry 2016; 58:432-437. [PMID: 28197001 PMCID: PMC5270269 DOI: 10.4103/0019-5545.196706] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE An increasing number of comparative studies are conducted on the stigmatization of persons with mental illness, in particular with regard to regional and diachronic variation. So far, there have been no studies comparing stigmatization of persons with mental illness in two different regions of India. Therefore, we examined the differences in perception of stigma attached to mental illnesses in Kolkata and Chennai, with regard to cultural and geographical differences to better understand the roots and origins of this issue. MATERIALS AND METHODS Explorative surveys in the context of public attitudes toward people with mental disorders were conducted among conveniently selected members of the general population in Chennai (n = 166) and Kolkata (n = 158) with identical methodology. Link's perceived devaluation-discrimination measure was used. The samples were matched for age, gender, and education. RESULTS The calculated sum score indicated that respondents from Kolkata had a higher level of perceived discrimination toward persons with mental illness than respondents from Chennai (P = 0.043). Furthermore, regression analysis revealed that lower perceived stigma was associated with stronger religious devotion (P = 0.049) and higher educational attainment (P = 0.001) in both cities. DISCUSSION The results showed that perceived stigma was higher in Kolkata than in Chennai. The correlation of higher stigma with lower education was in line with the previous research, and interestingly, it was found that higher stigma correlated with weaker religious devotion. Further studies exploring a wider variety of factors may provide us with a better understanding of the roots of perceived stigma in India.
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Affiliation(s)
- Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Stralsund, Germany; Department of Psychiatry, HELIOS Hanseklinikum, Stralsund, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW 2571, Australia
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Soni A, Fahey N, Byatt N, Prabhakaran A, Moore Simas TA, Vankar J, Phatak A, O'Keefe E, Allison J, Nimbalkar S. Association of common mental disorder symptoms with health and healthcare factors among women in rural western India: results of a cross-sectional survey. BMJ Open 2016; 6:e010834. [PMID: 27388353 PMCID: PMC4947826 DOI: 10.1136/bmjopen-2015-010834] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey. SETTING Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India. PARTICIPANTS 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were recruited in a quasi-randomised manner. PRIMARY AND SECONDARY OUTCOMES MEASURES CMD symptoms, ascertained using WHO's Self-Reporting Questionnaire-20 (SRQ-20), were associated with self-reported (1) number of healthcare visits in the prior year; (2) health status and (3) portion of yearly income expended on healthcare. RESULTS Data from 658 participants were used in this analysis; 19 surveys were excluded due to incompleteness, 18 surveys were excluded because the participants were visiting hospitalised patients and 5 surveys were classified as outliers. Overall, 155 (22·8%) participants screened positive for CMD symptoms (SRQ-20 score ≥8) with most (81.9%) not previously diagnosed despite contact with healthcare provider in the prior year. On adjusted analyses, screening positive for CMD symptoms was associated with worse category in self-reported health status (cumulative OR=9.39; 95% CI 5·97 to 14·76), higher portion of household income expended on healthcare (cumulative OR=2·31; 95% CL 1·52 to 3.52) and increased healthcare visits in the prior year (incidence rate ratio=1·24; 95% CI 1·07 to 1·44). CONCLUSIONS The high prevalence of potential CMD among women in rural India that is unrecognised and associated with adverse health and financial indicators highlights the individual and public health burden of CMD.
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Affiliation(s)
- Apurv Soni
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nisha Fahey
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Des Moines University, Des Moines, Iowa, USA
| | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | | | - Ajay Phatak
- Pramukhswami Medical College, Karamsad, Gujarat, India
| | | | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Murthy P, Isaac MK. Five-year plans and once-in-a-decade interventions: Need to move from filling gaps to bridging chasms in mental health care in India. Indian J Psychiatry 2016; 58:253-258. [PMID: 28066001 PMCID: PMC5100115 DOI: 10.4103/0019-5545.192010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mohan K Isaac
- Department of Psychiatry, Fremantle Hospital, The University of Western Australia, Crawley, WA, Australia
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Shah R, Eynan R, Srivastava A, Reiss L, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, Links PS. Indo-Canadian Collaboration for Suicide Prevention: Training Needs Assessment for Healthcare Professionals in India. Community Ment Health J 2016; 52:511-8. [PMID: 26007647 DOI: 10.1007/s10597-015-9895-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/16/2015] [Indexed: 11/27/2022]
Abstract
The main purpose of the study was to conduct a comprehensive needs assessment of primary healthcare professionals in order to develop a training program aimed at enhancing competencies in suicide risk assessment and management. A total of 144 primary healthcare professionals (physicians = 46; primary care workers = 98) completed the needs assessment questionnaire. The majority of healthcare professionals rated their level of comfort and competence in assessing, treating, and referring suicidal patients as medium or high. However, their knowledge about suicide, risk factors for suicide, asking about suicidal behaviour, and helping a suicidal patient was rated low or medium. Overall, the scarcity of qualified healthcare professionals and the existing gaps in core competencies for suicide risk assessment and management was identified. Development of innovative and effective competencies-based suicide specific training for primary care providers in India is urgently required.
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Affiliation(s)
- Ravi Shah
- Department of Psychiatry, Western University, London, ON, Canada.
- Lawson Health Research Institute, 750 Baseline Rd, Suite 105-5, London, ON, N6C 2R5, Canada.
| | - Rahel Eynan
- Department of Psychiatry, Western University, London, ON, Canada
| | | | - Leanna Reiss
- Department of Psychiatry, Western University, London, ON, Canada
| | | | - Shubhangi Parkar
- Department of Psychiatry, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Lakshman Dutt
- Department of Psychiatry, Indus University, Ahmedabad, India
| | - Kranti Kadam
- Department of Psychiatry, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Paul S Links
- Department of Psychiatry, Western University, London, ON, Canada
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Shields L, Chauhan A, Bakre R, Hamlai M, Lynch D, Bunders J. How can mental health and faith-based practitioners work together? A case study of collaborative mental health in Gujarat, India. Transcult Psychiatry 2016; 53:368-91. [PMID: 27199281 DOI: 10.1177/1363461516649835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the knowledge that people with mental illness often seek care from multiple healing systems, there is limited collaboration between these systems. Greater collaboration with existing community resources could narrow the treatment gap and reduce fragmentation by encouraging more integrated care. This paper explores the origins, use, and outcomes of a collaborative programme between faith-based and allopathic mental health practitioners in India. We conducted 16 interviews with key stakeholders and examined demographic and clinical characteristics of the user population. Consistent with previous research, we found that collaboration is challenging and requires trust, rapport-building, and open dialogue. The collaboration reached a sizeable population, was reviewed favourably by key stakeholders-particularly on health improvement and livelihood restoration-and perhaps most importantly, views the client holistically, allowing for both belief systems to play a shared role in care and recovery. Results support the idea that, despite differing practices, collaboration between faith-based and allopathic mental health practitioners can be achieved and can benefit clients with otherwise limited access to mental health care.
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Affiliation(s)
- Laura Shields
- Trimbos Institute/Netherlands Institute for Mental Health and Addiction, the Netherlands
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Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk Factors and Therapeutic Interventions. Psychiatr Q 2016; 87:129-54. [PMID: 25986531 DOI: 10.1007/s11126-015-9367-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It is a well known fact that postpartum depression (PPD) is a global phenomenon that women may experience, regardless of cultural identity and beliefs. This literature review presents the cultural beliefs and postnatal practices around the world, in each continent and people's origins, looking through the extent to which they contribute positively or negatively to the onset of the disease. 106 articles were used in this research, through a systematic electronic search of Pubmed (Medline) and Scopus. Comparison is also made between the prevalence, the risk factors and the different ways of appearance of the disease around the world and among immigrants. Finally, the initiatives and interventions made so far by the governments and institutions with a view to prevent and address this global problem are presented. The results showed (a) that different cultures share the same risk factors towards the disease (b) significant differences in the prevalence of the disease among both Western and non Western cultures and between the cultures themselves (c) more tendencies for somatization of depressive symptoms in non-Western cultures, (d) different postnatal practices between cultures, which are not always effective (e) the more non-West a culture is, the less interventions concern on mental health; the same phenomenon is observed on populations burdened by immigration. The beliefs held by culture should be taken seriously in detecting of PPD, as well as the assessment of the needs of women who have recently given birth.
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Malhotra S, Chakrabarti S, Shah R, Sharma M, Sharma K, Singh H. Diagnostic accuracy and feasibility of a net-based application for diagnosing common psychiatric disorders. Psychiatry Res 2015; 230:369-76. [PMID: 26493325 DOI: 10.1016/j.psychres.2015.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 07/29/2015] [Accepted: 09/10/2015] [Indexed: 02/05/2023]
Abstract
A net-based application, which enables users to diagnose and manage common psychiatric disorders independently, was developed. Diagnostic accuracy and reliability of the application were compared with the Mini International Neuropsychiatric Interview among 274 adult outpatients. The screening sub-module of the application had high sensitivity, specificity and negative predictive values for most disorders, but low positive predictive values for several disorders. The criteria-based diagnostic sub-module demonstrated moderate to substantial agreement (kappa>0.50) for all 4 broad categories and 10 of the 18 individual disorders included. Diagnostic agreement was, however, low (kappa<0.4) for most of the disorders comprising the broad category of 'neurotic and stress-related disorders'. Low sensitivity was also observed among these disorders, though specificity, and positive and negative predictive values were high for most disorders. Inter-rater reliability of the application's diagnoses was high. Symptom-severity and functional status scores correlated significantly with those on standard scales. Average time taken was 5min for screening and 20min for detailed diagnostic assessment. A majority of the patients, their relatives and interviewers were satisfied with the assessment. The results suggest that with further refinement the application could be suitable for use as a net-based diagnostic tool for psychiatric disorders.
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Affiliation(s)
- Savita Malhotra
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Subho Chakrabarti
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ruchita Shah
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Minali Sharma
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanupriya Sharma
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Hardeep Singh
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Eynan R, Reiss L, Links P, Shah R, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, De Souza A, Shrivastava A. Suicide prevention competencies among urban Indian physicians: A needs assessment. Indian J Psychiatry 2015; 57:397-402. [PMID: 26816429 PMCID: PMC4711242 DOI: 10.4103/0019-5545.171848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION India accounts for the highest estimated number of suicides in the World. In 2012, more than 258,000 of the 804,000 suicide deaths worldwide occurred in India. Early identification and effective management of suicidal ideation and behavior are paramount to saving lives. However, mental health resources are often scarce and limited. Throughout India, there is a severe shortage in mental health professions trained, which results in a treatment gap of about 90%. A comprehensive needs assessment was undertaken to identify the nature of the deficits in suicide prevention training for physicians in three Indian cities: Mumbai, Ahmedabad, and Mysore. MATERIALS AND METHODS The study was carried out in several concurrent phases and used a mixed-method approach of converging quantitative and qualitative methodologies. Data were collected using survey questionnaires, focus groups, consultations, and environmental scans. A total of 46 physicians completed the questionnaire. Focus groups were conducted in Mumbai and Ahmedabad with 40 physicians. Consultations were carried out with psychiatrists and psychiatric residents from hospitals and clinics in Mumbai, Ahmedabad, and Mysore. RESULTS Training gaps in suicide prevention exist across the health care professions. Existing training lacks in both quality and quantity and result in critical deficits in core competencies needed to detect and treat patients presenting with suicidal ideation and behavior. Only 43% of the surveyed physicians felt they were competent to treat suicidal patients. The majority of surveyed physicians believed they would greatly benefit from additional training to enhance their suicide risk assessment and intervention skills. CONCLUSIONS There is a dire need for medical schools to incorporate suicide prevention training as a core component in their medical curricula and for continuing medical education training programs for physicians to enhance competencies in early detection and management of suicidal behavior.
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Affiliation(s)
- Rahel Eynan
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Leanna Reiss
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul Links
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Ravi Shah
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - T S Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - Shubhangi Parkar
- Department of Psychiatry, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Lakshman Dutt
- Department of Psychiatry, Indus University, Ahmedabad, Gujarat, India
| | - Kranti Kadam
- Department of Psychiatry, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Avinash De Souza
- Consultant Psychiatrist and Research Coordinator, Mental Health Resource Foundation, Mumbai, Maharashtra, India
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Nayak A. Changing Medical Students' Attitudes to Psychiatry through Newer Teaching Techniques. Mens Sana Monogr 2015; 13:180-6. [PMID: 25838738 PMCID: PMC4381315 DOI: 10.4103/0973-1229.153338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/21/2015] [Accepted: 02/21/2015] [Indexed: 11/18/2022] Open
Abstract
The significance of mental health in the entire health scenario has increased. However, the representation of psychiatry in the current MBBS curriculum for undergraduate students in India still remains much less than desirable. Further, stigmatising attitudes lessen these future doctors’ ability to detect and manage patients with psychological problems despite adequate knowledge about psychiatry. Students believe that psychiatrically ill patients are unpredictable and can be dangerous to others. Some feel that psychiatry is unscientific, imprecise and treatment is not effective. Traditional teaching methods are directed more towards imparting knowledge than changing the attitudes of students. Newer teaching and assessment techniques should be used to bring about attitudinal changes and develop interest among medical students. Case based and problem based learning, small group teaching, simulated patients, using movies, multidisciplinary seminars, integrated teaching, attitude questionnaires, objective structured clinical examinations etc., could be introduced in the curriculum to achieve this objective.
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Affiliation(s)
- Ajita Nayak
- BPS President 2013-2014. Professor, Department of Psychiatry, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Seshadri K. Response to article: The manpower development scheme under the National Mental Health Program. Indian J Psychiatry 2013; 55:306-7. [PMID: 24082259 PMCID: PMC3777360 DOI: 10.4103/0019-5545.117157] [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: 12/05/2022] Open
Affiliation(s)
- Kalyanasundaram Seshadri
- The Richmond Fellowship Post Graduate College for Psychosocial Rehabilitation, Bangalore, Karnataka, India E-mail:
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Naik SK, Pattanayak S, Gupta CS, Pattanayak RD. Help-seeking Behaviors Among Caregivers of Schizophrenia and other Psychotic Patients: A Hospital-based Study in Two Geographically and Culturally Distinct Indian Cities. Indian J Psychol Med 2012; 34:338-45. [PMID: 23723541 PMCID: PMC3662130 DOI: 10.4103/0253-7176.108214] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND India is a country of several diversities and cultures, which may influence the help-seeking behavior of mentally ill patients and families. Only a few Indian studies have focused on help seeking, especially for severe mental disorders. OBJECTIVE The study aimed to describe and compare the help-seeking behaviors among caregivers of psychotic patients visiting psychiatric clinics at two distinct cities of India. MATERIALS AND METHODS This was a cross-sectional exploratory study of key caregivers (N=50) of patients with a DSM-IV TR diagnosis of schizophrenia and other psychotic disorders, visiting psychiatric out-patient departments of VIMHANS, New Delhi, and CIMS, Bilaspur, Chhattisgarh. After due informed consent was taken, a semi-structured proforma was administered for socio-demographic profile, illness details, causative beliefs, and information on help seeking. RESULTS Supernatural forces were held responsible by 40% of the Bilaspur sample in contrast to 8% in New Delhi sample. Faith-healers were initial contacts for 56% and 64% of sample, respectively, at New Delhi and Bilaspur. Faith-healers followed by a psychiatrist formed the commonest pathway of care at both centers (32% and 36%, respectively). The sample at New Delhi spent significantly more money (median: $4000 vs. $10) and traveled greater distances (median: 35 km vs. 10 km) for faith-healers during the course of illness. Two-thirds of sample in New Delhi and one-third at Bilaspur were aware of the nearby psychiatrist at the time of initial help seeking; however, only 28% and 12%, respectively, chose psychiatrist as an initial contact. The New Delhi sample reported a fear of medication adverse effects and stigma as perceived disadvantages of psychiatric help. The median time lost at both the centers was 1 month, with a maximum of 8.4 years in New Delhi and 4.9 years in Bilaspur. Of the total, 16% caregivers at New Delhi and 32% at Bilaspur center reported an intention to continue with faith-healing practices alongside psychiatric care. CONCLUSION In spite of differing causal attributions, the patients and families across these cities may not be as different when it comes to behaviors related to help seeking for mental illness. Future large-scale studies across various regions of India may help in determining sociocultural and regional patterns of help seeking in greater detail.
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Affiliation(s)
- Sujit Kumar Naik
- Department of Psychiatry, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
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Trivedi JK, Jilani AQ. Reply to queries raised on the article 'the pathway to psychiatric care'. Indian J Psychiatry 2012; 54:398-401. [PMID: 23372257 PMCID: PMC3554986 DOI: 10.4103/0019-5545.104852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jitendra Kumar Trivedi
- Department of Psychiatry, C.S.M. Medical University, Lucknow, Uttar Pradesh, India. E-mail:
| | - A. Q. Jilani
- Department of Psychiatry, C.S.M. Medical University, Lucknow, Uttar Pradesh, India. E-mail:
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