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Basu S, Maheshwari V, Sodhi B, Mannan P, Kukreti P. The prevalence of depression, determinants, and linkage with functional disability amongst postmenopausal women in India: Evidence from the Longitudinal Ageing Study in India. Asian J Psychiatr 2024; 96:104030. [PMID: 38598934 DOI: 10.1016/j.ajp.2024.104030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The study objective was estimating the prevalence and determinants of depression amongst postmenopausal women in India. Additionally, we used panel mediation analysis to model the extent to which multimorbidity was associated with depression after adjusting for the effects of functional disability in the participants. METHODS Data from 28,160 women aged 50 and above from the Longitudinal Aging Study in India (LASI) Wave 1 were analyzed. Depression was assessed using the Composite International Diagnostic Interview-Short Form (CIDI-SF), with multimorbidity and functional disability (ADL and IADL) considered as key predictor variables. Logistic regression and Karlson-Holm-Breen (KHB) mediation analysis were employed. RESULTS The weighted prevalence of depression among women aged ≥ 50 years was 21.76% (95% CI: 20.81, 22.73), significantly higher women aged < 50 years (17.60%, 95% CI: 16.33, 18.94). Factors independently associated with increased odds of depression included being unmarried, rural residence, and multimorbidity, while higher educational status was associated with lower odds of depression. The relationship between multimorbidity and depression was partially mediated by ADL and IADL disabilities. Notable regional (state) variations in the magnitude of depression were observed. CONCLUSIONS Nearly one in five postmenopausal women in India aged 50 years and older have clinical depression. Community screening for reaching the unreached with primary care mental health strengthening need enhanced policy focus.
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Affiliation(s)
- Saurav Basu
- Indian Institute of Public Health - Delhi, Public Health Foundation of India (PHFI), India
| | - Vansh Maheshwari
- Indian Institute of Public Health - Delhi, Public Health Foundation of India (PHFI), India
| | - Baani Sodhi
- Indian Institute of Public Health - Delhi, Public Health Foundation of India (PHFI), India
| | - Pallak Mannan
- Indian Institute of Public Health - Delhi, Public Health Foundation of India (PHFI), India
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Verma P, Raj DS, Sinha R, Kukreti P, Pemde H, Pawar SM, de Wagt A, Kumar P. Prevalence and Risk Factors of Undernutrition among Infants Less Than Six Months: A Hospital Based Cross-Sectional Assessment. Indian J Pediatr 2023; 90:1047. [PMID: 37256451 DOI: 10.1007/s12098-023-04647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Priyanka Verma
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Deepshikha Singh Raj
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Rajesh Sinha
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Harish Pemde
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Sameer M Pawar
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
| | - Arjan de Wagt
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India.
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Sharma M, Shankar P, Kukreti P, Kataria D. A rare case report of pseudo-pregnancy in a menopausal female. Indian J Psychiatry 2023; 65:789-792. [PMID: 37645358 PMCID: PMC10461587 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_430_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/21/2023] [Accepted: 06/17/2023] [Indexed: 08/31/2023] Open
Abstract
Pseudo-pregnancy is an uncommon psychiatric presentation, often having a complex interplay of psycho-social factors making it difficult to manage. It is common to present in the reproductive age range, rarely in postmenopausal women. We are reporting a rare presentation of a 48-year post-menopausal widowed HIV-positive female with no live issues having two years of secondary amenorrhea complaining to have documented weight gain and experience of perceiving fetal movements for the past 5 months. However, she persistently insisted on antenatal care despite repeated reports of ultra-sonographic pelvis imaging and gynecological examination pointed toward menopausal changes and the absence of any live issue. This case report emphasizes the clinical presentation and management strategies for patients with pseudocyesis, a peculiar and rare psychiatric manifestation.
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Affiliation(s)
- Mini Sharma
- Department of Psychiatry, RVRS Government Medical College, Bhilwara, Rajasthan, India
| | - Pavitra Shankar
- Department of Psychiatry, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Ransing R, Raghuveer P, Mhamunkar A, Kukreti P, Puri M, Patil S, Pavithra H, Padma K, Kumar P, Ananthathirtha K, Goel MK, Deshpande SN. COVID-19 vaccine confidence project for perinatal women (CCPP)-Development of a stepped-care model to address COVID-19 vaccine hesitancy in low and middle-income countries. Front Public Health 2023; 10:1100046. [PMID: 36711386 PMCID: PMC9881345 DOI: 10.3389/fpubh.2022.1100046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background COVID-19 vaccine hesitancy (CVH) is common among perinatal women in low and middle-income countries (LMICs), but it is often unaddressed. This could be due to a lack of feasible, scalable, and acceptable interventions and models for CVH in LMICs. Our study aimed to develop a CVH intervention model that can be implemented in LMICs using existing human healthcare resources. Methods A literature review was conducted on aspects of vaccine hesitancy, pre-existing interventions, and models for addressing vaccine hesitancy (COVID-19 and non-COVID-19). The lead authors (RR and PKuk) formed a team consisting of vaccinators, experts, and stakeholders. Members shared their perspectives and proposals for various models and interventions that could be implemented in LMICs. A CVH intervention model was developed using a logic model, a WHO implementation toolkit, experts' feedback, and consensus. Results A consensus was reached to develop a COVID-19 Vaccine Confidence Project for Perinatal Women (CCPP), which is a primary health care worker (HCWs)-based stepped-care model. The CCPP model includes HCW training, integration into ongoing COVID-19 vaccination programs, CVH screening, CVH intervention, and referral services suitable for implementation in LMICs. Conclusion The CCPP project/model provides a practical approach that can help in the early detection and management of CVH. The model can be tailored to different healthcare settings to improve COVID-19 vaccine uptake among perinatal women in LMICs.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Pracheth Raghuveer
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Aman Mhamunkar
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Suvarna Patil
- Department of Medicine, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Hegde Pavithra
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Kumari Padma
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Praveen Kumar
- Department of Paediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Kavya Ananthathirtha
- Department of Obstetrics and Gynecology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Manish Kumar Goel
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Smita N. Deshpande
- Department of Psychiatry, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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Ransing R, Kukreti P, Raghuveer P, Puri M, Paranjape AD, Patil S, Hegde P, Padma K, Kumar P, Kishore J, Deshpande SN. A brief psycho-social intervention for COVID-19 vaccine hesitancy among perinatal women in low-and middle-income countries: Need of the hour. Asian J Psychiatr 2022; 67:102929. [PMID: 34875559 PMCID: PMC8620014 DOI: 10.1016/j.ajp.2021.102929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/16/2021] [Indexed: 02/08/2023]
Abstract
COVID-19 vaccines are one of the most effective strategies for preventing COVID-19 infection, as well as the associated mortality and morbidity. Despite the availability of COVID-19 vaccines, vaccine acceptance among perinatal women is challenging in low and middle-income countries (LMICs). Further, the vaccine hesitancy among perinatal women may have an impact on their children's vaccinations. The purpose of this paper is to briefly discuss the existing research on COVID-19 and non-COVID-19 vaccine hesitancy, psychosocial aspects, measures, and the individual level interventions for vaccine hesitancy among perinatal women. In our opinion, there is a need for further research with a specific focus on developing effective and feasible individual-level interventions to address COVID-19 vaccine hesitancy among perinatal women in LMICs.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra 415606, India.
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi 110001, India
| | - Pracheth Raghuveer
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka 575001, India
| | - Manju Puri
- Department of Obstretics and Gyanecolgy, Lady Hardinge Medical College, New Delhi 110001, India
| | - Amey Diwakar Paranjape
- Department of TB and Chest Medicine, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra 415606, India
| | - Suvarna Patil
- Department of Medicine, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra 415606, India
| | - Pavithra Hegde
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka 575018, India
| | - Kumari Padma
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra 415606, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi 110001, India
| | - Jugal Kishore
- Dept of Community Medicine, Vardhman Mahavir Medical College, Ansari Nagar West, New Delhi, Delhi 110029, India
| | - Smita N Deshpande
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India
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6
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Kukreti P, Ransing R, Raghuveer P, Mahdevaiah M, Deshpande SN, Kataria D, Puri M, Vallamkonda OR, Rana S, Pemde HK, Yadav R, Nain S, Prasad S, Garg B. Stepped Care Model for Developing Pathways of Screening, Referral, and Brief Intervention for Depression in Pregnancy: A Mixed-Method Study from Development Phase. Indian J Soc Psychiatry 2022; 38:12-20. [PMID: 35418726 PMCID: PMC9005084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Depression in pregnancy affects nearly one in five women in low- and middle-income countries and is associated with adverse obstetric and neonatal outcome. Burden of morbidity is high, but specialized mental health resources are meager. Effective low intensity psychosocial interventions hold promise to fill the treatment gap for maternal depression. In this paper, we aim to describe the process of development of a stepped care model incorporating screening, providing brief intervention, and referral pathways developed for managing depression in pregnancy in antenatal care health facilities in India. METHODOLOGY Using complex intervention development and evaluation method of Medical Research Council, United Kingdom, we searched evidence-based strategies from preexisting manuals, conducted formative research for need assessment and stakeholder engagement, and developed the intervention following an expert review panel. We conducted pilot testing to assess the feasibility and acceptability of intervention supplemented by three focused group discussions. RESULTS Manual review identified psychoeducation, empathetic listening, behavior activation, and supportive counseling as important elements. Need assessment revealed huge gap in perinatal mental health knowledge. Nearly 92% of total 272 perinatal women had poor awareness and 35%-70% of total 62 health-care providers had poor knowledge. In qualitative interview, women reported depressive symptoms as a normal part of pregnancy and had poor help seeking, behavior symptoms of depression were more prominent. A stepped care algorithm was developed for screening all expectant mothers in each trimester for depression using Patient Health Questionnaire-9 (PHQ-9). Women with PHQ-9 score >19 or reporting self-harm ideation were urgently referred to psychiatrist. Women with PHQ-9 score 5-19 were given brief intervention for depression in pregnancy intervention by antenatal nurse. The intervention developed consists of three sessions of psychoeducation, relaxation exercise, and mental health promotion, each lasting 20 min and at gap of 2 weeks each. Service providers and mothers reported good acceptability of psychosocial intervention and reported satisfaction with content and delivery of intervention. CONCLUSION Low intensity brief psychosocial interventions can be adapted for implementation if relevant stakeholders are engaged at each step right from development of such as screening, intervention pathway to delivery, and effectiveness study.
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Affiliation(s)
- Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Ramdas Ransing
- Department of Psychiatry, B.K.L. Walawalkar Rural Medical College, Sawarda, Maharashtra
| | - Pracheth Raghuveer
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal
| | - Mahesh Mahdevaiah
- Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
| | | | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Manju Puri
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi
| | | | - Sumit Rana
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Harish K Pemde
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Reena Yadav
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi
| | - Shilpi Nain
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi
| | - Shiv Prasad
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Bhavuk Garg
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
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7
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Tikka SK, Parial S, Pattojoshi A, Bagadia A, Prakash C, Lahiri D, Jaiswal J, Puri M, Kukreti P, Behera RN, Agrawal S, Garg S, Dubey S, Gupta V, Bajaj A, Agrawal A, Singour C, Patel G, Maghade M, Purushotham A, Pany SK, Saurabh, Doria S, Tejan V, Chandra PS. Anxiety among pregnant women during the COVID-19 pandemic in India - A multicentric study. Asian J Psychiatr 2021; 66:102880. [PMID: 34688015 PMCID: PMC8526303 DOI: 10.1016/j.ajp.2021.102880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 01/27/2023]
Abstract
While higher anxiety during antenatal period cause several maternal and foetal health related complications, lower anxiety levels are found to be associated with lesser "precautionary behaviours" and consequently greater risk of infection, during the COVID-19 pandemic. In this study, we aimed to assess rates and determinants of generalized anxiety at the time of the pandemic as well as anxiety that was specific to the context of being pregnant during the COVID-19 pandemic. (COVID-19-antenatal anxiety) in Indian women. This hospital-based, cross-sectional study using face-to-face interviews was conducted at antenatal clinics of five medical college hospitals in India. The Generalized Anxiety Disorder-7 scale (GAD -7) and a customized scale to assess antenatal COVID-19 anxiety along with other tools that assessed social support and COVID-19-risk perception were administered to 620 pregnant women. We found that the percentage of women with moderate or severe anxiety based on GAD -7 was 11.1%. Multivariate analysis showed that higher COVID-19-risk perception, greater antenatal COVID-19 anxiety and lower perceived support significantly predicted moderate and severe generalized anxiety. Greater number of weeks of gestation, lower education, semiurban habitat and lower perceived social support were significant predictors of antenatal COVID-19 anxiety. We conclude that the rates of anxiety in pregnant women though not very high, still warrant attention and specific interventions.
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Affiliation(s)
- Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | | | - Amrit Pattojoshi
- Department of Psychiatry, Hi-Tech Medical college & Hospital, Bhubaneshwar, India
| | | | | | - Deyashini Lahiri
- Department of Clinical Psychology, Post Graduate Institute of Behavioral And Medical Sciences, Raipur, India
| | - Jyoti Jaiswal
- Department of Obstetrics and Gynaecology, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
| | - Manju Puri
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Rabindra Nath Behera
- Department of Obstetrics and Gynaecology, Hi-Tech Medical college & Hospital, Bhubaneshwar, India
| | - Sarita Agrawal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Shobit Garg
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
| | - Surbhi Dubey
- Department of Psychiatry, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
| | - Vineeta Gupta
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
| | - Aakash Bajaj
- Department of Biostatistics, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Akanksha Agrawal
- Department of Obstetrics and Gynaecology, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
| | - Chhaya Singour
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
| | - Geetanjali Patel
- Department of Obstetrics and Gynaecology, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
| | - Megha Maghade
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, India
| | - A Purushotham
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, India
| | - Sanjaya Kumar Pany
- Department of Psychiatry, Hi-Tech Medical college & Hospital, Bhubaneshwar, India
| | - Saurabh
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Simran Doria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Veena Tejan
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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VidhiChaudhary, Puri M, Kukreti P, Chhapola V, Kanwar D, Tumpati A, Jakhar P, Singh G. Postpartum depression in Covid-19 risk-stratified hospital zones: A cross-sectional study from India. J Affect Disord Rep 2021; 6:100269. [PMID: 34725651 PMCID: PMC8550899 DOI: 10.1016/j.jadr.2021.100269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To determine point prevalence of postpartum depression (PPD) and whether quarantine policies required in postpartum COVID-19 suspects increased the risk of depressive symptoms when compared COVID -19 non suspects in early postpartum period. Methods A cross-sectional study conducted in the postnatal ward of Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi from August 2020 to February 2021 using Edinburgh Postnatal Depression Scale (EPDS) to estimate point prevalence of postpartum depression (PPD) in the stratified zones (suspect and nonsuspect) of the hospital. Results Total of 408 postpartum women,204 each (COVID-19 suspects, and nonsuspects zone) were enrolled. Prevalence of Postpartum depression using an EDPS score of >9 was 11.9%. Prevalence of depression (17.9%; vs 4.85%, p <0.001) and level of depression (5.01±3.41 vs 4.14± 2.54, p 0.004) was significantly higher in mothers in isolated quarantine wards of COVID-19 suspect zone as compared to nonsuspect zones. Anhedonia was reported significantly higher (p <0.001) in suspect zone mothers. Multivariate analysis showed 'stay in COVID-19 suspect zone' and 'COVID-19 Suspect status' as a significant predictor of PPD. Conclusion Covid -19 postpartum suspects are at increased risk of developing postpartum depressive symptoms due to isolation and quarantine measures required in suspect zones to mitigate viral transmission. Limitations - Due to the cross-sectional nature of the study long-term impacts on mental health due to isolation could not be assessed. Factors such as marital relationship, COVID -19 related risk factors weren't assessed which may have bearing on the risk of developing PPD.
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Affiliation(s)
- VidhiChaudhary
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi 110001, India
| | - Manju Puri
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi 110001, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi 110001, India
| | - Viswas Chhapola
- Department of Paediatrics, Lady Hardinge Medical College, New Delhi 110001, India
| | - Divya Kanwar
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi 110001, India
| | - Anujna Tumpati
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi 110001, India
| | - Poonam Jakhar
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi 110001, India
| | - Geetanjali Singh
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi 110001, India
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Ransing R, Kukreti P, Mahadevaiah M, Raghuveer P, Karkal R, Rana S, Yadav R, Choudhary V, Patil I, Sonkar S, Deshpande SN. COVID-19 Pandemic and Stepped Care Model for Perinatal Depression in Rural India: Lessons Learned and the Way Forward. Indian J Psychol Med 2021; 43:246-251. [PMID: 34345101 PMCID: PMC8287401 DOI: 10.1177/02537176211005017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ramdas Ransing
- Dept. of Psychiatry, BKL Walawalkar
Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Prerna Kukreti
- Dept. of Psychiatry, Lady Hardinge
Medical College, New Delhi, Delhi, India
| | - Mahesh Mahadevaiah
- Dept. of Psychiatry, Dharwad Institute
of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | - Pracheth Raghuveer
- Dept. of Community Medicine, Yenepoya
Medical College, Mangalore, Karnataka, India
| | - Ravichandra Karkal
- Dept. of Psychiatry, Yenepoya Medical
College, Mangalore, Karnataka, India
| | - Sumit Rana
- Dept. of Psychiatry, Lady Hardinge
Medical College, New Delhi, Delhi, India
| | - Reena Yadav
- Dept. of Obs and Gyne, Lady Hardinge
Medical College, New Delhi, Delhi, India
| | - Vinod Choudhary
- Dept. of Pediatrics, BKL Walawalkar
Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Ishwar Patil
- Dept. of Psychiatry, BKL Walawalkar
Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Suruchi Sonkar
- Dept. of Psychiatry, Dharwad Institute
of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | - Smita N. Deshpande
- Dept. of Psychiatry, De-Addiction
Services and Resource Center for Tobacco Control, Centre of Excellence in Mental
Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia
Hospital, New Delhi, Delhi, India
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Ransing R, Kukreti P, Raghuveer P, Mahadevaiah M, Puri M, Pemde H, Karkal R, Patil S, Nirgude A, Kataria D, Sagvekar S, Deshpande SN. Development of a brief psychological intervention for perinatal depression (BIND-P). Asia Pac Psychiatry 2021; 13:e12436. [PMID: 33098740 DOI: 10.1111/appy.12436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND. METHODS A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit. RESULTS A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene). CONCLUSION The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Pracheth Raghuveer
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | - Manju Puri
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Harish Pemde
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Ravichandra Karkal
- Department of Psychiatry, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Suvarna Patil
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Abhay Nirgude
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Shraddha Sagvekar
- Department of Mental Health Nursing, SVJCT's Samarth Nursing College, Sawarde, Ratnagiri, Maharashtra, India
| | - Smita N Deshpande
- Department of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Raghuveer P, Ransing R, Kukreti P, Mahadevaiah M, Elbahaey WA, Iyengar S, Pemde H, Deshpande SN. Effectiveness of a Brief Psychological Intervention Delivered by Nurse for Depression in Pregnancy: Study Protocol for a Multicentric Randomized Controlled Trial from India. Indian J Psychol Med 2020; 42:S23-S30. [PMID: 33487799 PMCID: PMC7802037 DOI: 10.1177/0253717620971559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Perinatal depression (PD) has important implications for maternal and infant well-being but largely goes undetected. There is a need to develop low-intensity psychosocial interventions applicable to obstetric health care facilities. OBJECTIVE To assess the effectiveness of a brief psychological intervention for mild to moderate PD delivered by a nurse as compared to treatment-as-usual (TAU). METHODS This study is a randomized, open-label, parallel-group, multicentric trial being conducted in four sites of India. A total of 816 pregnant women with mild to moderately severe depression (Patient Health Questionaire-9 score of 5-19) are being assessed for the effectiveness of the intervention. Participants are randomly allocated to two groups of trial intervention (psychological intervention given by nurse) and TAU. The primary outcome is to compare the proportion of women reporting improvement across both groups. Participants are serially followed-up in each trimester and at 6, 10, 14 weeks, and 6 months postpartum. Secondary outcomes include pregnancy outcomes, feeding practices, physical growth, and immunization status of the infants. CONCLUSION It is a prospective pregnancy birth cohort with a robust design and long-term follow-up. This is one of the largest studies utilizing non-specialist health workers for the screening and management of PD. This study also holds promise to cast light on the course and outcome of depression during pregnancy in different parts of India. It is envisaged to help in developing a sound screening and referral-based protocol for obstetric settings.
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Affiliation(s)
- Pracheth Raghuveer
- Dept. of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Ramdas Ransing
- Dept. of Psychiatry, BKL Walawalkar Rural Medical College, Sawarde, Maharashtra, India
| | - Prerna Kukreti
- Dept. of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Mahesh Mahadevaiah
- Dept. of Psychiatry, Dharwad institute of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | | | - Satish Iyengar
- Dept. of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Harish Pemde
- Dept. of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Smita N. Deshpande
- Dept. of Psychiatry, De-Addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Ransing R, Deshpande SN, Shete SR, Patil I, Kukreti P, Raghuveer P, Mahadevaiah M, Bhosale N, Ramesh VO, Puri M, Bantwal P. Assessing antenatal depression in primary care with the PHQ-2 and PHQ-9: Can It Be carried Out by auxiliary nurse midwife (ANM)? Asian J Psychiatr 2020; 53:102109. [PMID: 32474343 PMCID: PMC10035069 DOI: 10.1016/j.ajp.2020.102109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
Antenatal Depression (AD) is prevalent in India but remains unidentified and untreated in primary care settings. The Auxiliary Nursing Midwife (ANM), a non-specialist health care worker at antenatal care (ANC) clinic or at a primary care centre can improve the detection of women with AD. In this study, we aimed to estimate the inter-rater reliability of the Patient Health Questionnaire (PHQ-9) and PHQ-2, administered by ANMs, with mental health professionals, that is, Clinical Psychologists(CP). The prospective, blind, observational study was conducted in an antenatal clinic of tertiary care rural hospital of India. PHQ-2 and PHQ-9(Marathi) valid and translated versions were administered to consecutive antenatal women (n = 108) aged 18-45 years by two raters (CP, ANM) independently. Raters and data analyst were blinded to each other's scores. Kappa Coefficient, weighted kappa, Intra-class correlation coefficients (ICC) were used to assess Inter-rater reliability. The mean age of the study participants was 25.91 ± 4.39 years. Inter-rater reliability for PHQ-2 (Screen -Positive or Negative for depression) and PHQ-9 (Severity of depression) was (k = 0.675) and (kw = 0.732) respectively, which suggested the 'substantial' agreement between ANMs and CP. Among raters, the ICC (95 % confidence interval) was 0.90 (0.85, 0.93) for the PHQ-9 score and for the PHQ-2 was 0.873 (0.819-0.911), which was suggestive of excellent and good reliability respectively. The 'substantial' agreement and 'good to excellent' inter-rater reliability among ANM and CP suggest that these two scales can be used to screen and assess the severity of AD by either qualified or minimally trained, community health workers.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India.
| | - Smita N Deshpande
- Dept. of Psychiatry, De-Addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.
| | - Shreya R Shete
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India.
| | - Ishwar Patil
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India.
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, 110001, India.
| | - Pracheth Raghuveer
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, 575018, India.
| | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad institute of Mental Health and Neurosciences (DIMHANS), Dharwad, 580008, India.
| | - Nandkumar Bhosale
- Department of Obstetrics and gynecology, BKL Walwalkar Rural Medical College, Sawarde, Maharashtra, 415606, India
| | | | - Manju Puri
- Department of Obstetrics & Gynecology, Lady Hardinge Medical College, New Delhi, 110001, India.
| | - Priyanka Bantwal
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, 575018, India.
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Ransing R, Kukreti P, Deshpande S, Godake S, Neelam N, Raghuveer P, Mahadevaiah M, Kataria D, Patil S, Puri M, Padma K. Perinatal depression-knowledge gap among service providers and service utilizers in India. Asian J Psychiatr 2020; 47:101822. [PMID: 31710947 DOI: 10.1016/j.ajp.2019.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lack of access to perinatal mental health (PMH) services is a significant public health problem in India. Barriers to accessing PMH services include the stigma, non-availability of services, poor knowledge, negative perception, attitude among perinatal women (PWs) and service providers. The present study attempted to examine the knowledge gap regarding perinatal depression (PD) among service providers [Nursing providers (NPs), Medical Practitioners (MPs)] and service utilizers (PWs). METHODS This cross-sectional study was conducted in two tertiary care teaching hospitals of India, one in a major metro and the other in a rural area. PWs, MPs and NPs were assessed for knowledge about PD using a semi-structured proforma and Perinatal Depression Monitor. RESULTS Among the 270 PWs, 8.51% were knowledgeable (PWA) and 91.49% were ignorant (PWB) about depression. PWB group were low educated (n = 140, 56.68%), and unemployed (n = 207, 83.80%) with lower family income [(≤₹10,356 per month), n = 170, 68.28%)]. There was knowledge discrepancy among NPs, MPs and PWA group in terms of a) PD is a normal part of pregnancy (agree- NPs = 71.52%, MPs = 10.00%, PWA-17.39%), b)biological causes of PD (agree- NPs = 45.23%, MPs = 70.00%, PWA = 26.03%) and c)antidepressant medications for PD (useful- NPs = 23.80%, MPs = 70.00%, PWA = 21.73%). Majority of the respondents agreed that all women should be screened for depression during pregnancy (NPs = 34.78%, MPs = 80.95%, PWA = 95.00%) and postpartum periods (NPs = 34.78%, MPs = 76.19%, PWA = 90.00%). CONCLUSIONS Low PD literacy among the PWs, misconception about aetiology and management among the NPs could be major barrier for delivery and utilisation of PD services. Thus, there is an urgent need to improve PD literacy among PWs and NPs.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical college
| | - Prerna Kukreti
- Lady Hardinge Medical College, Department of Psychiatry, C-604 Shaheed Bhagat Singh, Road, DI, India.
| | - Smita Deshpande
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, Banga Bandhu Sheikh Mujib Road, New Delhi 110001
| | - Shashwati Godake
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri
| | - Neelam Neelam
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | | | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad institute of Mental Health and Neurosciences (DIMHANS)
| | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi
| | - Suvarna Patil
- Department of Medicine, BKL Walawalkar Rural Medical College
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College
| | - Kumari Padma
- Department of Psychiatry, BKL Walawalkar Rural Medical College
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Abstract
Delhi hasn't always enjoyed the status of the India's capital, but it has always played a pivotal role in the history of India as a gateway city. The same way, it received mental health services much later than the rest part of country, but it has witnessed an evolution from colonial era to the birth of state of art modern psychiatry services. Journey started with the landmark inaugural meeting in Delhi University of few visionaries paving the birth of Indian psychiatry society. Subsequently, it witnessed emergence of general hospital psychiatry units & saw their transformation to apex institutes of teaching and research like AIIMS and others. It saw an exemplary worth replicating transformation of hospital for mental diseases into the state of art neuropsychiatry center, IHBAS. Delhi of today represents a microcosm of psychiatry institutes offering entire range of therapeutic, rehabilitative and academic services with equally important share in policy making at national level. This article traces the trends and developments that happened in mental health services in last six decades.
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Affiliation(s)
- R C Jiloha
- Department of Psychiatry and Rehabilitation Sciences, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
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Kukreti P, Ali W, Jiloha RC. Rising Trend of Use of Antidepressants Induced Non- Puerperal Lactation: A Case Report. J Clin Diagn Res 2016; 10:VD01-VD02. [PMID: 27504388 DOI: 10.7860/jcdr/2016/19266.7928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
Abstract
Non puerperal lactation or galactorrhea is a well known side effect of antipsychotic drugs but has been infrequently described with the use of antidepressants. In past few decades, there have been emerging trend of isolated case reports of selective serotonin reuptake inhibitors induced non puerperal lactation. We report a case of non puerperal lactation following usage of second generation tricyclic antidepressant, nortriptyline and resolution on withdrawing the drug. Literature review has been done for antidepressant induced galactorrhea to understand the current trends, putative mechanism as different from one implicated for antipsychotics and its clinical utility.
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Affiliation(s)
- Prerna Kukreti
- Assistant Professor, Department of Psychiatry, Hamdard Institute of Medical Science & Research (HIMSR) , Jamia Hamdard, Delhi, India
| | - Wazid Ali
- Pharmacovigilance Technical Associate, IPC Ghaziabad, MoH & FW, Govt. of India, posted at Hamdard Institute of Medical Science & Research (HIMSR), Jamia Hamdard, Delhi, India
| | - R C Jiloha
- Professor and Head, Department of Psychiatry & Rehabilitation Sciences, Hamdard Institute of Medical Science & Research (HIMSR) , Jamia Hamdard, Delhi, India
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Jiloha RC, Kukreti P. Caregivers as the fulcrum of care for mentally ill in the community: The urban rural divide among caregivers and care giving facilities. Indian J Soc Psychiatry 2016. [DOI: 10.4103/0971-9962.176765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kukreti P, Bhirud L. Musical hallucination: Silent presentation of stroke. J Mental Health Hum Behav 2016. [DOI: 10.4103/0971-8990.193435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Gender identity is the sense of belonging that one feels for a particular sex psychologically and socially, independent of one's biological sex. There is much less systematic data on gender identity in females with congenital adrenal hyperplasia (CAH). We report a case of non-classical CAH presenting as a case of gender identity disorder.
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Affiliation(s)
- Prerna Kukreti
- Department of Psychiatry, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Manish Kandpal
- Department of Psychiatry, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - R C Jiloha
- Department of Psychiatry, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
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