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Jena S, Swain PK, Senapati RE, Acharya SK. Trajectory of suicide among Indian children and adolescents: a pooled analysis of national data from 1995 to 2021. Child Adolesc Psychiatry Ment Health 2024; 18:123. [PMID: 39350277 PMCID: PMC11443910 DOI: 10.1186/s13034-024-00818-9] [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: 03/25/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Suicide is a major public health concern in India especially among children and adolescents. The yearly national statistics show a concerning trend of rising suicide deaths in these age groups. METHODS The present study, taking 26 years of national data from the National Crime Record Bureau during 1995-2021, examined the trend, patterns, means, and modes of children/adolescent suicides in India. We also undertook a time series analysis by using ARIMA (0,2,1) model to forecast the expected suicide rate for the next one decade. RESULTS A rising trend of suicide rate among children and adolescents was observed in India over the last 26 years. The forecast indicates a continuance of rising suicide cases for the upcoming decade in India. A substantially different trend of suicide rate was observed among early and late adolescents indicating significantly high vulnerability of late adolescents. Among children /adolescents, the most common causes of suicide were family problems, academic failure, illness, and unemployment. Illness has emerged as one of the leading causes of suicide, with a significant rise over time. Poverty and unemployment were also found as the important contributors with a steadily increasing trend of suicide among children and adolescents facing these problems in recent years. CONCLUSION The study provides important analysis and information on suicide among children/adolescents in India, by providing useful insights for parents, teachers, policymakers, healthcare practitioners, and stakeholders aiming to prevent and control children and adolescent suicide and boost mental health. The study also provides important leads on risk factors with a forecast of suicide trends for the next 10 years.
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Affiliation(s)
- Susangita Jena
- ICMR-Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, 751023, Odisha, India
| | | | - Rachel Elizabeth Senapati
- ICMR-Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, 751023, Odisha, India
| | - Subhendu Kumar Acharya
- ICMR-Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, 751023, Odisha, India.
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Ilori EO, Eziechi NM, Erechukwu C, Obijiofor NB, Agazie O, Obitulata-Ugwu VO, Okobi OE, Aderemi L, Salawu MA, Ewuzie ZD, Anamazobi EG, Alozie AS. Analyzing Trends in Mental and Behavioral Health Support for Children: A Comprehensive Study Using National Survey of Children's Health Database. Cureus 2024; 16:e59499. [PMID: 38826937 PMCID: PMC11143464 DOI: 10.7759/cureus.59499] [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] [Accepted: 04/24/2024] [Indexed: 06/04/2024] Open
Abstract
Objective This study aimed to explore mental and behavioral health support trends for children aged 3-17, analyzing treatment and counseling using United States data from the 2016-2020 National Survey of Children's Health (NSCH) database. Methods Employing a retrospective observational design, we systematically retrieved and analyzed NSCH Database data from 2016 to 2020. The focus was on understanding mental and behavioral health treatment percentages over time, specifically targeting demographic variations such as age groups, gender, race/ethnicity, and the federal poverty level percentage. Graphical representation utilized Excel, summarizing results based on aggregated data for distinct time intervals, highlighting the importance of mental and behavioral health support for children aged 3-17. Results The study identified significant temporal trends in mental and behavioral health treatment, revealing notable fluctuations across demographic and socio-economic variables. Of the 22,812 participants, 51.7% (CI: 50.2-53.1%, n=12,686) received treatment, exposing disparities. Gender differences were evident, with higher treatment rates in females (53.7%, CI: 51.6-55.9%, n=6,166) than males (50.1%, CI: 48.2-52.0%, n=6,520). Age-specific patterns indicated lower intervention rates in younger children (33.5%, CI: 28.6-38.8%, n=447, ages 3-5) compared to adolescents (58.1%, CI: 56.2-59.9%, n=8, 222 ages 12-17). Conclusion The conclusion highlights significant temporal fluctuations and pronounced demographic disparities. Findings underscore varying prevalence rates among age groups, genders, racial/ethnic backgrounds, and socio-economic status categories. This study provides valuable insights for policymakers, healthcare professionals, and researchers, informing targeted interventions to enhance mental and behavioral health support for United States children.
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Affiliation(s)
- Emmanuel O Ilori
- Psychiatry and Behavioral Sciences, Garnet Health Medical Center, Middletown, USA
| | | | | | | | - Ogochukwu Agazie
- General Physician, College of Medicine, University of Lagos, Idi-Araba, NGA
| | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Lara Aderemi
- Family Medicine, University of Calgary, Calgary, CAN
| | - Mujeeb A Salawu
- Medicine and Surgery, University of Ilorin College of Health Sciences, Ilorin, NGA
- Internal Medicine and Psychiatry, Houston Health Department, Houston, USA
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Sarkar A, Rahaman SM, Das DK, Banerjee N. Mental Health Disorders among Children and Associated Parental Stress: A Cross-Sectional Study in Pediatric OPD of Burdwan Medical College, West Bengal. Indian J Community Med 2024; 49:417-423. [PMID: 38665434 PMCID: PMC11042142 DOI: 10.4103/ijcm.ijcm_49_23] [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: 01/29/2023] [Accepted: 12/29/2023] [Indexed: 04/28/2024] Open
Abstract
Background Identification of mental health disorders during childhood is crucial for healthy 'adult roles' in the society, so this study aimed to estimate the magnitude of 'any mental health disorder' and to find out its correlates among children attending the pediatric out-patient department (OPD) of a medical college in West Bengal and to estimate parental stress among their parents. Materials and Methods It was a descriptive cross-sectional study done in the pediatric OPD of Burdwan Medical College, West Bengal, during July-December, 2021. The calculated size of 288 children aged between 4 and 12 years and attending with either of their parents was selected through systematic random sampling. One of their parents (preferably mother) was interviewed using a schedule, containing a pre-validated pediatric symptom checklist and parental stress scale. Ethical clearance was obtained from the Institutional Ethics Committee. Data were analyzed using SPSS-v23. Results The median age of the children was 7 years (5-8 y.). The majority of them were male (57.6%), lived in urban areas (59.0%), and lived in joint families (57.6%). One-fifth (20.5%) of the children were found to have any mental health disorder (AMHD). Living in an urban area (aOR = 2.5, 95% CI: 1.1-5.7), belonging to a nuclear family (aOR = 3.6, 95% CI: 1.7-8.1), and belonging to a family with social problems (aOR = 7.8, 95% CI: 2.3-27.2) were significant correlates of AMHD. Parental stress [median: 60 (55-63)] was found significantly higher (P < 0.001) among parents of children with AMHD as compared to the parents of others. Conclusion The magnitude of AMHD was high in this study, indicating toward the necessity of implementing opportunistic screening and appropriate public health action.
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Affiliation(s)
- Anisha Sarkar
- Department of Community Medicine, Burdwan Medical College, West Bengal, India
| | | | - Dilip K. Das
- Department of Community Medicine, Murshidabad Medical College, West Bengal, India
| | - Niladri Banerjee
- Department of Community Medicine, Nil Ratan Sircar Medical College, West Bengal, India
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Sharma R, Danish M, Khajenoori Y, Shaikh D, Chaudary Y, Khan H, Bhat N, Doshi A, Nalawade S, Rajput P, Shahi S, Shankar P. Codeveloping an Adolescent Health Program in India During the COVID-19 Pandemic: A Case Study of a Community-Partnered Responsive Feedback Approach. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200224. [PMID: 38110201 PMCID: PMC10727469 DOI: 10.9745/ghsp-d-22-00224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/19/2023] [Indexed: 12/20/2023]
Abstract
We describe the responsive feedback (RF) approach experience of a nongovernmental organization, Girls Health Champions (now known as Adolescent Health Champions [AHC]), that undertakes peer education interventions in Mumbai, India, schools to improve gender equality and health outcomes for adolescents aged 13-19 years. AHC used the RF approach at the onset of the COVID-19 pandemic in light of uncertainties stemming from school closures and the negative impact of the lockdown on adolescents' physical and mental health. Using an RF approach, AHC was able to: (1) understand pandemic-specific challenges faced by adolescents; (2) overhaul its theory of change; (3) pilot new modes of intervention delivery; (4) design a curriculum for parents/guardians and a COVID-19 module; (5) design an AHC mobile app; (6) develop a new, more gender-inclusive name and visual identity; (7) change the overall structure, adolescent-friendly nature, and agility of the organization; (8) and help clarify future directions taken by the organization. Overall, use of the RF approach had significant positive impacts on AHC as an organization, such as changes in organizational culture, deeper stakeholder engagement, and innovation, and was instrumental in AHC's growth, development, and pandemic response. This article outlines the steps of the process, from initial informal stakeholder consultations to the eventual formalization of the RF approach into the everyday working of AHC through the creation of a youth advisory board. We discuss challenges, such as time and resource constraints encountered; strategies for dealing with such challenges; and general key findings and learnings from this experience that could be beneficial to other youth- and community-serving organizations.
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Affiliation(s)
- Ricky Sharma
- Adolescent Health Champions, San Francisco, CA, USA
| | | | | | | | | | - Hiba Khan
- Adolescent Health Champions, Mumbai, India
| | - Neha Bhat
- Adolescent Health Champions, Mumbai, India
| | | | | | | | | | - Priya Shankar
- Adolescent Health Champions, San Francisco, CA, USA.
- University of California, San Francisco, San Francisco, CA, USA
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Luz PDO, de Souza AA, Boska GDA, Cardoso MMDA, Candido BDP, de Oliveira MAF. Nursing experiences in specialized services in child and adolescent mental health: a systematic review of qualitative studies. Rev Bras Enferm 2023; 76Suppl 2:e20220550. [PMID: 38088654 PMCID: PMC10704658 DOI: 10.1590/0034-7167-2022-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to synthesize evidence from qualitative studies on nursing experiences regarding child and adolescent mental health care in specialized services. METHOD a systematic review with meta-synthesis of qualitative studies according to JBI guidelines. CINAHL, EMBASE, MEDLINE, LILACS, PSYCinfo, Scopus and Web of Science databases were used. The findings were classified according to the level of reliability and credibility and categorized by similarity between contents. RESULTS 229 articles were identified, and five were included in the final sample and organized into the categories: Emotional impact; and Understanding nursing role. The level of evidence found was moderate. FINAL CONSIDERATIONS nursing experiences are permeated by emotional exhaustion, feelings of frustration and difficulty in understanding their professional role. The need for training spaces that qualify this care is highlighted.
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Bazargan M, Dehghani A, Ramezani MA, Ramezani A. Prevalence of depression among Iranian children and adolescents: An updated systematic review and meta-analysis. Health Sci Rep 2023; 6:e1584. [PMID: 37795313 PMCID: PMC10545890 DOI: 10.1002/hsr2.1584] [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: 05/17/2023] [Revised: 08/03/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
Background and Aims One of the most common mental disorders among children and adolescent is depression. Some of the conducted studies indicate a too-high prevalence of depression, which cannot be generalized to the entire country. So the pooled estimation of the results of different studies is very important to reach valid results. So the current study aimed to determine the prevalence of depression among Iranian children and adolescents using an updated systematic review and meta-analysis. Methods A random-effects model was used to estimate the pooled prevalence of depression (I 2 = 99.7% and Cochran's Q, p < 0.001). To assess the effect of different factors on heterogeneity, the univariate meta-regression model was used. Publication bias was evaluated by Beggs and Eggers tests as well as funnel plots. Data were analyzed by STATA v 11 (StataCorp.). The significance level of the tests was considered less than 0.05. Results The prevalence of depression was 33.3% (95% CI: 27.3-39.2). The most prevalence estimated using the Beak questionnaire (57.1% [95% CI: 50.2-64.0]) and the lowest was estimated using the K-SADS-PL (9.0% [95% CI: 4.0-13.6]). This estimate among females was more than among males (47.2% [95% CI: 35.4-58.9] vs. 30.5 [95% CI: 7.4-53.6]). Regarding the geographical region, the most and the lowest amount of depression was seen in the central with 41.7% (95% CI: 19.2-64.3) and southern region with 21.9% (95% CI: 14.2-29.6), respectively. Conclusion The high prevalence of depressive disorders in Iranian children emphasizes the importance of prevention measures for these disorders.
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Affiliation(s)
- Maedeh Bazargan
- Department of Psychology, Najafabad BranchIslamic Azad UniversityNajafabadIran
| | - Akram Dehghani
- Department of Psychology, Najafabad BranchIslamic Azad UniversityNajafabadIran
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Meghrajani VR, Marathe M, Sharma R, Potdukhe A, Wanjari MB, Taksande AB. A Comprehensive Analysis of Mental Health Problems in India and the Role of Mental Asylums. Cureus 2023; 15:e42559. [PMID: 37637646 PMCID: PMC10460242 DOI: 10.7759/cureus.42559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
This review article provides a comprehensive overview of the current state of mental health in India, highlighting the challenges faced, the existing initiatives, and the future directions for improving mental healthcare delivery. India is grappling with a high prevalence of mental health disorders, including depression, anxiety disorders, bipolar disorder, schizophrenia, and substance use disorders. The burden of mental health issues on individuals, families, and society is immense, leading to reduced quality of life, impaired functioning, and significant economic and social consequences. Various social and cultural factors, such as stigma, discrimination, gender inequalities, poverty, rapid urbanization, and cultural beliefs surrounding mental illness, further exacerbate the challenges of addressing mental health problems. Access to mental healthcare remains a significant concern, with considerable gaps in access to and quality of treatment and limited availability of mental health professionals, especially in rural areas. Inadequate infrastructure, a lack of awareness, and insufficient integration into primary healthcare systems hinder access to appropriate care. The historical development of mental asylums in India is examined, highlighting their establishment, purpose, and evolution over time. Critiques and challenges associated with mental asylums are discussed, including stigmatization, human rights concerns, the absence of human center approaches, quality of care, and the need for alternative approaches to mental healthcare.
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Affiliation(s)
- Vanee R Meghrajani
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manvi Marathe
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ritika Sharma
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwini Potdukhe
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research Scientist, Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chatterjee K, Srivastava K, Prakash J, Dangi A. Positive mental health for all serving the under-served. Ind Psychiatry J 2023; 32:234-239. [PMID: 38161446 PMCID: PMC10756617 DOI: 10.4103/ipj.ipj_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023] Open
Abstract
Mental disorders are major contributors to global burden of disease measured in Disability Adjusted Life Years (7% of all disease burden in 2017). Large treatment gaps for these disorders exist in all parts of the world. In India, overall treatment gap for mental disorders was found to be 83%. Women, children and adolescents, ethnic minorities, LGBTQ+ community, elderly and those living in remote and inaccessible areas have disproportionately higher rates of mental illness. They face unique and characteristic barriers to access to mental healthcare which increases treatment gap. These gaps have persisted despite global efforts and interventions to mitigate these barriers. Hence, there is a need to find alternatives to reduce mental health gap in these groups. Positive Mental Health interventions focuson well-being and health promoting activities, rather than on illness. The potential role of these interventions in promoting mental health and reducing treatment gap has been explored in this article.
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Affiliation(s)
- Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankit Dangi
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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Raman V, Thomas S. School Mental Health Program in India-Issues and Possible Practical Solutions. Indian J Psychol Med 2023; 45:283-288. [PMID: 37152393 PMCID: PMC10159568 DOI: 10.1177/02537176231165033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Affiliation(s)
- Vijaya Raman
- Dept. of Psychiatry, St. John’s Medical
College, Bangalore, Karnataka, India
- Vijaya Raman, Dept. of Psychiatry, St. John’s
Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India.
| | - Shanti Thomas
- Dept. of Psychiatry, St. John’s Medical
College, Bangalore, Karnataka, India
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Khan NU, Khan U, Khudadad U, Ali A, Raheem A, Waheed S, Razzak JA. Trends in mortality related to unintentional poisoning in the South Asian region from 1990 to 2019: analysis of data from the Global Burden of Disease Study. BMJ Open 2023; 13:e062744. [PMID: 36754559 PMCID: PMC9923325 DOI: 10.1136/bmjopen-2022-062744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the burden of unintentional poisoning in South Asian countries from 1999 to 2019. DESIGN An ecological study conducted at the regional level for South Asian countries, based on data from the Global Burden of Disease Study 2019. SETTING We extracted unintentional poisoning data from the Global Burden of Disease Study data set from 1990 to 2019 to assess trends in mortality, disability-adjusted life-years (DALYs), years of life lost, years lived with disability (YLDs) and causative agents in South Asian countries (Bangladesh, Bhutan, India, Nepal and Pakistan). OUTCOME MEASURES We determined the per cent change and 95% CI for the period between 1990 and 2019 by age, gender and country. We also conducted Poisson regression to measure the percentage change in the rate per year. RESULTS The absolute number of deaths due to unintentional poisoning in South Asia decreased (-32.6%) from 10 558 deaths in 1990 to 7112 deaths in 2019. The age standardised death rate from unintentional poisoning in South Asia has seen a downward trend (-55.88%), declining from 0.87 (0.67-1.01) age-standardised per 100 000 population in 1990 to 0.41 (0.34-0.47) in 2019. Among age groups, under 9 years and 10-19 years have seen downward trends for death and DALYs, accounting for -93.5% and -38.3%, respectively. YLDs have seen an upward trend (5.9%), increasing from 10 461.7 per 100 000 in 1990 to 11 084 per 100 000 in 2019. YLDs in women increased by 7.4%, from 11 558.2 per 100 000 to 12 418.3 per 100 000. The incidence rate ratios (IRRs) adjusted by all age groups and gender for DALYs in all South Asian countries has reduced significantly (IRR 0.97, 95% CI 0.96 to 0.97) from 1990 to 2019. CONCLUSION This study showed reduction in death and DALYs due to unintentional poisoning in South Asia except YLDs which is showing an increasing trend. Public health systems should continue efforts to minimise and prevent disabilities arising from unintentional poisoning in South Asia.
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Affiliation(s)
- Nadeem Ullah Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Uzma Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Umerdad Khudadad
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Asrar Ali
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Ahmed Raheem
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Shahan Waheed
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Deng J, Zhou F, Hou W, Heybati K, Lohit S, Abbas U, Silver Z, Wong CY, Chang O, Huang E, Zuo QK, Moskalyk M, Ramaraju HB, Heybati S. Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis. Ann N Y Acad Sci 2023; 1520:53-73. [PMID: 36537131 PMCID: PMC9880764 DOI: 10.1111/nyas.14947] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic and its accompanying infection control measures introduced sudden and significant disruptions to the lives of children and adolescents around the world. Given the potential for negative impacts on the mental health of youths as a result of these changes, we conducted a systematic review and meta-analysis to examine the prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances in children and adolescents during the pandemic. We searched major literature databases for relevant cross-sectional or longitudinal studies that included primary and secondary school students or children and adolescents ≤18 years of age. Prevalence values were extracted, logit-transformed, and pooled. Based on 191 included studies with 1,389,447 children and adolescents, we found the pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances to be 31%, 31%, and 42%, respectively. Age, grade levels, education levels, gender, geographical regions, and electronics use were correlated with the prevalence of mental health symptoms. The prevalence of mental health symptoms also increased with time, although signs of recovery and stabilization were also observed. Overall, the results from this review demonstrate the need for increased mental health research, monitoring, and intervention for children and adolescents during the current and future pandemics.
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Affiliation(s)
- Jiawen Deng
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Fangwen Zhou
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Wenteng Hou
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Schulich School of Medicine & DentistryUniversity of Western OntarioLondonOntarioCanada
| | - Kiyan Heybati
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Mayo Clinic Alix School of MedicineMayo Clinic (Rochester)RochesterMinnesotaUSA
| | - Simran Lohit
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Umaima Abbas
- Schulich School of Medicine & Dentistry (Windsor Campus)University of Western OntarioWindsorOntarioCanada
| | - Zachary Silver
- Department of Neuroscience, Faculty of ScienceCarleton UniversityOttawaOntarioCanada
| | - Chi Yi Wong
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Michael G. DeGroote School of Medicine (Waterloo Regional Campus)McMaster UniversityKitchenerOntarioCanada
| | - Oswin Chang
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Physician Assistant Education Program, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Emma Huang
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Qi Kang Zuo
- Department of AnesthesiologyRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
- Faculty of ScienceMcGill UniversityMontréalQuebecCanada
| | - Myron Moskalyk
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Harikrishnaa Ba Ramaraju
- Virginia Commonwealth University School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Shayan Heybati
- Faculty of Health SciencesQueen's UniversityKingstonOntarioCanada
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Devi SP, Mishra AK. The Testing Effect: Looking Through Implicit Theories’ Perspectives. PSYCHOLOGICAL STUDIES 2023. [DOI: 10.1007/s12646-022-00710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Bhardwaj T. Development and Validation of the Multidimensional Psychosocial Risk Screen (MPRS): An Approach towards Primary Prevention. Indian J Psychol Med 2023; 45:220-229. [PMID: 37152390 PMCID: PMC10159557 DOI: 10.1177/02537176221140150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: The prevalence of mental health problems in adolescents has been identified as a global concern. Early screening and identification can offer benefits in terms of primary prevention and reduced healthcare costs. This study aimed to develop a tool to assess the risk of developing mental health problems in adolescents. Methods: The study followed an exploratory sequential design and was divided into five phases. The Multidimensional Psychosocial Risk Screen (MPRS) is a newly developed self-report measure. The various steps in its development and validation have been elaborated. The MPRS was evaluated with a sample of 934 adolescents aged 12-18, spread across the 8th-12th grade. Results: Exploratory and confirmatory factor analyses revealed a robust factor structure. The extracted five factors were named as Parent–Child Relationship (PCR), Self-Concept (SC), Teacher–Student Dynamics (TSD), Social Media Use (SMU), and Peer Interaction (PI). The reliability of the subscales ranged from 0.60 to 0.80. The overall reliability of the scale was good (a = 0.87). Convergent validity of the scale was established using standard measures of risk factors and emotional and behavioural problems. Conclusions: The MPRS can be considered an effective tool with an adequate factor structure and good psychometric properties. It can be beneficial in the early detection of vulnerabilities to mental health problems in adolescents and, therefore, seen as a key element in primary prevention and fostering individualized interventions.
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Affiliation(s)
- Tanuja Bhardwaj
- Dept. of Psychology, CHRIST (Deemed to be University) Delhi NCR, Ghaziabad, Uttar Pradesh, India
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14
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Perceived Wellbeing, Happiness, and Related Challenges among Indian College Students. PSYCHOLOGICAL STUDIES 2023; 68:70-81. [PMID: 36686373 PMCID: PMC9845819 DOI: 10.1007/s12646-022-00705-3] [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: 06/07/2021] [Accepted: 11/09/2022] [Indexed: 01/19/2023] Open
Abstract
The present study aimed to examine the conceptualisation and determinants of happiness among Indian college students and identify areas in which they require help. The sample consisted of 362 students in the age group of 18 to 30 years (Mage = 20.9, SDage = 2.25) from two locations in North and South India. Online forms, including the Satisfaction with Life Scale (Diener et al., 1985), Positive and Negative Affect Schedule (Watson et al. in J Pers Soc Psychol 54:1063-1070, 1998) and a qualitative survey, were used to collect the data. Results indicated that participants from institutions that offered mental health initiatives reported higher well-being than those who did not. Findings from the qualitative survey suggest that most participants conceptualised happiness in terms of need for satisfaction and well-being. The responses also indicated that leisure activities and time spent with the family determined the participants' happiness. Concerns related to interpersonal relationships made the participants unhappy, and most of them were willing to seek help in this regard. Factors beyond immediate self and interpersonal networks had a limited role in participants' perceived happiness and unhappiness. Study findings could guide the development of customised mental health and well-being promotion initiatives to meet the needs of Indian college students.
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15
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Quasi-experimental study to assess the effectiveness of mental health programme on promoting mental health characteristics among adolescents in Coimbatore, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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16
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Vanderburg JL, Bhattarai S, Ferrarone P, Giri P, Lamb MM, Giardina AA, Hampanda K, Gaynes BN, Matergia M, Cruz CM. Teacher and caregiver perceptions of family engagement in teacher-led task-shifted child mental health care in a low-and-middle-income country. Glob Public Health 2022; 17:2946-2961. [PMID: 34906038 DOI: 10.1080/17441692.2021.2002924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The mental health needs of children in low-and-middle income countries (LMICs) often go unmet due to a lack of qualified mental health professionals. Task-shifting the provision of mental health services to teachers may facilitate access to care. Family engagement in task-shifting may support mental health outcomes but is understudied in this context. The current study explored teacher and caregiver perceptions of family engagement within a teacher-led, task-shifted mental health intervention in an LMIC. Primary school teachers from five schools in Darjeeling, India delivered evidence-based, indicated mental health care to children with mental health needs throughout the school day. We conducted semi-structured interviews (SSIs) with teachers (n=17) and caregivers (n=21). SSIs were coded for themes related to family engagement. Teachers and caregivers were compared based on perceived levels of engagement. Participants reported three patterns of engagement: families who fully engaged; families who felt positively about teachers but displayed little engagement; and families with limited engagement. Barriers included logistical challenges and misconceptions about the programme. Many teachers implicated family engagement as a facilitator of the programme, suggesting that family involvement may support intervention outcomes. Future work could involve the development of an intervention component to better facilitate engagement in this context.Trial registration: Clinical Trials Registry India identifier: CTRI/2018/01/011471.
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Affiliation(s)
- Juliana L Vanderburg
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC, USA
| | | | - Peter Ferrarone
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.,Centre for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | | | - Karen Hampanda
- Centre for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.,Department of Obstetrics and Gynaecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Michael Matergia
- Centre for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.,Broadleaf Health & Education Alliance, Stroudsburg, PA, USA
| | - Christina M Cruz
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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17
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Hossain MM, Nesa F, Das J, Aggad R, Tasnim S, Bairwa M, Ma P, Ramirez G. Global burden of mental health problems among children and adolescents during COVID-19 pandemic: An umbrella review. Psychiatry Res 2022; 317:114814. [PMID: 36055064 PMCID: PMC9420079 DOI: 10.1016/j.psychres.2022.114814] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022]
Abstract
Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease (COVID-19) pandemic. In this umbrella review, we aimed to synthesize global evidence on the epidemiologic burden and correlates of child and adolescent mental health (CAMH) problems during this pandemic from existing systematic reviews and meta-analyses. Adopting the Joanna Briggs Institute (JBI) methodology, we evaluated 422 citations and identified 17 eligible reviews with medium to high methodological quality. Most of the reviews reported a high prevalence of anxiety, depression, sleep disorders, suicidal behavior, stress-related disorders, attention-deficit/hyperactivity disorder, and other mental health problems. Also, factors associated with CAMH such as age, gender, place of residence, educational attainment, household income, sedentary lifestyle, social media and internet use, comorbidities, family relationships, parents' psychosocial conditions, COVID-19 related experiences, closure of schools, online learning, and social support were reported across reviews. As most studies were cross-sectional and used nonrepresentative samples, future research on representative samples adopting longitudinal and intervention designs is needed. Lastly, multipronged psychosocial care services, policies, and programs are needed to alleviate the burden of CAMH problems during and after this pandemic.
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Affiliation(s)
- M Mahbub Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX 77204, USA; Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77204, USA.
| | - Fazilatun Nesa
- Research Initiative for Health Equity, Khulna, Bangladesh
| | - Jyoti Das
- Research Initiative for Health Equity, Khulna, Bangladesh
| | - Roaa Aggad
- School of Public Health, Texas A&M University, College Station, TX 77840, USA
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College Station, TX 77840, USA
| | - Mohan Bairwa
- All Indian Institute of Medical Sciences, New Delhi, India
| | - Ping Ma
- School of Public Health, Texas A&M University, College Station, TX 77840, USA
| | - Gilbert Ramirez
- Robert Stempel College of Public Health and Social Work, Florida International University, FL 33174, USA
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18
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Cruz CM, Dukpa C, Vanderburg JL, Rauniyar AK, Giri P, Bhattarai S, Thapa A, Hampanda K, Gaynes BN, Lamb MM, Matergia M. Teacher, caregiver, and student acceptability of teachers delivering task-shifted mental health care to students in Darjeeling, India: a mixed methods pilot study. DISCOVER MENTAL HEALTH 2022; 2:21. [PMID: 36341156 PMCID: PMC9622553 DOI: 10.1007/s44192-022-00024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Background The acceptability of teachers delivering task-shifted mental health care to their school-aged students is understudied. Here, we evaluate teachers', students', and caregivers' acceptability of Tealeaf (Teachers Leading the Frontlines), an alternative system of care in which teachers are trained and supervised to deliver transdiagnostic, non-manualized task-shifted care to their students. Methods In a 2019 single-arm, mixed methods, pragmatic acceptability pilot study in Darjeeling, India, 13 teachers delivered task-shifted child mental health care to 26 students in need. Teachers delivered care through using a transdiagnostic, non-manualized therapy modality, "education as mental health therapy" (Ed-MH). Measured with validated scales, teachers' and students' acceptability were compared after teacher training (PRE) and at the end of intervention (POST) using paired t tests. Teachers (n = 7), students (n = 7), and caregivers (n = 7) completed semi-structured interviews POST. Results Teachers' quantitative measures indicated moderate acceptability PRE and POST and did not change PRE to POST. Children's measures showed acceptability PRE and POST but decreased PRE to POST. Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers' ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out. Conclusion Teachers, caregivers, and children found teacher delivering task-shifted care acceptable, a key factor in care adoption and sustainability, though interviewed children were unaware of receiving care.Trial registration The trial was registered on January 01, 2018 with Clinical Trials Registry-India (CTRI), Reg. No. CTRI/2018/01/011471, Ref. No. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27. Supplementary Information The online version contains supplementary material available at 10.1007/s44192-022-00024-z.
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Affiliation(s)
- Christina M. Cruz
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599 USA
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC USA
| | - Choden Dukpa
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India
| | - Juliana L. Vanderburg
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC USA
| | | | - Priscilla Giri
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India
| | | | - Arpana Thapa
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599 USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, MacNider Bldg. Suite 304, CB#7160, 333 S. Columbia St., Chapel Hill, NC 27599 USA
| | - Molly M. Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO USA
- Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA
| | - Michael Matergia
- Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA
- Broadleaf Health and Education Alliance, Stroudsburg, PA USA
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19
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Shawon MSR, Jahan E, Rouf RR, Hossain FB. Psychological distress and unhealthy dietary behaviours among adolescents aged 12-15 years in nine South-East Asian countries: a secondary analysis of the Global School-Based Health Survey data. Br J Nutr 2022; 129:1-10. [PMID: 35856273 DOI: 10.1017/s0007114522002306] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It is unclear whether there is any association between psychological distress and unhealthy dietary habits among adolescents in low- and middle-income countries. We aimed to estimate the prevalence of these factors in South-East Asia region and investigate their associations. We used data from the Global School-based Health Survey for nine South-East Asian countries. Psychological distress was defined by presence of ≥ 2 factors from loneliness, anxiety, suicide ideation, suicide planning and suicide attempt. We assessed inadequate fruit intake, inadequate vegetable intake, daily soft drink and weekly fast-food consumption. We used random-effects meta-analysis to estimate pooled prevalence. Logistic regressions were used to estimate OR of unhealthy dietary behaviours for psychological distress. Among 30 013 adolescents (56 % girls) aged 12-15 years, the prevalence of psychological distress was 11·0 %, with girls reporting slightly higher than boys (11·8 % v. 10·1 %). The prevalence of inadequate fruit intake, inadequate vegetable intake, daily soft drink consumption and weekly fast-food consumption was 42 %, 26 %, 40 % and 57 %, respectively. Psychological distress was associated with inadequate fruit intake (pooled OR = 1·20, 95 % CI 1·03, 1·40), inadequate vegetable intake (pooled OR = 1·17, 1·05, 1·31) and daily soft drink consumption (pooled OR = 1·14, 1·03, 1·26); but not with weekly fast-food consumption (pooled OR = 1·13, 0·96, 1·31). We observed substantial cross-country variations in prevalence and OR estimates. In conclusion, South-East Asian adolescents have significant burden of psychological distress and unhealthy dietary behaviours, with those having psychological distress are more likely to have unhealthy dietary behaviours. Our findings will guide preventative interventions and inform relevant policies around adolescent nutrition in the region.
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Affiliation(s)
| | - Esrat Jahan
- Department of Health Systems and Populations, Macquarie University, Sydney, Australia
| | - Rashawan Raziur Rouf
- Shaheed Suhrawardy Medical College, Sher-E-Bangla Nagar, Dhaka, Bangladesh
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation (BRF), Bangladesh
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20
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Hart MJ, Sable R, Gupta A, Boddu J, McQuillin SD. Adapting a School-Based Motivational Interviewing Mentoring Program for Use in India. SCHOOL PSYCHOLOGY INTERNATIONAL 2022. [DOI: 10.1177/01430343221080782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on the process of planning, adapting, and implementing a brief, instrumental, school-based mentoring curriculum originally developed in the United States, in three cities in India. India has the world’s largest population of young adults aged 10-24 years, a developmental period associated with heightened psychosocial stressors and the onset of mental health issues, as well as a dire shortage of mental health professionals. Moving services that are typically provided by highly skilled professionals to individuals with fewer credentials or less formal training (e.g., from psychologists to mentors) can increase access to adolescent mental health services. Yet, transferring programs internationally is accompanied by unique barriers including cultural differences, and should be guided by an established framework. In this paper, we discuss the formation of a research-practice partnership designed to generate applied knowledge through emic cultural perspectives. We describe each stage of the program adaptation process within the Cultural Adaptation Framework ( Fendt-Newlin et al., 2020 ), including our decisions to strategically adjust, remove, or retain content from the original mentoring intervention. Although program delivery was prematurely discontinued due to the COVID-19 pandemic, we provide a brief synopsis of lessons learned through the international partnership.
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Affiliation(s)
- Mackenzie J. Hart
- Department of Psychology, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Rahul Sable
- Mentor Together, 76/1, 7th A Cross, 27th Main Rd, 1st Sector, HSR Layout, Bengaluru, Karnataka 560102, India
| | - Arundhuti Gupta
- Mentor Together, 76/1, 7th A Cross, 27th Main Rd, 1st Sector, HSR Layout, Bengaluru, Karnataka 560102, India
| | - Jean Boddu
- Mentor Together, 76/1, 7th A Cross, 27th Main Rd, 1st Sector, HSR Layout, Bengaluru, Karnataka 560102, India
| | - Samuel D. McQuillin
- Department of Psychology, University of South Carolina, Columbia, South Carolina 29208, United States
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21
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Ramaswamy S, Seshadri S, Bunders-Aelen J. Shifting landscapes of global child mental health: Imperatives for transdisciplinary approaches. Asian J Psychiatr 2022; 69:103002. [PMID: 34990912 DOI: 10.1016/j.ajp.2021.103002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
There are a multitude of stakeholders involved in the protection, education, mental health and psychosocial care of children for children in LMIC countries. The article presents how the current medical and public health models for child mental healthcare, do not adequately address the complexities of child protection and mental health. It argues for mental health professionals to: (a) recognise the role of Adverse Childhood Experiences (ACEs) in mental health morbidity; (b) adopt an alternative approach, namely that of transdisciplinarity, to enable more effective solutions to children's psychosocial and mental health issues, through systemic reform and transformation.
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Affiliation(s)
- Sheila Ramaswamy
- SAMVAD (Support, Advocacy & Mental Health Interventions for Children in Vulnerable circumstances and Distress), Department of Child & Adolescent Psychiatry, National Institute of Mental Health & Neurosciences, India.
| | - Shekhar Seshadri
- Department of Child & Adolescent Psychiatry, National Institute of Mental Health & Neurosciences, India.
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22
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Vanderburg JL, Dukpa C, Rauniyar AK, Giri P, Bhattarai S, Thapa A, Gaynes BN, Hampanda K, Lamb MM, Matergia M, Cruz CM. Exploring Mental Health and Academic Outcomes of Children Receiving Non-manualized, Transdiagnostic, Task-Shifted Mental Health Care From Their Teachers in a Low-and-Middle Income Country. Front Pediatr 2022; 10:807178. [PMID: 35386261 PMCID: PMC8979063 DOI: 10.3389/fped.2022.807178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
A majority of children worldwide who face mental health difficulties, especially in low-and-middle income countries, remain undiagnosed and untreated. This deficit roots in part from a lack of trained professionals qualified to provide care. Task-shifting the provision of treatment to teachers, individuals with consistent access to children, can reduce the care gap. The current study investigated whether the implementation of a pilot trial of Tealeaf-Mansik Swastha (Teachers Leading the Frontlines-Mental Health; "Tealeaf") was associated with improvements in child mental health and academic outcomes. Tealeaf is a transdiagnostic, non-manualized, task-shifting intervention in which teachers identify students in need of mental health care and then provide task-shifted care for them using an emerging, novel therapy modality, "education as mental health therapy" (Ed-MH). Pre-post standardized quantitative measures focused on child mental health status and academics. The measures were completed by multiple raters and compared to determine whether changes occurred. Results indicated that primary teacher raters observed significant improvements in child mental health symptoms overall, while secondary teacher raters and caregivers noted improvement for certain diagnostic categories. Caregivers observed on average a decreased impact of their children's mental health symptoms on their children's lives. Academically, math scores significantly improved while reading trended toward significance. Preliminary evidence overall supports the viability of Tealeaf and Ed-MH for positively impacting child mental health and academics. Future directions include the implementation of a formalized, randomized-controlled trial to strengthen preliminary outcomes.
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Affiliation(s)
- Juliana L Vanderburg
- School Psychology Program, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Choden Dukpa
- Darjeeling Ladenla Road Prerna, Darjeeling, India
| | - Abhishek K Rauniyar
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | | | | | - Arpana Thapa
- Darjeeling Ladenla Road Prerna, Darjeeling, India
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States.,Center for Global Health, Colorado School of Public Health, Aurora, CO, United States
| | - Michael Matergia
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Broadleaf Health and Education Alliance, Stroudsburg, PA, United States
| | - Christina M Cruz
- School Psychology Program, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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23
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Wang J, Aaron A, Baidya A, Chan C, Wetzler E, Savage K, Joseph M, Kang Y. Gender differences in psychosocial status of adolescents during COVID-19: a six-country cross-sectional survey in Asia Pacific. BMC Public Health 2021; 21:2009. [PMID: 34736426 PMCID: PMC8568363 DOI: 10.1186/s12889-021-12098-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND School closures and family economic instability caused by the COVID-19 lockdown measures have threatened the mental health and academic progress of adolescents. Through secondary data analysis of World Vision Asia Pacific Region's COVID-19 response-assessments in May-June 2020, this study examined whether adolescents' study, physical, and leisure activities, psychosocial status, and sources of COVID-19 information differed by gender. METHODS The assessments used cross-sectional surveys of adolescents in poor communities served by World Vision (n = 5552 males and n = 6680 females) aged 10-18 years old in six countries. The study households of adolescents were selected either by random sampling or non-probability convenience sampling and assessed using telephone or in-person interviews. Multivariate logistic regression analyses examined the relationship between gender and psychosocial status; daily activities (e.g., play, study); and sources of information about COVID-19. RESULTS Participation in remote education was low (range: 0.5-20.7% across countries), with gender difference found only in Vietnam. Compared to males, female adolescents were less likely to play physically with a range of AOR: 0.36-0.55 (n = 5 countries) or play video games with a range of AOR: 0.55-0.72 (n = 2 countries). Female adolescents were more likely to feel isolated or stressed (India, AOR = 1.13, 95%CI:1.00, 1.26); feel unsafe (the Philippines, AOR = 2.22, 95%CI:1.14, 4.33; Vietnam, AOR = 1.31, 95%CI:1.03, 1.47); be concerned about education (India, AOR = 1.24, 95%CI:1.09, 1.41; Myanmar, AOR = 1.59, 95%CI:1.05, 2.40); or be concerned about household income (India, AOR = 1.13, 95%CI:1.00, 1.28; Vietnam, AOR = 1.31, 95%CI:1.09, 1.58). Female adolescents were also less likely to obtain COVID-19 related information through internet/social media (Bangladesh, AOR = 0.51, 95%CI:0.41, 0.64; India, AOR = 0.84, 95%CI:0.73, 0.96; and Myanmar, AOR = 0.65, 95%CI:0.43, 0.97) and mobile call or short message (India, AOR = 0.88, 95%CI:0.80, 0.98) but more likely to get the information from friends (Vietnam, AOR = 1.18, 95%CI:1.02, 1.36) and family (Bangladesh, AOR = 1.44, 95% CI:1.21, 1.70; India, AOR = 1.29, 95% CI:1.15, 1.45). CONCLUSIONS An understanding of gender differences in the impacts of COVID-19 on adolescents' schooling, physical, and mental health can inform adolescent protection interventions. Psychosocial support during response and recovery phases needs to pay special attention to gender differences, since female adolescents' psychosocial status is at higher risk when facing the challenges of this pandemic.
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Affiliation(s)
- Jun Wang
- Johns Hopkins School of Education, Baltimore, MD, USA
| | - Alec Aaron
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anurima Baidya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christabel Chan
- World Vision Asia Pacific Regional Office, Singapore, Republic of Singapore
| | | | | | | | - Yunhee Kang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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24
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Simelane SRN, de Vries PJ. Child and adolescent mental health services and systems in low and middle-income countries: from mapping to strengthening. Curr Opin Psychiatry 2021; 34:608-616. [PMID: 34419969 DOI: 10.1097/yco.0000000000000740] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Most of the world's children and adolescents live in low and middle-income countries (LMICs) where mental health services are very limited. Here, we reviewed literature over the last 18 months describing the current landscape of child and adolescent mental health services and systems (CAMHSS) in LMICs, and present findings from systems strengthening research. RECENT FINDINGS The challenges in CAMHSS are well described with little change over the last two decades. Fortunately, research has started to move from 'mapping' towards systems 'strengthening'. Using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) framework, we reviewed recent CAMHSS innovations. Clinical care and human resource innovations focused on primary care with validation of screening tools, training and task-sharing for capacity-building. Intersectoral collaboration emerged as a priority domain for strengthening, alongside a theme around the importance of participatory research to inform policy reforms. The potential role of digital technology to strengthen CAMHSS was identified as an emerging theme. SUMMARY There is an urgent need to increase the priority of CAMHSS in LMICs. This will require innovations at multiple levels aimed at all CAMHSS domains, with active participation of all relevant local stakeholders to ensure the translation of research into policy and practice.
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Affiliation(s)
- Simphiwe R N Simelane
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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25
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TRIVEDI GUNJANY, PILLAI NISHITHA, TRIVEDI RIRIG. Adverse Childhood Experiences & mental health - the urgent need for public health intervention in India. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E728-E735. [PMID: 34909501 PMCID: PMC8639107 DOI: 10.15167/2421-4248/jpmh2021.62.3.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Global evidence has demonstrated that Adverse Childhood Experiences (ACEs) up to age 18 significantly increases the risk of mental and physical health for an adult. The research linking ACE with health and well-being has confirmed a dose-response relationship between the number of ACEs experienced and the extent of the impact on wellbeing. The source of ACE is the family, community, and the immediate environment, and it causes long-term risk for mental health with the potential to carry it over beyond the present generation. The findings are consistent across the developed and developing countries, and the evidence highlights the need for new elements beyond the 10 ACE elements in the pathbreaking original study. India needs urgent intervention on ACE prevention and management with 0.4 billion children and adolescents, with one out of seven Indians with mental health issues. Firstly, this commentary reviews global research and summarizes the limited evidence available in India on ACE elements' impact on mental health. And, secondly, it proposes a multi-pronged approach to identify, manage and prevent the mental health implications of ACE in India to preempt a significant public health challenge.
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Affiliation(s)
- GUNJAN Y. TRIVEDI
- Cofounder, Society for Energy & Emotions, Wellness Space, Ahmedabad, India
| | - NISHITHA PILLAI
- Interning Psychologist, Society for Energy & Emotions, Wellness Space, Ahmedabad, India
| | - RIRI G. TRIVEDI
- Cofounder, Society for Energy & Emotions, Wellness Space, Ahmedabad, India
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Sultana A, Tasnim S, Sharma R, Pawar P, Bhattcharya S, Hossain MM. Psychosocial Challenges in Palliative Care: Bridging the Gaps Using Digital Health. Indian J Palliat Care 2021; 27:442-447. [PMID: 34898939 PMCID: PMC8655652 DOI: 10.25259/ijpc_381_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Psychosocial health is a major palliative care concern globally. Patients and caregivers engaged in palliative care may experience deteriorated mental and social health conditions. Global evidence informs a high burden of depression, anxiety, psychological distress and other mental health problems among the palliative care populations. Those challenges aggravate the preexisting palliative care issues, such as lack of access and suboptimal quality of care. Palliative caregiving, both in the institutional and community settings, should be strengthened, incorporating psychosocial support for the patients and their caregivers. The recent advancements in digital health technologies have shown promising impacts in facilitating health communication, decision-making and delivering psychosocial interventions using digital devices and platforms. Adopting evidence-based interventions can help the users to access mental health resources and communicate with each other to promote shared decision-making and management of health problems. Health-care organisations and systems may explore opportunities to advance psychosocial care using digital technologies. Leveraging advanced technologies in palliative caregiving may require multifaceted research exploring potential barriers and opportunities at the user, institutional and systems levels. Nonetheless, palliative care policies and health systems measures should be strengthened to develop and implement digital support systems that may improve psychosocial health and overall palliative care outcome.
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Affiliation(s)
- Abida Sultana
- Department of Mental Health, EviSyn Health, Khulna, Bangladesh
| | - Samia Tasnim
- Department of Health Promotion and Community Health Sciences, Texas A&M University, Texas, United States
| | - Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, United States
| | - Priyanka Pawar
- Department of Programs, GRID Council, Delhi-NCR, Delhi, India
| | - Sudip Bhattcharya
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, Texas A&M University, Texas, United States
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Joshi N, Shrestha A, Karki D, Singh PM. Psychiatric Disorders in Adolescents Attending Psychiatry Outpatient Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:564-570. [PMID: 34508405 DOI: 10.31729/jnma.6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/28/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. METHODS A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. RESULTS A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). CONCLUSIONS Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.
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Affiliation(s)
- Neelam Joshi
- Department of Psychiatry, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu
| | - Asim Shrestha
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu
| | - Deepika Karki
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu
| | - Pradip Man Singh
- Department of Psychiatry, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu
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Cruz CM, Lamb MM, Hampanda K, Giri P, Campbell M, Chowdhury B, Giardina AA, Gaynes BN, Matergia M. Teacher Nomination of School-aged Children for Mental Health Services in a Low and Middle Income Country. Glob Health Action 2021; 14:1861921. [PMID: 33588698 PMCID: PMC7894443 DOI: 10.1080/16549716.2020.1861921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Knowledgeable in child development, primary school teachers in low- and middle-income countries (LMICs) have the potential to identify their students needing mental health care. Objective: We evaluated whether teachers in Darjeeling, India can accurately nominate school-aged children for mental health services after training and aided by a novel tool. Methods: In 2018, 19 primary school teachers from five low-cost private (LCP) schools in rural Darjeeling were trained to nominate children needing care. Teachers evaluated all of their students aided by a novel tool, 'Behavior Type and Severity Tool' (BTST), completed the Achenbach Teacher Report Form (TRF) as a mental health status reference standard, and nominated two students for care. Sensitivity and specificity of being nominated compared to TRF overall and subdomain scores were calculated. BTST performance was determined by comparing BTST and TRF scores and creating Receiver Operating Characteristic curves to determine optimal cutoffs. Multivariable regression models were used to identify demographic predictors of teacher accuracy using the BTST. Results: For students demonstrating a clinical or borderline score in at least one TRF subdomain, the sensitivity (72%) and specificity (62%) of teacher nomination were moderately high. BTST overall scores and TRF Total Problem scores were correlated (Spearman's ρ = 0.34, p < 0.0001), as were all subdomains. For the TRF Total Problem score, a maximum Youden's J of 0.39 occurred at BTST cutoff >4 for borderline struggles and 0.54 at the BTST cutoff >6 for clinical struggles. Younger teacher age, less education, less formal education training, and more years of experience were positively associated with teacher accuracy. Conclusions: With training and a simple decision support tool, primary school teachers in an LMIC nominated students for mental health services with moderate accuracy. With the BTST being weakly accurate, teachers' judgment largely accounted for the moderate accuracy of nominations.
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Affiliation(s)
- Christina M Cruz
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC, USA
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health , Aurora, CO, USA.,Center for Global Health, Colorado School of Public Health , Aurora, CO, USA
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health , Aurora, CO, USA
| | - Priscilla Giri
- Department of Child Mental Health, Darjeeling Ladenla Road Prerna , Darjeeling, India
| | - Matthew Campbell
- Department of Epidemiology, Colorado School of Public Health , Aurora, CO, USA
| | - Bijita Chowdhury
- Department of Epidemiology, Colorado School of Public Health , Aurora, CO, USA
| | | | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC, USA
| | - Michael Matergia
- Center for Global Health, Colorado School of Public Health , Aurora, CO, USA.,Broadleaf Health and Education Alliance , Stroudsburg, PA, USA.,Department of Family Medicine, St. Joseph Hospital, SCL Health , Denver, CO, USA
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Joshi N, Shrestha A, Karki D, Singh PM. Psychiatric Disorders in Adolescents Attending Psychiatry Outpatient Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59. [PMID: 34508405 PMCID: PMC8369568 DOI: 10.31729/jnma.5580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. METHODS A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. RESULTS A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). CONCLUSIONS Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.
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Affiliation(s)
- Neelam Joshi
- Department of Psychiatry, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Asim Shrestha
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Deepika Karki
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal,Correspondence: Deepika Karki, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal. deepika. , Phone: +977-9841836374
| | - Pradip Man Singh
- Department of Psychiatry, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
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Acceptability and preliminary efficacy of a school-based body image intervention in urban India: A pilot randomised controlled trial. Body Image 2021; 37:282-290. [PMID: 33813345 DOI: 10.1016/j.bodyim.2021.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 01/27/2023]
Abstract
This pilot study evaluated the acceptability and preliminary efficacy of a culturally adapted school-based body image intervention, Dove Confident Me, for use in urban India. Two private schools in New Delhi were randomly assigned at the school level to receive either the five-session intervention facilitated by trained psychologists or lessons-as-usual (control). Participants were Year 7 students (N = 166; Mage = 11.9 years). Students, facilitators, and observing teachers, provided acceptability feedback. Fidelity was assessed. Body image and related measures were completed by students in a classroom setting at pre-intervention, post-intervention, and two-month follow-up. Most students enjoyed (73.7 %) and understood (84.2 %) the intervention. Facilitators (90 %) and observing teachers (70 %) reported that the learning objectives were achieved. Adherence and facilitator competence were rated as very good. Body esteem improved significantly among intervention students at post-intervention and follow-up (Cohen's ds = .45-.46), relative to control students. Positive affect also improved at post-intervention (d = .58). No significant effects on internalisation, life engagement, eating pathology, self-esteem, or negative affect emerged. This study provides evidence for the acceptability and preliminary efficacy of Dove Confident Me in urban India. Intervention refinements to increase acceptability and efficacy are recommended.
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Cruz CM, Lamb MM, Giri P, Vanderburg J, Ferrarone P, Bhattarai S, Giardina AA, Hampanda K, Gaynes BN, Matergia M. Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study. Int J Ment Health Syst 2021; 15:40. [PMID: 33926487 PMCID: PMC8082764 DOI: 10.1186/s13033-021-00453-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Low and middle-income countries (LMICs) lack trained child mental health professionals. While teachers’ child development experience potentially positions them to fill the gap as lay mental health counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions of serving as lay counselors and their mental health attitudes and knowledge. Methods In 2018, with training and supervision, 19 primary school teachers from five rural, low cost private schools in Darjeeling, India, served as lay counselors in their classrooms. Using mixed methods, we examined teacher perceptions of serving as lay counselor and mental health attitudes and knowledge through a survey (n = 15), a summative assessment (n = 14), and semi-structured interviews (n = 17). For the survey and summative assessment, pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ perceptions of serving as lay counselor and mental health attitudes and knowledge. Results Qualitatively, teachers expressed being willing to serve as lay counselor, having more inclusive mental health attitudes, and retaining mental health knowledge as applicable to use during instructional time or incorporation into the knowledge transfer process, their primary duty. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health knowledge on the summative assessment did not change pre-training versus post-training versus post-intervention. Conclusions Training, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by utilizing therapeutic techniques during class time and incorporating them into their typical instruction, not through delivering traditional office-like care. Teacher practices may be pointing to the potential emergence of an “education as mental health therapy” system of care. Their changes in attitudes and knowledge reflected their emerging practices. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes. Trial Registration The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27.. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-021-00453-3.
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Affiliation(s)
- Christina M Cruz
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC, 27599, USA.
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop C245, Aurora, 80045, CO, USA.,Center for Global Health, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO, 80045, USA
| | - Priscilla Giri
- Darjeeling Ladenla Road Prerna, 42 Ladenla Road, Darjeeling, West Bengal, 734101, India
| | - Juliana Vanderburg
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, 100 E. Cameron Ave, Chapel Hill, NC, 27514, USA
| | - Peter Ferrarone
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Surekha Bhattarai
- Darjeeling Ladenla Road Prerna, 42 Ladenla Road, Darjeeling, West Bengal, 734101, India
| | - Aileen A Giardina
- Broadleaf Health and Education Alliance, 919 Main Street, Stroudsburg, PA, 18360, USA
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO, 80045, USA.,Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC, 27599, USA
| | - Michael Matergia
- Center for Global Health, Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO, 80045, USA. .,Broadleaf Health and Education Alliance, 919 Main Street, Stroudsburg, PA, 18360, USA.
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Khanna P, Singh K, Proctor C. Exploring the Impact of a Character Strengths Intervention on Well-Being in Indian Classrooms. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09450-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hossain MM, Rahman M, Trisha NF, Tasnim S, Nuzhath T, Hasan NT, Clark H, Das A, McKyer ELJ, Ahmed HU, Ma P. Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis. Heliyon 2021; 7:e06677. [PMID: 33898819 PMCID: PMC8056240 DOI: 10.1016/j.heliyon.2021.e06677] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic. METHOD We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression. RESULTS A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups. CONCLUSION South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.
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Affiliation(s)
- Md Mahbub Hossain
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Mariya Rahman
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Nusrat Fahmida Trisha
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Tasmiah Nuzhath
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Nishat Tasnim Hasan
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Heather Clark
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Arindam Das
- The IIHMR University, Jaipur, Rajasthan 302029, India
| | - E. Lisako J. McKyer
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Helal Uddin Ahmed
- National Institute of Mental Health (NIMH), Sher-E-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Ping Ma
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
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Stress management training and gratitude journaling in the classroom: an initial investigation in Indian context. CURRENT PSYCHOLOGY 2021; 40:5737-5748. [PMID: 34522074 PMCID: PMC8430282 DOI: 10.1007/s12144-020-01242-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 01/07/2023]
Abstract
Stress and allied difficulties are pervasive among school students in present times. This concern is further magnified in the Indian context with the large represention of young people in the population and limited resources to match. The present study aimed to evaluate the impact of a classroom based stress management training and gratitude journaling intervention (Flinchbaugh et al., 2012) among Indian adolescents. The intervention curriculum was adapted to suit the study context. A total of 238 students (57% males) from Grades 7–9 participated in this study. Participants were recruited from two schools, and their age ranged from 11 to 14 years. In each participating school, students were randomised at the classroom level into three intervention groups (Stress Management Training, Gratitude Journaling, combination of both), and one control group. Using a pre-test – post-test design, intervention impact on measures of well-being, life satisfaction, perceived stress, meaning, and engagement in the classroom was evaluated. Results suggested limited effectiveness of stress management training and gratitude journaling among participants in the present context. Plausible explanations for these findings are discussed. The study emphasizes the need for customised interventions to obtain optimal outcomes among diverse populations.
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Cruz CM, Giri P, Vanderburg JL, Ferrarone P, Bhattarai S, Giardina AA, Gaynes BN, Hampanda K, Lamb MM, Matergia M. The Potential Emergence of "Education as Mental Health Therapy" as a Feasible Form of Teacher-Delivered Child Mental Health Care in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study. Front Psychiatry 2021; 12:790536. [PMID: 34975588 PMCID: PMC8717545 DOI: 10.3389/fpsyt.2021.790536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We assessed task-shifting children's mental health care to teachers as a potential approach to improving access to child mental health care. Methods: In Darjeeling, India, we conducted a single-arm, mixed-methods feasibility study with 19 teachers and 36 children in five rural primary schools to determine whether teachers can deliver transdiagnostic mental health care to select children-in-need with fidelity to protocol, to assess which therapeutic options teachers chose to use within the protocol, and to evaluate for a potential signal of efficacy. Results: Participation rates for intervention activities were >80%. A majority of teachers met or exceeded quality benchmarks for all intervention activities. Teachers chose to deliver teacher-centric techniques, i.e., techniques that only teachers could deliver given their role in the child's life, 80% of the time. Children improved in mental health score percentiles on the Achenbach Teacher Report Form. Key facilitators included the flexibility to adapt intervention activities to their needs, while identified barriers included limited time for care delivery. Conclusion: Findings support the feasibility of task-shifting children's mental health care to classroom teachers in resource-limited schools. Fidelity to protocol appeared feasible, though the freedom to choose and adapt therapeutic techniques may also have enhanced feasibility. Surprisingly, teachers consistently chose to deliver teacher-centric therapeutic techniques that resulted in a potential signal of efficacy. This finding supports the potential emergence of "education as mental health therapy" (Ed-MH) as a new therapy modality. Continued investigation is required to test and refine strategies for involving teachers in the delivery of transdiagnostic mental health care.
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Affiliation(s)
- Christina M Cruz
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States.,School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC, United States
| | | | - Juliana L Vanderburg
- School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC, United States
| | - Peter Ferrarone
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Aileen A Giardina
- Broadleaf Health & Education Alliance, Stroudsburg, PA, United States
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Molly M Lamb
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Michael Matergia
- Broadleaf Health & Education Alliance, Stroudsburg, PA, United States.,Center for Global Health, Colorado School of Public Health, Aurora, CO, United States
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George Joseph R, Kallivayalil RA, Rajeev A. Pathways to care in children- perspectives from a child guidance clinic in South India. Asian J Psychiatr 2020; 54:102310. [PMID: 32739861 DOI: 10.1016/j.ajp.2020.102310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In India the pathways to care in children with mental health problems remain relatively unexplored. Investigating the factors that drive the pathway will help determine interventions and also draft policies for a streamlined Child and adolescent mental health service. METHOD Children who attended the Child Guidance Clinic sampled by WHO Pathways Encounter questionnaire. Statistical tests applied to find key influencers like gatekeepers, intermediate points of care, symptoms initiating referral, duration of untreated illness, time to arrive at appropriate care and primary diagnosis. RESULTS The most common diagnostic category was externalizing disorder 51(37.5 %). The gatekeepers identified were 111(81.6 %) Parents/Relatives/Guardians and teachers 25 (18.3 %). Academic concerns identified by teachers took a mean of 72 months (30.271) to arrive at appropriate care versus 50.4 months (23.18) when identified by Parents/Relatives/Guardians group. Significant delays were observed with Neurodevelopmental disorders arriving to care with delays up to 130.2 (70.11) months (p < 0.001) and having 64.2 (33.7) months (p < 0.001) duration of untreated illness. Externalizing disorders took a duration of 94.08 (54.17) months (p < 0.001) to arrive to appropriate care and had 54.2 (36.33) months (p < 0.001) duration of untreated illness. Teachers took longer time in detecting the indicators and this caused duration of untreated illness of 73.44 (36.05) months (p < 0.001) and a delay of 128.08 (71.23) months (p < 0.001) to arrive to appropriate care. CONCLUSIONS The pathways to care in children are characterized by long duration of untreated illness and undue time to care. Gatekeepers like teachers and intermediary points of care were associated with inadvertent delays along the pathway.
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Affiliation(s)
- Rachna George Joseph
- Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India; Christian Medical College Vellore, Department of Psychiatry, Vellore, India; Cumberland Hospital, The New South Wales Department of Health, Sydney, Australia.
| | - Roy Abraham Kallivayalil
- Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India
| | - A Rajeev
- Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India; All India Institute of Medical Sciences, Department of Community and Family Medicine, Mangalagiri, India
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Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses. Asian J Psychiatr 2020; 51:102041. [PMID: 32315966 DOI: 10.1016/j.ajp.2020.102041] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/08/2023]
Abstract
Mental disorders are highly prevalent in eight South Asian countries, yet there is a gap of a synthesized overview of the prevalence of mental disorders in this region. This umbrella review aims to summarize the prevalence of mental disorders from systematic reviews and meta-analyses of South Asian studies. A systematic search of 11 major databases and additional sources was conducted until December 11, 2019. Articles were included if they were systematic reviews or meta-analyses, reported the prevalence of mental disorders, and reported primary studies conducted in South Asian countries only. Among 2591 citations, a total of 23 reviews met all the criteria of this umbrella review. The synthesized findings from those reviews suggest high prevalence rates for mental disorders, including depressive disorders, anxiety disorders, mood disorders, suicidal behavior and self-harm, schizophrenia, substance use disorders, neurodevelopmental disorders, dementia, and other mental health problems. Also, findings suggest a high burden of maternal depression, psychiatric comorbidities in chronic physical illnesses, and various mental disorders among children, elderly adults, refugees, and other vulnerable populations. Most studies were from India whereas evidence from Afghanistan, Bhutan, and Maldives was limited. The findings of this review are constrained with heterogeneity in prevalence estimations, methodologies, sampling issues, and limitations in the existing literature, which should be addressed in future research. The evidence synthesized in this review provides national and regional overview of the prevalence of mental disorders, which may inform better policymaking and practice advancing mental health in South Asia.
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Hossain MM, Khan N, Sultana A, Ma P, McKyer ELJ, Ahmed HU, Purohit N. Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res 2020; 287:112922. [PMID: 32203749 DOI: 10.1016/j.psychres.2020.112922] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/15/2020] [Indexed: 12/25/2022]
Abstract
With ever-increasing prevalence of various mental disorders worldwide, a comprehensive evaluation of the prevalence of co-occurring psychiatric disorders among individuals with autism spectrum disorder (ASD) is needed to strengthen the knowledge base. This umbrella review aims to summarize the current evidence on the prevalence of comorbid psychiatric disorders among people with ASD. A systematic search of 12 major databases and additional sources was conducted. Any systematically conducted narrative, qualitative, or meta-analytic review reporting the prevalence of psychiatric disorders among people with ASD with no age or geographical restriction were included. From a total of 2755 records, 26 articles representing 14 systematic reviews and 12 meta-analyses met the criteria of this review. The synthesized findings reveal a high burden of comorbid psychiatric disorders among people with ASD, including anxiety disorders, depressive disorders, bipolar and mood disorders, schizophrenia spectrum, suicidal behavior disorders, attention-deficit/hyperactivity disorder, disruptive, impulse-control and conduct disorders amongst diverse age groups, with a majority in younger participants. Most studies were conducted in developed nations, with limited evidence from low and middle-income countries. These synthesized findings provide high-quality evidence for clinical and policy-level decision-making from a global overview of the status of comorbid psychiatric disorders among people with ASD.
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Affiliation(s)
- Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, TX 77843, USA.
| | - Nusrat Khan
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Ping Ma
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, TX 77843, USA
| | - E Lisako J McKyer
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, TX 77843, USA
| | - Helal Uddin Ahmed
- National Institute of Mental Health (NIMH), Sher-E-Bangla Nagar, Dhaka, 1207 Bangladesh
| | - Neetu Purohit
- The IIHMR University, Jaipur, Rajasthan 302029, India
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Kommu JVS, Jacob P. Specialty training in child and adolescent psychiatry in India. Eur Child Adolesc Psychiatry 2020; 29:89-93. [PMID: 31529268 DOI: 10.1007/s00787-019-01407-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022]
Abstract
India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well.
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Affiliation(s)
| | - Preeti Jacob
- Department of Child and Adolescent Psychiatry, NIMHANS, Bangalore, 560029, India
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Madasu S, Malhotra S, Kant S, Sagar R, Mishra AK, Misra P, Ahamed F. Anxiety Disorders among Adolescents in a Rural Area of Northern India using Screen for Child Anxiety-Related Emotional Disorders Tool: A Community-based Study. Indian J Community Med 2019; 44:317-321. [PMID: 31802792 PMCID: PMC6881902 DOI: 10.4103/ijcm.ijcm_359_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Anxiety disorders are the most frequent mental disorders encountered in childhood and adolescent years. The number of epidemiological studies done in this area within India is limited. Objectives We determined the prevalence of anxiety disorders among adolescents in a rural community of Ballabgarh block, district Faridabad, Haryana. Secondarily, we also assessed sociodemographic and other factors associated with anxiety disorders among adolescents. Materials and Methods This community-based cross-sectional study was conducted among 729 adolescents (10-19 years). Screen for Child Anxiety-Related Emotional Disorders tool was used for assessing prevalence and type of anxiety disorders. Sociodemographic and personal factors were included in the logistic regression multivariable model to establish associations. Adjusted odds ratios (AOR) along with 95% confidence intervals (CI) are computed. Results The prevalence of anxiety disorders among adolescents was (22.7%; 95% CI: 19.7-26.0). Girls (27.6%) had higher prevalence than boys (18.3%) (P < 0.01). Social anxiety disorder (14.3%; 95% CI: 11.7-16.9) was the most common form of anxiety disorder. Female sex (AOR 1.8; 95% CI 1.2-2.6; P < 0.01), lower-middle socioeconomic status (AOR 1.96; 95% CI 1.2-3.1; P < 0.01), and presence of stressful event within the past 1-year (AOR 2.48; 95% CI: 1.12-5.06; P = 0.01) were found to be associated with the presence of anxiety disorders. Conclusions Anxiety disorders are common among adolescents in rural settings of India. Tackling them will require appropriate health systems response. Adequate interventions should be incorporated at primary care level to address the mental health concerns of adolescents.
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Affiliation(s)
- Swapna Madasu
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- 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
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Puneet Misra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Farhad Ahamed
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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