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Garg R, Chavan BS, Das S, Puri S, Banavaram AA, Benegal V, Rao GN, Varghese M, Gururaj G. Treatment gap for mental and behavioral disorders in Punjab. Indian J Psychiatry 2023; 65:1269-1274. [PMID: 38298876 PMCID: PMC10826874 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_839_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background and Aims There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.
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Affiliation(s)
- Rohit Garg
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Bir Singh Chavan
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Subhash Das
- Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Sonia Puri
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Arvind A. Banavaram
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Tegegne KD, Boke MM, Lakew AZ, Gebeyehu NA, Kassaw MW. Alcohol and khat dual use among male adults in Ethiopia: A multilevel multinomial analysis. PLoS One 2023; 18:e0290415. [PMID: 37733791 PMCID: PMC10513231 DOI: 10.1371/journal.pone.0290415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Substance use has been a long-standing global public health problem with detrimental physical, psychological, social, and economic consequences at individual and societal levels. Large-scale and gender-specific studies on the dual use of alcohol and khat are limited. This study aimed to estimate the prevalence of dual alcohol and khat use and identify associated factors among male adults in Ethiopia. METHODS The present study used data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Prior to data analysis, the data were weighted to ensure a representative sample and obtain a reliable estimate. Multilevel multinomial logistic regression was used to identify the factors associated with alcohol and khat use. Adjusted Odds Ratios (AOR) with 95% confidence interval and P value ≤ 0.05 in the multivariable model were used to identify significant factors associated with alcohol and khat use. RESULTS This study included 12,688 participants, of which (80.29%) were from rural areas. The mean age of participants was 30.92 years old. The prevalence of neither Alcohol nor Khat users were (33.2%); 95% Confidence Interval (CI) (32.4-34.1) only Khat users (22.0%); 95% CI (21.2-22.7), only Alcohol users (35.6%); 95% CI (34.7-36.4), and dual Alcohol and Khat users were (9.0%); 95% CI (8.5-9.5). At the individual level: being in the age group of 15-29 years and 30-49years increases the odds of Khat chewing by AOR (95%CI) 2.27 (1.75, 2.89) and 1.55 (1.16, 2.07) times, respectively. At the community level: males from Amhara 3.49(1.91, 6.42), and Tigray 2.7(1.49, 5.05) regions were more likely to drink alcohol. CONCLUSION The high prevalence of dual alcohol and khat use implies for greater access to evidence-based treatment. Multiple factors are associated with alcohol and khat use at individual and community levels. All male adults would benefit from targeted preventive strategies.
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Affiliation(s)
- Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Moges Muluneh Boke
- Department of Reproductive Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asres Zegeye Lakew
- Associate Animal Health Researcher at Sirinka Agricultural Research Center, Woldia, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolita Sodo University, Wolita Sodo, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Bansal P, Saini B, Bansal PD, Bansal A, Dhillon JS, Kaur V, Singh G, Saini S. Presenting Pattern and Psychiatric Comorbidities in Rural versus Urban Substance Dependent Patients: A Hospital-Based Cross-Sectional Study. Indian J Community Med 2023; 48:666-675. [PMID: 37970168 PMCID: PMC10637592 DOI: 10.4103/ijcm.ijcm_618_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/27/2023] [Indexed: 11/17/2023] Open
Abstract
Background "Locality" is a significant factor in substance initiation, maintenance, and relapse. The pattern of substance dependence among rural and urban populations varies across studies and is scarcely studied, warranting further research. To compare presenting patterns (sociodemographic and drug-related variables), reasons for substance use, and psychiatric comorbidities (prevalence, type, and severity) between rural and urban substance-dependent groups. Materials and Methods This study was a cross-sectional analytical study in a government de-addiction center, including rural and urban patient groups aged 18-65. International Classification of Diseases, Tenth Revision (ICD-10) criteria, and severity of dependence scale were used for diagnosing substance dependence. After detoxification, psychiatric comorbidity was assessed using brief psychiatric rating scale, Young's mania rating scale, and patient health questionnaire - somatic, anxiety, and depression symptoms scale. Post-analysis was performed to assess socioeconomic variables and access to de-addiction services. Results The final sample was 500 (250 rural and 250 urban). The post-analysis sample size was 386 (211 rural and 175 urban). The mean age was 38.2 ± 12.4 years, mostly males (n = 495, 99%). Substance frequency was opioids (92%)> benzodiazepines (24.8%) > alcohol (22%) > cannabis (1.6%) for rural and opioids (91.2%) > alcohol (29.6%) > benzodiazepines (14.8%) > cannabis (2%) for urban patients. More than half of patients had comorbid nicotine dependence. Rural patients were more benzodiazepine dependent (P = 0.007), and urban were more opioid + alcohol dependent (P = 0.001). Rural patients had higher age (P = 0.012), less education (P < 0.001), positive family history of substance (P = 0.028), daily wagers, and farmers (P < 0.001) than urban patients who were younger, students (P = 0.002), businessmen and government employed (P < 0.001). Urban patients expended more on drugs (P < 0.001), had higher treatment attempts (P = 0.008), and had better availability and accessibility of de-addiction services (P < 0.001). More rural users initiated substances to "enhance performance," whereas urban ones initiated for "stress relief/novelty" (P < 0.001). For treatment seeking, "External pressure" was a more common reason in urban patients (P < 0.001), who also had more psychiatric comorbidities (P = 0.026). Conclusion Significant pattern differences exist between rural and urban substance dependents, warranting emphasis on locality-specific factors for appropriate intervention.
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Affiliation(s)
- Priyanka Bansal
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Bhavneesh Saini
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Pir D. Bansal
- DDAC, District Hospital, Bathinda, Punjab, India
- Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | | | | | - Vanipreet Kaur
- Department of Psychiatry, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Sumit Saini
- Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, India
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Tiwari A, Sharma A, Jaswal S, Kaur SS, Thakur N. Assessing the Patient Outcomes and Performance of a Cardiothoracic and Vascular Surgery (CTVS) Unit During Its First Two Years in a Tier-2 City in India: A Comprehensive Audit and Analysis. Cureus 2023; 15:e42910. [PMID: 37664258 PMCID: PMC10474900 DOI: 10.7759/cureus.42910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
This detailed article presents a comprehensive overview of the initial two-year experience in establishing a new cardiothoracic vascular surgery (CTVS) facility in a tier-2 city in India. The article discusses various aspects of setting up and operating a specialized healthcare facility. The first two years of developing the CTVS facility were included in the study period. The manpower included one cardiothoracic vascular surgeon, one cardiac anesthesiologist, two perfusionists, and two physician assistants, along with four other ancillary staff to assist in the smooth functioning of the operation theater. The CTVS recovery staff included 15 nursing officers. There was only one modular operation theater reserved for cardiothoracic vascular surgeries, along with a five-bed recovery room (CTVS intensive care unit). One-hundred-seventy-two procedures were done, including 122 open heart surgeries, 36 vascular procedures, and 14 thoracic procedures. The majority of patients were discharged by the seventh day postoperatively. Overall complication and mortality rates were 8% and 4.6%, respectively. This article also discusses relevant hospital policy, challenges faced, and future recommendations for similar endeavors. The findings highlight the successful implementation of the facility and its impact on providing specialized cardiac care to the local population.
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Affiliation(s)
- Anuj Tiwari
- Department of Surgery, Sri Guru Ram Das (SGRD) Institute of Medical Sciences and Research, Amritsar, IND
| | - Abhishek Sharma
- Department of Anaesthesia, Sri Guru Ram Das (SGRD) Institute of Medical Sciences and Research, Amritsar, IND
| | - Sofia Jaswal
- Department of Anesthesia and Critical Care, Homi Bhabha Cancer Hospital and Research Center, Chandigarh, IND
| | - Suzen S Kaur
- Department of Anesthesia, Sri Guru Ram Das (SGRD) Institute of Medical Sciences and Research, Amritsar, IND
| | - Niketa Thakur
- Department of Radiation Oncology, Government Medical College, Amritsar, Amritsar, IND
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Mekonen T, Chan GCK, Connor J, Hall W, Hides L, Leung J. Treatment rates for alcohol use disorders: a systematic review and meta-analysis. Addiction 2021; 116:2617-2634. [PMID: 33245581 DOI: 10.1111/add.15357] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/11/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023]
Abstract
AIMS To estimate the treatment rate for alcohol use disorders (AUDs) in the general adult population. Treatment rates were also considered in relation to economic differences. METHODS Systematic review and meta-analysis. We searched PubMed, EMBASE, PsycINFO and CINAHL databases to identify studies that reported treatment rates for alcohol use disorders in the general population. Independent reviewers screened the articles based on predefined inclusion criteria. Data were extracted using a standardized data extraction form. We conducted quality assessments of the included studies. The overall treatment rates were estimated from studies that reported any treatment for AUDs from healthcare or informal non-healthcare settings (any treatment). We estimated the separate treatment rates for each diagnostic category as reported in the primary studies: AUD as a single disorder, alcohol abuse and alcohol dependence. Data were pooled using a random-effect model. RESULTS Thirty-two articles were included to estimate the treatment rates (percentage treated among the total number of people with AUDs). The pooled estimate of people with AUDs who received any treatment were 14.3% (95% CI: 9.3-20.3%) for alcohol abuse, 16.5% (95% CI: 12-21.5%) for alcohol dependence and 17.3% (95% CI: 12.8-22.3%) for AUD. A subgroup analysis by World Bank economic classification of countries found that the treatment rate for AUD was 9.3% (95% CI: 4.0-15.7%) in low and lower-middle-income countries. CONCLUSION Globally, approximately one in six people with AUDs receives treatment. Treatment rates for AUDs are generally low, with even lower rates in low and lower-middle-income countries.
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Affiliation(s)
- Tesfa Mekonen
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia.,Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia.,Discipline of Psychiatry, The University of Queensland, Brisbane, QLD, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia.,Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Rather YH, Bhat FR, Malla AA, Zahoor M, Ali Massodi PA, Yousuf S. Pattern and prevalence of substance use and dependence in two districts of Union Territory of Jammu & Kashmir: Special focus on opioids. J Family Med Prim Care 2021; 10:414-420. [PMID: 34017763 PMCID: PMC8132791 DOI: 10.4103/jfmpc.jfmpc_1327_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Kashmir has been at the centre of conflict between India and Pakistan after partition of erstwhile British India in 1947. While research suggests that conflict exposure may result in increased substance use, the prevalence of substance use disorders has remained an under-searched area in Kashmir. Method: We employed respondent-driven sampling (RDS) for recruiting substance users from two districts of Kashmir. Estimation of substance dependence was done using benchmarkmultiplier method. Results: Prevalence of any substance dependence was estimated to be 1.95% while as for any opioids, it was 1.80%. Heroin was the most common opioid with last year use by 84.33% respondents. Current prevalence of injection drug use was 0.95% and heroin was the most common opioid among Injection Drug User (IDU), being used by 91.12% IDUs followed by Pentazocine (5.92%). Conclusion: Our results indicate that RDS was a feasible and acceptable sampling method for recruiting 'difficult to reach 'participants like illicit substance users including IDUs. Our results further demonstrate that opioids are highly prevalent in Kashmir and heroin injection is not uncommon. All these findings call for attention from policy makers as opioids are one of the important contributors to mortality and morbidity related to substances.
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Affiliation(s)
- Yasir Hassan Rather
- Department of Psychiatry, Institute of Mental Health and Neuroscience, Government Medical College, Srinagar, Kashmir, India
| | - Fazle Roub Bhat
- Drug De Addiction and Treatment Centre, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Altaf Ahmad Malla
- Department of Psychiatry, Institute of Mental Health and Neuroscience, Government Medical College, Srinagar, Kashmir, India
| | - Marya Zahoor
- Department of Psychiatry, Institute of Mental Health and Neuroscience, Government Medical College, Srinagar, Kashmir, India
| | | | - Saleem Yousuf
- Department of Psychiatry, Institute of Mental Health and Neuroscience, Government Medical College, Srinagar, Kashmir, India
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