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Mass media including television, internet, and newspapers influences public views about various issues by means of how it covers an issue. Newspapers have a wider reach and may affect the impact that a news story has on the reader by factors such as placement of the story within the different pages. We did a pilot study to see how two English newspapers from Mumbai, India were covering psychiatry related news stories. The study was done over a period of 3 months. We found a total of 870 psychiatry related news stories in the two newspapers over 3 months with the majority of them being covered in the main body of the newspapers. Sex‑related crime stories and/or sexual dysfunction stories received the highest coverage among all the news while treatment and/or recovery related stories received very little coverage. It is crucial that the print media takes more efforts in improving reporting of psychiatry‑related stories and help in de‑stigmatizing psychiatry as a discipline. [ABSTRACT FROM AUTHOR]

The development of the Diagnostic and Statistical Manual-5 (DSM-5) has been an exhaustive and elaborate exercise involving the review of DSM-IV categories, identifying new evidence and ideas, field testing, and revising issues in order that it is based on the best available evidence. This report of the Task Force of the Indian Psychiatric Society examines the current draft of the DSM-5 and discusses the implications from an Indian perspective. It highlights the issues related to the use of universal categories applied across diverse cultures. It reiterates the evidence for mental disorders commonly seen in India. It emphasizes the need for caution when clinical categories useful to specialists are employed in the contexts of primary care and in community settings. While the DSM-5 is essentially for the membership of the American Psychiatric Association, its impact will be felt far beyond the boundaries of psychiatry and that of the United States of America. However, its atheoretical approach, despite its pretensions, pushes a purely biomedical agenda to the exclusion of other approaches to mental health and illness. Nevertheless, the DSM-5 should serve a gate-keeping function, which intends to set minimum standards. It is work in progress and will continue to evolve with the generation of new evidence. For the DSM-5 to be relevant and useful across the cultures and countries, it needs to be broad-based and consider social and cultural contexts, issues, and phenomena. The convergence and compatibility with International Classification of Diseases-11 is a worthy goal. While the phenomenal effort of the DSM-5 revision is commendable, psychiatry should continue to strive for a more holistic understanding of mental health, illness, and disease. [ABSTRACT FROM AUTHOR]

Background: Depression is a major public health concern among Indian adolescents. Pre- and post-natal depression can often alter fetal development and have negative consequences on the physical and mental health of the mother. This paper aims to draw attention to the prevalence of depression and its correlates among currently married, ever-pregnant adolescents from two Indian States, i.e. Uttar Pradesh and Bihar. Methods: This study utilizes data from a subsample (n = 3116) of the prospective cohort study Understanding the Lives of Adolescents and Young Adults (UDAYA) among 10 to 19 year-old adolescents. Bivariate analysis was performed to assess the prevalence of depression by sociodemographic and behavioral characteristics. To further access the predictors associated with depression a logistic regression model was applied. Results: Around one-tenth (9%) of pregnant adolescents had depression. Regression analysis indicated that substance use, religion, autonomy, considering attempting suicide, premarital relationship, violence, dowry, adverse pregnancy outcome, menstrual problem, and parental pressure for the child immediately after marriage were significantly associated with depression. Conclusions: This study confirms the pre-existing annotation that teen pregnancy is linked with depression. Findings indicate that Adolescent mothers experiencing violence, and a history of adverse pregnancy outcomes are at increased risk of developing depression. These study findings call for an urgent need to address depression among adolescent mothers. [ABSTRACT FROM AUTHOR]

Background: General hospital psychiatric units (GHPUs) are one of the major service and training providers in the field of mental health in India. However, there has not been any systematic attempt at their contributions toward research. Aim: The present paper reports on contributions of the GHPUs toward the psychiatric research based on analysis of publications in the Indian Journal of Psychiatry (IJP). Materials and Methods: All the issues of IJP of the last 25 years (1989-2013) were manually searched for original research papers, brief reports, and case reports. A semi-structured performa was used to collect information on various parameters. Results: About two-thirds of the papers were contributed by the GHPUs, most being multi-authored and from tertiary care centers. The research covered a variety of psychiatric disorders including schizophrenia, mood disorders, and common mental disorders. Most of the research reported was self-funded. Conclusion: GHPUs have contributed significantly to psychiatric research in India in the last 25 years. [ABSTRACT FROM AUTHOR]

Background: Qualitative research methods (QRMs) bear a critical role in psychiatry as they explore the phenomenology of psychiatric illness and its sociocultural dimensions. However, there is limited evidence regarding its use in psychiatric research in India. Aim: This study, under the aegis of mapping qualitative health research in India initiative, attempted to landscape the use of QRMs in psychiatry and elicited expert opinion on its potential, perceived quality, and scope for improvement. Materials and Methods: We reviewed studies using qualitative methodology published in the Indian Journal of Psychiatry (IJP) and the abstracts presented at the Annual Conference of the Indian Psychiatric Society (ANCIPS) between 2010 and 2019. Titles and abstracts were screened and shortlisted; full-text articles were checked to identify the relevant ones. In addition, ten experts comprising psychiatry journal reviewers, editors, and conference scientific committee members were interviewed to elicit their views and suggestions. Results: Out of 356 papers published in IJP between 2010 and 2019, only 12 papers used QRMs: five qualitative and seven mixed methods. Out of 2297 abstracts published between 2010 and 2019 in ANCIPS, only 28 had used QRMs, consisting of 20 qualitative and eight mixed methods. The findings reveal that qualitative research is still an understudied domain in Indian psychiatry with a substantial need for rigor and quality. Conclusions: To catalyze the use of qualitative research in Indian psychiatry, continuing medical education programs through workshops or webinar mode need to be imparted. These trainings should aim at building skills on qualitative study design, data collection, analysis, and writing. [ABSTRACT FROM AUTHOR]

Background: Primary Care Doctors (PCDs) are the first contact for majority of patients with psychiatric disorders across the world including India. They often provide symptomatic treatment which is naturally inadequate. Absence or inadequate exposure to psychiatric training during undergraduate medical education is one of the prime reasons. Classroom training (CRT), a standard practice to train PCDs is driven by specialist based psychiatric curriculum and inherently lacks clinical translational value. Aim and Context: The 'Department of Psychiatry' of 'National Institute of Mental Health and Neurosciences', Bengaluru, India has recently come up with an innovative digitally driven modules of 'Primary Care Psychiatry Program' (PCPP) for practicing PCDs. Goal of this paper is to provide an overview of all these (five) modules with its various stages of implementation. Methods: Authors briefly discuss the current status of primary care psychiatry in India and also narrate the newly designed five modules of PCPP in this paper. Results and Discussion: An adopted psychiatric curriculum is designed in 'Clinical Schedules for Primary Care Psychiatry' (CSP) which is an integral part of PCPP. This is brief clinical schedules contains culturally appropriate screening questionnaire, transdiagnostic classification of 8 core psychiatric disorders, diagnostic, referral and management guidelines. PCPP contains 5 modules named as orientation module, basic module, advanced module [Tele-psychiatric 'On-Consultation Training' (Tele-OCT)], videoconference based continuing skill development module, and collaborative video consultation modules which covers all essential areas of primary care psychiatry for practicing PCDs. Last three modules are fully designed digital modules in hub and spoke model of Tele Medicine. In this designed program, the CSP and Tele-OCT are two path braking innovations having inbuilt higher clinical translation value. The challenges and opportunities that could be faced during its implementation across India are also discussed. Conclusion and Future Directions: Innovative PCPP is pragmatic in nature and has potential for higher clinical translational value. Once validated thoroughly, PCPP has potential for pan-India expansion. There is a need for artificial intelligence-based modules for next phase of PCPP in India considering her population and lesser number of available psychiatrists. [ABSTRACT FROM AUTHOR]

Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient--carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care. [ABSTRACT FROM AUTHOR]

Introduction: Not much is known about impact of 1918 Influenza on patients confined inside mental asylums of that period. Aim and Methods: The study aimed to assess impact of Influenza pandemic on mentally ill patients in asylums, based on data extracted from provincial asylum reports (1915–1923) from British India. Results: The asylum population in most provinces was impacted both in terms of direct mortality (1918) as well as all-cause morbidity and mortality (1918; 1918–1920). Agra and Oudh lost 9.5% of average daily asylum strength directly due to influenza in 1918. All-cause mortality (1918) was highest for mental asylum/s in provinces of Agra and Oudh (16.83%), Punjab (14.83%), and Bombay (14.4%). Isolated outbreaks continued till 1923. Another peculiar finding was markedly reduced sickness and death rates in 1921–1923 compared to 1915–1917, across asylums of all provinces. Conclusion: Findings point to a significant impact of Influenza pandemic in mental asylums across several provinces, and provide historical insights with implications for the current pandemic. [ABSTRACT FROM AUTHOR]

Background and Aims: Sexual dysfunction is often associated with substance use disorders. This study aimed to synthesize Indian literature on sexual dysfunction among patients with substance use disorders. Materials and Methods: Electronic search engines were used to identify studies of the last 20 years that reported sexual dysfunction with different substance use disorders. Information was extracted using a predefined template. Quality appraisal of the included studies was carried out using Joanna Briggs Institute checklist. Results: Twenty-seven relevant papers were identified that pertained to 24 distinct studies. Most of them were in patients with alcohol dependence, and fewer were in patients with opioid dependence. The study designs were primarily single-group cross-sectional, though many case--control, cross-sectional studies were also identified. The proportion of participants with sexual dysfunction ranged from 22.2% to 76% for studies related to alcohol dependence and 40% to 90% for studies pertaining to opioid dependence. Varied types of sexual dysfunctions were identified, including poor satisfaction, lack of desire, premature ejaculation, and erectile dysfunction. Efforts to address bias and confounders were not reported in most studies. Conclusion: Sexual dysfunction affects a substantial proportion of patients with substance use disorders. Clinicians can make an effort to ascertain and address sexual dysfunction in their routine clinical practice while dealing with patients with substance use disorders. [ABSTRACT FROM AUTHOR]

Background: General hospital psychiatry units (GHPUs) are the major providers of mental health services in India. Unlike in high-income countries, GHPUs in India are also the main training centers for providing postgraduate training in psychiatry and allied disciplines. Aim: This paper traces the history of the GHPUs in India from beginning to the present. Material and Methods: PubMed, old issues of the Indian Journal of Psychiatry and related sources were searched with key words general hospital and psychiatry both electronically and manually to look for the related literature. Results: The history of the development of GHPUs is discussed under 3 phases: beginning to the preindependence period, independence to the year of the launch of the National Mental Health Programme of India, and afterward. Contributions of the GHPUs towards service development, teaching, research, community awareness and reducing stigma, and their future scope are discussed. Conclusion: GHPUs have been a revolutionary development in India with great contribution in the field of mental heath [ABSTRACT FROM AUTHOR]

School mental health program (SMHP) has been recognized worldwide as key to improve the mental health and wellbeing of school going children. Unfortunately, in India, SMHP is badly neglected. There is no comprehensive SMHP that covers all school children (from rural and urban areas) across the country. A few sporadic activities that occur are praiseworthy; however, they lack a long-term approach. Major reasons for such neglect of SMHP in India could be lack of a steering body, poor intersectoral coordination, and minimal stakeholders' involvement. India, as any other country, needs to implement countrywide SMHP on the model of mental health promotion, prevention, and early intervention (PPEI). This paper outlines the deplorable state of SMHP in India and the needed steps to implement an effective countrywide SMHP on the PPEI model. [ABSTRACT FROM AUTHOR]

Introduction: Injection drug use (IDU) is intricately linked to preventive aspects for human immunodeficiency virus from a public health perspective. No large-scale data are yet available for injectable drug use among children and adolescents in India, apart from few anecdotal reports. Aims and Methods: The present paper reports on the profile and substance use pattern of 509 child IDU users, among a total sample of over 4000 children using substances across 100 sites from 27 states and 2 UTs in India. It was undertaken in 2012-2013 by the National Commission of Protection for Child Rights in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. For inclusion, participants had to be 18 years or less, should have used at least one other substance besides tobacco in the last 1 year, and should be living at home/street, in or out of school. Data were gathered using a 95-item semi-structured questionnaire. Results: A large proportion of ever users of IDU also reported use in the past year (96.5%) and past month (92.7%). Apart from IDU, tobacco, alcohol, cannabis, and pharmaceutical opioids were the most common substances of abuse in order of frequency. There was an interval of about 3 years from the initiation of tobacco to the initiation of IDU. Average age of onset for IDU was a year lesser in males than female users. The street children initiated IDU earlier than out-of-school and schoolgoing children. No quit attempt was made by more than half of the children. More than 40% had frequent familial conflicts, more than half had a familial history of substance use, and three-fourths had drug-using peers. Conclusion: The paper highlights the profile and pattern of children and adolescents using IDU across many parts of India, dispelling the myth that IDU is largely an adult phenomenon in India. There is a clear need to promote different harm reduction and preventive strategies across the "hard-to-reach" younger age groups using injecting drugs. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes a fictitious study of a fictitious drug. A companion paper in this issue of the Indian J Psychiatry critically examines this paper and provides author, reader, reviewer, and researcher perspectives on problems related to the design and conduct of a clinical trial; on issues related to the analysis of data; on how to write a research paper; and on how to critically read or review a journal article. Readers are invited to appraise this paper and then compare their assessment with that presented in the companion paper. Background: This study sought to compare the safety and efficacy of placeboxetine (PB) hydrochloride extended release capsules with sertraline hydrochloride in patients diagnosed with major depressive disorder in 15 general hospitals in south India. Materials and Methods: In a prospective, open-label, 15-center, randomized controlled clinical trial, consecutive outpatients diagnosed with major depressive disorder of at least moderate severity were randomized 1:1 to receive flexible doses of either PB or sertraline once each morning. Patients were evaluated every two weeks, until the study endpoint, using the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Rating Scale (MADRS). Safety was determined through assessments of vital signs, adverse events, study discontinuation rates, hematological parameters, metabolic parameters, electrocardiography, and other measures. Results: Ten patients dropped out of the study from each treatment arm. There was a significant, marked improvement in HAM-D and MADRS scores in each group by the treatment endpoint. There was no significant difference between PB and sertraline groups on either HAM-D or MADRS at any visit. The response rate was 90% with PB and 92% with sertraline. The remission rate was 70% with PB and 75% with sertraline. All laboratory parameters were within normal limits in all patients. There were no serious adverse events. Conclusions: Placeboxetine is as safe and effective as sertraline in Indian patients with major depressive disorder. [ABSTRACT FROM AUTHOR]

Background: A staggering 85% of the global population resides in low- and middle-income countries (LAMICs). India stands as an exemplary pioneer in the realm of mental health initiatives among LAMICs, having launched its National Mental Health Program in 1982. It is imperative to effectively evaluate mental health systems periodically to cultivate a dynamic learning model sustained through continuous feedback from mental healthcare structures and processes. Materials and Methods: The National Mental Health Survey (NMHS) embarked on the Mental Health Systems Assessment (MHSA) in 12 representative Indian states, following a pilot program that contextually adapted the World Health Organization's Assessment Instrument for Mental Health Systems. The methodology involved data collection from various sources and interviews with key stakeholders, yielding a set of 15 quantitative, 5 morbidity, and 10 qualitative indicators, which were employed to encapsulate the functional status of mental health systems within the surveyed states by using a scorecard framework. Results: The NMHS MHSA for the year 2015--16 unveiled an array of indices, and the resultant scorecard succinctly encapsulated the outcomes of the systems' evaluation across the 12 surveyed states in India. Significantly, the findings revealed considerable interstate disparities, with some states such as Gujarat and Kerala emerging as frontrunners in the evaluation among the surveyed states. Nevertheless, notable gaps were identified in several domains within the assessed mental health systems. Conclusion: MHSA, as conducted within the framework of NMHS, emerges as a dependable, valid, and holistic mechanism for documenting mental health systems in India. However, this process necessitates periodic iterations to serve as critical indicators guiding the national mental health agenda, including policies, programs, and their impact evaluation. [ABSTRACT FROM AUTHOR]

The National Mental Health Survey 2016 (NMHS 2016) was a large epidemiological study, one of its kind, conducted by the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru to overcome the shortcomings of the previous surveys. The detailed report of the study is available in two parts- 'mental health systems' and 'prevalence, pattern and outcomes'. Though done comprehensively, there are some inevitable limitations. The private sector, a substantial health care provider in the country was not a participant in the survey. Though MINI version 6.0 is a standard and structured instrument, it does not cover many commonly encountered mental illnesses like somatoform disorders. Further, the methodology of the survey makes it difficult for an accurate calculation of the prevalence of individual major psychiatric disorders. The survey has been appraised using a standard checklist for prevalence studies. The detailed qualitative data has not been shared in the report. The contribution of the traditional indigenous systems of healthcare and accessibility of services in rural areas have not been elaborated. Thus, the need for a comprehensive and culturally sensitive assessment tool, involvement of the private sector, and enhancing funding provision to improve the infrastructure are emphasized as future directions for the subsequent phases of the survey. [ABSTRACT FROM AUTHOR]

The National Mental Health Survey of India (NMHS) was a ground-breaking nationwide study that harnessed a uniform, standardized methodology blending quantitative and qualitative approaches. Covering data from 12 states across diverse regions, its mission was to gauge the prevalence of psychiatric disorders, bridge treatment gaps, explore service utilization, and gauge the socioeconomic repercussions of these conditions. This initiative provided pivotal insights into the intricate landscape of mental health in India. One of the analyses planned for NMHS data was to undertake a logistic regression analysis with an aim to unravel how various sociodemographic factors influence the presence or absence of specific psychiatric disorders. Within this pursuit, two substantial challenges loomed. The first pertained to data separation, a complication that could perturb parameter estimation. The second challenge stemmed from the existence of disorders with lower prevalence rates, which resulted in datasets of limited density, potentially undermining the statistical reliability of our analysis. In response to these data-driven hurdles, NMHS recognized the critical necessity for an alternative to conventional logistic regression, one that could adeptly navigate these complexities, ensuring robust and dependable insights from the collected data. Traditional logistic regression, a widely prevalent method for modeling binary outcomes, has its limitations, especially when faced with limited datasets and rare outcomes. Here, the problem of "complete separation" can lead to convergence failure in traditional logistic regression estimations, a conundrum frequently encountered when handling binary variables. Firth's penalized logistic regression emerges as a potent solution to these challenges, effectively mitigating analytical biases rooted in small sample sizes, rare events, and complete separation. This article endeavors to illuminate the superior efficacy of Firth's method in managing small datasets within scientific research and advocates for its more widespread application. We provide a succinct introduction to Firth's method, emphasizing its distinct advantages over alternative analytical approaches and underscoring its application to data from the NMHS 2015--2016, particularly for disorders with lower prevalence. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders, such as mood, anxiety, and substance use disorders, are significant contributors to disability globally, including India. Available research is, however, limited by methodological issues and heterogeneities. Aim: The present paper focuses on the 12-month prevalence and 12-month treatment for anxiety, mood, and substance use disorders in India. Materials and Methods: As part of the World Health Organization World Mental Health (WMH) Survey Initiative, in India, the study was conducted at eleven sites. However, the current study focuses on the household sample of 24,371 adults (≥18 years) of eight districts of different states, covering rural and urban areas. Respondents were interviewed face-to-face using the WMH Composite International Diagnostic Interview after translation and country-specific adaptations. Diagnoses were generated as per the International Classification of Diseases, 10th edition, Diagnostic Criteria for Research. Results: Nearly 49.3% of the sample included males. The 12-month prevalence of common mental disorders was 5.52% - anxiety disorders (3.41%), mood disorders (1.44%), and substance use disorders (1.18%). Females had a relatively higher prevalence of anxiety and mood disorders, and lower prevalence of substance use disorders than males. The 12-month treatment for people with common mental disorders was 5.09% (range 1.66%--11.55% for individual disorders). The survey revealed a huge treatment gap of 95%, with only 5 out of 100 individuals with common mental disorders receiving any treatment over the past year. Conclusion: The survey provides valuable data to understand the mental health needs and treatment gaps in the Indian population. Despite the 12-month prevalence study being restricted to selected mental disorders, these estimates are likely to be conservative due to under-reporting or inadequate detection due to cultural factors. [ABSTRACT FROM AUTHOR]

Women, the fair sex, are principal providers of care and support to families. But, they are considered to be the weaker sex and one of the most powerless and marginalized sections of our society. The provision of Rehabilitation for mentally ill women has been, and still is, one of the major challenges for mental health systems reform in the last decades, for various reasons. The present paper discusses the global and Indian scenario of rehabilitation of mentally ill women and goes on to detail the contribution of the state and voluntary agencies in this regard. It explores the need of recovery, multilayered strategy of Rehabilitation services and the availability of present services. The stigma attached and legal defects which interfere in good quality of life for the mentally ill women are reviewed. Strategies for changes in future are recommended. [ABSTRACT FROM AUTHOR]

Context: The Big Five model is a well-accepted model of personality but there is scant research on the factor structure of personality from Asian populations. It is unclear whether the Big Five personality model can account for cross-cultural variation in personality structures. Aim: To explore the factor structure of personality by analyzing the Big Five personality factors in a sample from Karnataka, South India. Settings and Design: This was a cross-structural observational study conducted in Udupi and Mangalore. Methods and Material: 400 community participants (200 women) from diverse socio economic backgrounds were recruited for the study and were assessed on either an English or Kannada version of the BFI-2-S. The reliability of the translated version of BFI-2-S was established. Statistical Analysis Used: Exploratory factor analysis using Principal Component Analysis with Varimax Rotation and Kaiser Normalization was carried out. Results: Factor Analysis revealed a four-factor and a five-factor solution that varied distinctly from the original Big Five. None of the identified factors fit into the original five factors. The four-factor solution explained 36.86% of the variance and the five-factor solution explained 41.74%. The five factors were named as -- Social Effectiveness, Interpersonal Ability, Altruism, Emotional Instability, and Innovativeness. The translated tool showed good temporal stability. Conclusions: The Five factors identified in the present study differ from the Big Five model or the General Factor of Personality. This raises questions about the cross-cultural validity of the Big Five model as well as highlighting the need to adopt more culturally adaptive methods of assessing personality. [ABSTRACT FROM AUTHOR]

Background and Aims: There is lack of research on somatic symptoms in schizophrenia. We aimed at finding prevalence and types of somatic symptoms in patients with schizophrenia and assessed their association with socio-demographic and clinical characteristics. Methods: We assessed somatic symptoms using Patient Health Questionnaire-15 (PHQ-15) in 93 patients with schizophrenia diagnosed on ICD10-DCR. Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms, WHO Disability Assessment Schedule 2.0, WHO Quality of Life (BREF) Hindi version and Liverpool University Neuroleptic Side-Effect Rating Scale were used to assess psychopathology, disability, quality of life and side effects. Results: Significant somatic symptoms (n ≥5 on PHQ-15) were present in 62 (67.7%) patients with schizophrenia. Forty three (69.4%) had mild (n = 5-9 on PHQ-15), 17 (27.4%) had moderate (n = 10-14 on PHQ-15), and only 2 (3.2%) had severe (n = ≥15 on PHQ -15) somatic symptoms. Mean somatic symptoms score on PHQ-15 was 7.28 (± 3.83); 96.8% reported feeling tired, 76.3% had constipation or diarrhoea, 67.7% trouble in sleeping, 61.3% nausea or indigestion, 52.7% back pain and 51.6% headache. Patients with somatic symptoms were older in age, had longer duration of illness and treatment, and had more negative symptoms. They had higher disability and poor quality of life especially in physical domain. Conclusion: Somatic symptoms are common in patients with schizophrenia and are associated with chronicity, refractoriness and negative symptoms, significant disability and poor quality of life. Thus during routine clinical practice, somatic symptoms should be assessed and managed in these patients. [ABSTRACT FROM AUTHOR]

The articles that appeared in Indian Journal of Psychiatry were related to different areas of psychotherapy. Case reports dealt with a wide variety of cases. The review papers focused on the suitability of psychotherapy in the Indian context, different approaches in psychotherapy, psychotherapy training and supervision. Psychotherapy has been viewed very close to faith orientation. There were attempts to identify the indigenous concepts that are applicable to psychotherapy. Empirical studies are low in number. Concerted effort is needed to generate interest in psychotherapy, conduct more research on evidence-based therapies as well as on psychotherapeutic process variables. [ABSTRACT FROM AUTHOR]

The objective of this paper is to provide a review on the psychiatric comorbidity research in India based on the data published in the last six decades. The comorbidity data world over reflects that it is a much more common phenomenon than observed in routine clinical practice. In India, research into this domain of psychiatry has been limited, with comorbidity reported to be as high as 60%. In the few publications in this area, most of the authors have looked into substance related comorbidity. Small numbers of studies have looked into comorbid conditions in child psychiatry, especially mental retardation and very few studies have looked at other comorbidities. The landmarks in the studies in the area of psychiatric comorbidity have been highlighted in this review article. [ABSTRACT FROM AUTHOR]

HIV/AIDS has gained prominence in India as a growing public health issue. There is a complex but significant interaction between mental health and HIV/AIDS. HIV affects mental health by its direct neurobiological action, the impact of having the illness, by its treatment including that for opportunistic infections and by its impact on the family. In addition, substance use and mental illness as vulnerability factors add to the complexity of assessment, differential diagnosis and management. This paper reviews literature published in India on the topic. [ABSTRACT FROM AUTHOR]

Background: The causal impact of income shocks on mental well-being in developing countries is an under-researched area. The COVID-19 pandemic, along with the economic recession caused by the lockdowns to reduce transmission, provides a natural experimental setting to examine the causal impact of a decline in monthly per capita expenditure (MPCE) on mental health of the general population in India during the pandemic. Aim: To evaluate the impact of income shocks on mental health of adults in metro cities during the COVID-19 pandemic. Materials and Methods: The data were collected using the abridged version of the Depression Anxiety Stress Schedule administered through a telephonic survey on adult residents of six metropolitan cities in September-August 2020 and July-August 2021. Results: In the present study, 994 adults participated from six metropolitan cities. Average treatment effects were estimated using Propensity Score Matching. The mean normalized scores are significantly higher for respondents whose MPCE had fallen (treated) vis-à-vis respondents whose MPCE had remained same or increased (control): anxiety (0.21 for treated vs -0.19 for control), stress (0.16 vs -0.14), and depression (0.04 vs -0.19). Propensity score matching reveals that the normalized scores for anxiety, stress, and depression were 33 (95% confidence intervals, CI: 20.0-46.7), 25 (95% CI: 12.9-36.9), and 36 (95% CI: 18.6-53.1) higher among the treated group vis-a-vis control group. The ATET was 34 (95% CI: 18.9-48.9), 26 (95% CI: 10.1-42.9), and 32 (955 CI: 12.3-50.7) for these three outcomes, respectively. The post-estimation tests indicated that the results are valid. Conclusions: The study advocates that policies to ensure income security should be made an integral part of the response packages to tackle pandemics like COVID-19. [ABSTRACT FROM AUTHOR]

Background: The interest in life skills education programs in schools is growing. Yet, there is limited evidence on implementation indicators for such programs in low-income countries. Aim: We present a qualitative evaluation of the acceptability and feasibility of the Heartfulness Way program—a secondary school-based social-emotional program, based on mindfulness techniques delivered by teachers in India. Methods: This qualitative study collected data from 12 schools in four Indian cities, namely, Chennai, Hyderabad, Prayagraj, and Pune. Data collection included focus group discussions with adolescents (n = 24) and teachers (n = 12), semistructured interviews with school principals (n = 12), program delivering teachers (n = 7), and program staff (n = 4). A thematic analysis was performed using NVivo 12. Results: Overall, the mindfulness-based classroom curriculum was strongly supported by participants. Acceptability was determined by positive responses, prosocial behavior, self-acceptance, and supportive bonds, according to students. Several themes of perceived benefits of the program including, improved relationships among peers and between students and teachers were identified. In general, the teachers' interviews indicated that there was a high level of satisfaction with the training and curriculum provided by the program. Teachers were able to provide high coverage (75%–80%) of the program activities, but several potential barriers were also identified, including insufficient training for teachers and the need for direct supervision. Conclusion: The Heartfulness Way program, a social-emotional learning intervention, has shown strong support for acceptance and delivery by school communities. Future studies are needed to examine the effectiveness and cost-effectiveness of this program for improving the health and well-being of school-aged adolescents. [ABSTRACT FROM AUTHOR]

Background and Aim: Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence. Materials and Methods: A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24–April 14) and the second phase (April 15–May 3) of lockdown. Results: A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid. Conclusion: Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown. [ABSTRACT FROM AUTHOR]

Background: Health-care communication is essential for amiable provider-recipient relationship. This study explored various health-care experiences and expectations of service recipients and providers in private clinical establishments of West Bengal, India, while breaking difficult news, bad news, and death. Aim: The current study was framed with the following research question: What are the varying perceptions, experiences, and expectations of healthcare recipients and their providers while seeking/delivering support in situations of breaking bad news and communications on death? Materials and Methods: The data were collected through individual in-depth interviews-31 respondents that included 16 patients and their families (recipient) and 15 medical practitioners (provider). Inductive thematic analysis was used. Results: Three main themes and nine sub-themes were identified highlighting livid experiences and perceptions of respondents. The findings suggest that interpersonal communications involve language barriers, health literacy and COVID-19 pandemic, situations of sudden unexplained death, perceptual negativity surrounding healthcare, empathy as well as emotions and multiple affiliations leading to ethical moral conflicts to influence individual perception. Regarding treatment attributes, factors of inaccessibility misconceived as incompetence and waiting and contact time are involved. The behavior and personality dimensions include attitude and robustness of the patient party and capability to handle emotions that affect provider-recipient relationship during communications of bad news and death. Conclusion: This study provided a local perspective about the experiences and expectations of healthcare recipients and their providers. Understanding this critical realm shall help in bridging the gap between recipient expectations and provider practices. It will also attempt towards possible alignment to improve patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Despite their higher prevalence, the Common Mental Disorders (CMDs) are under-recognized and under-treated resulting in huge disability. India, home to one-fifth of the global population, could offer insights for organizing better services for CMDs. However, the prevalence and resultant disability in the general population is unknown, and consequently, gaps in management or plan for services are enormous, by default overlooked. Aim: Estimating the current prevalence, disability, socioeconomic impact, and treatment gap of CMDs in a nationally representative sample from India. We attempt to identify the missed opportunities and list priorities for planning. Methodology: The National Mental Health Survey of India (2016) is a multisite nationwide household survey conducted across India using a uniform methodology. Overall, 39,532 adults were surveyed with a response rate of 88%. Diagnoses are based on the Mini International Neuropsychiatric Interview 6.0.0. CMDs for this analysis include depressive and anxiety disorders (generalized anxiety disorder, social phobia, agoraphobia, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder). Results: The weighted prevalence of current CMDs was 5·1% (95% CI: 5.06–5.13). Prevalence was highest in females, among the 40–59 years of age group, and in metros. Nearly 60% of them reported disabilities of varying severity. The treatment gap was 80·4%. On average, patients and their families spent ₹1500/month towards the treatment of CMDs. Conclusions: This survey gives valuable insights regarding the disability and treatment gap due to CMDs and is imperative for reframing mental health policies and planning interventions. This study also suggests an international investigation to understand the difference in the prevalence of CMDs in developing versus developed countries. [ABSTRACT FROM AUTHOR]

The Indian Journal of Psychiatry published three articles in its first issue way back in 1958. Since then, it has steadily published more than 200 papers on one or the other aspect of schizophrenia. From rudimentary research methodology and descriptive approach, schizophrenia research, as published in the Journal, seems to have come of age with more and more sophisticated research designs and methodologies. Our ardent researchers have made significant contributions in the understanding of this riddle called schizophrenia. Notable contributions have been made in the field of epidemiology, course and outcomes and phenomenology of this disorder. However, research in psycho-social rehabilitation of schizophrenia and related areas is sparse and sporadic. The need to conduct research that impacts health policies and planning of services for this disorder is evident and our researchers would do well to provide impetus in these areas. [ABSTRACT FROM AUTHOR]

Background: Media portrayal of mental illness may influence public stigma and service utilization. Aim: This study aims to explore the overall tone and content of the news articles on mental illnesses in India. Materials and Methods: This descriptive cross-sectional study was conducted on online English and Hindi news portals for articles which made reference to mental illness, published by local and national media sources between September 2019 and August 2020. The search was performed using location and news-only filters in the "Google" search engine; we used predefined search queries and selection criteria. A previously published checklist was used for the content analysis; it was done by two independent investigators. Results: A total of 273 news reports met inclusion criteria (Hindi n = 164, English n = 109). Results showed that more than half (54.9%) had a positive tone. Nearly a third (30.8%) of these articles were stigmatizing in tone. Persons with mental illness were portrayed as violent, unreliable, and unpredictable. Uses of blanket terms (33.3%) such as mentally ill, mentally unstable, mentally retarded, and stigmatizing photographs (36.9%) were also common. Overall, Hindi media had a significantly better quality of reporting than the English language media. National media reports had a less negative and stigmatizing tone than local articles. Conclusion: There is a need for a concerted attempt to improve the quality of media reporting of mental illness in India. [ABSTRACT FROM AUTHOR]

Background: The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly. Aim: The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research. Materials and Methods: Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies. Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively. Results: Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas: alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services. Sociocultural factors play a major role in understanding and determining mental disorders. Conclusion: This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis. [ABSTRACT FROM AUTHOR]

Background: No review has been attempted, so far, on Indian psychological autopsy (PA) literature. There is also a dearth of interview guides which is at the heart of a PA procedure. Materials and Methods: Electronic searches of MEDLINE through PubMed, PsycINFO, and Google scholar databases were carried out from inception till February 2020 to identify relevant English language peer-reviewed articles from India, as well as global literature that provided information on best practice elements in PA. Abstracts generated were systematically screened for eligibility. Relevant data were extracted using a predesigned structured proforma, and a semi-structured interview guide was developed. Results: A total of 18 original articles, one case report, and three reviews/expert opinion articles which tried to give a description of PA procedure were found from India. Most Indian studies are of suicide PA (SPA), done to assess risk factors associated with suicide. There was a wide variation in reported rates of psychiatric morbidity among suicide decedents, while the other major risk factor for suicide in the Indian setting was stressful life events. An optimal approach to PA involves systematically collecting information from key informants and other sources using a narrative interviewing method, supplemented with psychological measures, and is probably best carried out within 1–6 months after the death. Conclusion: There have been limited attempts to standardize PA. Most Indian studies use SPA. We propose a semi-structured PA interview guide, suitable for both research and investigational purposes. [ABSTRACT FROM AUTHOR]

Background: Gaps in lithium-related knowledge among bipolar disorder (BD) patients on lithium prophylaxis may pose safety concerns and could adversely influence attitudes to lithium. Objective: To assess the lithium-related knowledge and attitudes among patients with BD. Materials and Methods: This was a cross-sectional, observational study assessing euthymic, adult outpatients with BD on lithium prophylaxis (≥1 year) using a semi-structured pro forma, lithium questionnaire for knowledge, lithium attitude questionnaire (LAQ), and medication adherence rating scale (MARS). Results: Descriptive analysis revealed several deficits in knowledge, including lack of critical safety information or need for periodic blood tests. Lower knowledge group had significantly more negative attitudes. Favorable attitude toward lithium (lower LAQ score) was significantly associated with the number of psychiatric follow-ups in the last year and MARS score. Conclusion: There were critical deficits in lithium-related knowledge among the patients. Lower lithium knowledge was associated with negative lithium attitudes. Educative interventions should be delivered periodically to regular lithium users. [ABSTRACT FROM AUTHOR]

Background: Qualitative studies on students' perspectives about stress in medical education are sparse but nonetheless potentially relevant. Aim: The aim of the study was to assess the proportion of students who considered medical education to be excessively stressful and to elicit students' perspectives about ways to reduce stress in medical education. Materials and Methods: All medical undergraduate students of the college were asked about various aspects of stress in medical training using a self-rated questionnaire. Qualitative answers about the ways of reducing stress were also obtained using the questionnaire. Results: Medical education was considered to be excessively stressful by 265 (55.1%) students. The most common themes expressed for reducing the stress of medical education included those of "less frequent exams," "more spare time," and "slowing the pace of study or reducing syllabuses." Conclusion: Majority of students considered medical training to be stressful and curricular overload is an important reason for the same. [ABSTRACT FROM AUTHOR]

Background: Social skills deficits are hallmark symptoms of chronic mental illness. The absence of a culturally sensitive instrument to measure social skills in the Indian population demands the need to develop and standardize such instruments. Aim: The aim of this study was to develop and validate a context-specific, culturally relevant, and performance-based assessment scale for social performance. Materials and Methods: An expert committee of mental health professionals reviewed existing literature, identified standardized scales, examined items for cultural relevance, and identified possible issues for measurement. The items were categorized into 5 domains with a 7-point scale. The instrument was initially piloted on 10 participants, then among 101 consecutive clients with chronic mental illness between 18 and 60 years of age who provided written informed consent. They were assessed by two therapists to evaluate inter-rater reliability and test–retest reliability. They were also assessed on the Social Interaction and Communication Skills Checklist (SICSC) to evaluate convergent validity and on the 12-item General Health Questionnaire (GHQ-12) to assess divergent validity. Standard statistical tests were used to study its characteristics. Results: The scale had good inter-rater reliability (0.941; 95% confidence interval [CI]: 0.914, 0.960) and test–retest reliability (0.928; 95% CI: 0.810, 0.965). The correlation between total score of Vellore Assessment of Social Performance (VASP) and SICSC (Pearson's correlation coefficient = 0.696; P = 0.001) suggested moderate convergent validity. The correlation between total score of VASP and GHQ-12 (Pearson's correlation coefficient = −0.046; P = 0.648) implied good divergent validity. Conclusion: VASP seems to be a promising scale to assess social performance in people with mental illness. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is a life-shortening disease. Although the rate of mortality of persons with schizophrenia in India is established to be more compared to that in the general population, there is a little exploration of the causes for the same. Aim: The aim of this study is to explore the causes of death in two rural cohorts of schizophrenia. Materials and Methods: In-person interviews of primary caregivers of 53 deceased persons with schizophrenia were conducted using the World Health Organization's verbal autopsy 2014 instrument. Physician-based method was used to determine the causes of death. Results: Average age of 53 deceased schizophrenia patients was 50.45 ± 13.65 years with almost equal gender ratio. Just more than two-thirds of patients were married, just more than one-third are educated up to primary school and also had no formal education each. Noncommunicable diseases (NCDs) were the most common causes of death (30, 56.6%) in this sample, followed by communicable disease (7, 13.2%), and then unnatural deaths (suicide – 8, 15%, and road traffic accidents – 3, 5.6%). Conclusions: It is the first study in India to explore the causes of death in schizophrenia. NCDs being the most common cause of death in schizophrenia suggests to the need of integration of schizophrenia care into general health care. [ABSTRACT FROM AUTHOR]

India enacted the Mental Healthcare Act, 2017 (MHCA 2017) on April 7, 2017 to align and harmonize with United Nations Convention on Persons with Disabilities and the principles of prioritizing human rights protection. While MHCA 2017 is oriented toward the rights of the patients, the rights of the family members and professionals delivering treatment, care, and support to persons with severe mental disorder (SMD) often suffer. MHCA 2017 mandates discharge planning in consultation with the patients for admitted patients and makes the service providers responsible for ensuring continuity of care in the community. The concerns surrounding the chances of relapse and recurrence when a person with a SMD stops medications continue to remain largely unaddressed. The rights-based MHCA 2017 makes it difficult for the prevailing practices of surreptitious treatment by the family/caregiver and proxy consultations on behalf of the patients. This will, in turn, lead to increased chances of relapse, risk of violence, homelessness, stigma, and suicide in persons with SMDs in the community, largely due to noncompliance to treatment. This will also result in increased caregiver burden and burnouts and may also cause disruptions in the family and the community. To strike a balance over the current MHCA 2017, there is a need to amend or bring-forth a new law rooted in the principles of community treatment order. [ABSTRACT FROM AUTHOR]

Background: Use of coercive measures in mental health care is an important issue for research. There are scarce data available on perception and attitudes toward coercion among Indian psychiatrists. Aims: This study aims to study psychiatrists' attitude and perspectives on the use of coercive measure in clinical practice against the background of family and patients' opinion. Materials and Methods: The study was conducted at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India. Psychiatrist in charge of the inpatients was asked about their general opinion on coercion and was administered Staff Attitude to Coercion Scale questionnaire. Findings were compared to previously published studies on patients' opinion and family opinion in the same sample. Data were analyzed using descriptive statistics. Results: Coercion proved to be a common measure applied in nearly 70% of the patients studied. The 189 psychiatrists participating in the study almost all perceived coercion as care, protection and safety, and as protection from dangerous situations. About 66% of psychiatrists perceived physical and chemical restraint (sedation) as necessary and acceptable in acute emergency care. One-third of the psychiatrists felt their patients lost autonomy, dignity, and the possibility of interpersonal contact. The same amount agreed that some patients could have been treated with less restriction and fewer coercive measures. Conclusion: Psychiatrists felt that physical and chemical restraints are necessary and acceptable in acute emergencies. Most psychiatrists considered coercion as a caring protective and safety attitude but also acknowledged its potential negative impact on patient dignity and therapeutic relationships. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to assess the perception of the young psychiatrists (aged ≤45 years) about their training received during the postgraduate training period. Methodology: An online E-mail survey using Survey Monkey electronic platform evaluated the perception of 451 psychiatrists about their own perception of training received during the postgraduation period. Results: About two-third (n = 308; 68.3%) of the respondents reported that their overall training was 'good' or 'very good'. However, training was rated as poor/very poor in subspecialties of child and adolescent psychiatry and geriatric psychiatry by 26.2% and 26.9% of the participants, respectively. Exposure/training was rated as "poor/very poor" by more than one-fifth of the participants in areas of repetitive transcranial magnetic stimulation and deep brain stimulation (69.9%), rehabilitation psychiatry (47%), forensic psychiatry (45.5%), psychodynamics (40.5%), neuroimaging (38.1%), psychotherapy (34.8%), orientation to private practice (26.9%), statistics (34.1%), writing skills (24.4%), ethical principles of research (23.5%), women mental health (23.3%), psychosexual medicine (22.7%), and research methodology (21.5%). Regarding academic activities involving writing skills, although majority (72.5%) of the participants reported being involved in writing case reports and half (50.3%) reported involvement in writing original articles, but exposure to writing other types of article was quite low. Training in different types psychotherapies in the form of adequate exposure, carrying out and supervision to different types of psychotherapy was inadequate/low for psychodynamic psychotherapies, rational emotive therapy, dialectical behavior therapy, eclectic psychotherapy, and other kind of therapies. A high proportion of respondents reported having good competence in the administration of modified electroconvulsive therapy and making presentation in academic fora just after passing degree from their institutes and at the time of survey (current competence). When comparisons were done between the different groups of institutes, significant difference was noted across all aspects of training. Conclusions: The present survey reflects that there is a variation in the psychiatry training in India. Accordingly, it can be said that there is a need to develop a model for competency-based training program at the level of the Indian Psychiatric Society in consonance with training regulatory bodies like the Medical Council of India, which can be implemented across the country to harmonize the training. [ABSTRACT FROM AUTHOR]

While guidelines for psychosocial interventions in addictive disorders in India were earlier rooted in clinical experience and global empirical evidence, recently there have been efforts to develop guidelines for intervention based on the local needs assessments of specific populations and more appreciably, a testing of the effectiveness of the interventions. This supplement on psychosocial interventions for addictive disorders covers some of the important aspects of psychosocial interventions in five sections. Section I covers the general principles of management and specific assessment approaches, screening for cognitive dysfunction and assessment of co-morbidities. Section II focuses on specific psychosocial interventions including brief interventions, relapse prevention, cognitive behavioural interventions, psychoanalytical interventions, cognitive rehabilitation, interventions in dual disorders, marital and family therapy, psychosocial interventions for sexual dysfunction and sexual addictions. Section III describes innovative approaches including third wave therapies, video-based relapse prevention, digital technology as a tool for psychosocial interventions as well as psychosocial interventions in technological addictions. The latter part of this section also deals with psychosocial interventions in special populations including children and adolescents, women, sexual minorities and the elderly. Section IV pans into community based psychosocial interventions including community camps and workplace prevention. The need to develop task sharing through the involvement of trained health workers to deliver community and home-based interventions is highlighted. Section V underscores the ethical issues in different aspects of psychosocial intervention and the need for research in this area. Although there is a tendency to formulate addiction in either biomedical or psychosocial terms and to view interventions either as pharmacological or psychosocial, these dichotomies neither exist in the affected individual's mind, nor should be present in the treating clinician. A comprehensive understanding of addiction requires an understanding of the person in his/her environment and needs a personalised holistic approach that addresses the diverse physical/mental health, occupational, legal, social and aftercare needs. [ABSTRACT FROM AUTHOR]

Context: There is scarce data on the prevalence of harm to adolescents from others' use of alcohol from India. Aims: The aim is to study the prevalence of harm to school students from others' alcohol use in the district of Ernakulam, Kerala and examines its psychosocial correlates among victims. Settings and Design: This was a cross-sectional survey of 7560 students of the age range of 12–19 years from 73 schools. Materials and Methods: Harm consequent to others' drinking was assessed using a brief version of the World Health Organization–Thai Health Questionnaire on Harm to Others from Drinking. Standardized instruments were used to assess other measures. Statistical Analysis: The prevalence of various harms was determined. Mixed-effect logistic regression was used to explore the sociodemographic, academic, and psychological factors associated with various types of harms and odds ratios reported. Results: Harm due to others' alcohol use was reported by 44.5%, frequent harm by 15.7%, psychological harm by 43.3%, physical harm by 9.7%, property harm by 2.9%, and financial harm by 15.4%. Boys reported greater harm than girls. Girls experienced relatively greater harm within the family and boys outside the family. Being older, having a part-time job and urban residence increased the odds of harm. Adolescents reporting harm had higher odds of substance use, psychological distress, suicidality, sexual abuse, and attention-deficit/hyperactivity disorder symptom-counts. Conclusion: The high prevalence of harm from others alcohol use to adolescents with multiple negative impacts underscore the urgent need for public health measures to reduce social costs of alcohol use. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study is to analyze the internal consistency, factor structure, and external validity of the 12-item General Health Questionnaire (GHQ-12) among older adults in India. Settings and Design: This study analyzes data collected as part of the UNFPA "Building Knowledge Base on Ageing in India (BKPAI)" project. The BKPAI Survey was conducted in 2011 in seven major demographically advanced states of India – Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala, and Tamil Nadu. Materials and Methods: A community-based representative sample of 9692 respondents aged 60 and above from seven Indian states was employed. The GHQ-12 questionnaire was administered. Statistical Analysis: The Cronbach's alpha was calculated to analyze internal consistency. Factor analysis was applied to explore the factor structure of GHQ-12, and then correlation coefficients were calculated to examine the external validity of the measurement. Results: The Cronbach's alpha of the GHQ-12 is 0.9. Factor analysis reveals two significant components which accounted for 59% of the variance. The correlation between the overall score of GHQ-12 and the subjective well-being inventory (SUBI) is 0.58. Conclusions: The GHQ-12 shows adequate reliability among the older population in India. [ABSTRACT FROM AUTHOR]

Background: Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes. Materials and Methods: Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference. Results: Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion. Conclusion: In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health. [ABSTRACT FROM AUTHOR]

Background: There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis. Materials and Methods: This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t-test. Results: A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40--F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30--F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40--G47) with 334 cases (12%). Conclusions: We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program. [ABSTRACT FROM AUTHOR]

Introduction: In India, girl is raped every 20 min. The majority of reports reveals youth is vulnerable group for rape victimization. A set of prejudicial, stereotyped, or false beliefs about rape, rape victims, and rapist exist in the community. Aims/Objectives: To study the attitude and myths toward rape among college going students of Surat City. Materials and Methods: College students of various streams were participated in the study based on attitude toward rape scale (21 items) and updated Illinois Rape Myth Acceptance Scale (22 items). A total of 332 participants from three different colleges of the city took part in the survey. Data analysis was done with the SPSS version 19. Results: Among the responders, 61.75% were female. Mean age of participants was 20.22 ± 1.27 years. Almost two-third (73%) of female participants and 42% of the male participants disagreed with the myth that "When a woman says 'no' she really means 'yes'." Around 30% of the participants were uncertain about the myth that "A woman cannot be raped by someone she previously knew or had sex with." While almost 35% of participants believed that "Most rapes are carried out by strangers." Strong sexual desire of guys, drunkenness, and girl's clothes were reported to be factors that provoke rape by 50%, 40%, and 33% of respondents, respectively, around 95% of female and 92% of male participants think that 7-year imprisonment for rape is not enough. Conclusions: Rape myths are found to be highly prevalent among youth and higher among males. [ABSTRACT FROM AUTHOR]

Human rights and mental health care of vulnerable population need supportive legislations and policies. Both "hard" and "soft" laws relevant to mental health care have been devised internationally and locally. Amendments in laws and the formulation of new laws are often required and have been seen to occur in the area of mental health care in India. So far, reform in mental health care has largely been reactive, but newer legislations and policies carry the hope of proactive reform. The lack of trained human resources is one of the biggest problems in effective mental health care delivery in India. While postgraduate psychiatric guidelines recommend a 2-week training in forensic psychiatry, this is insufficient to develop the necessary competence in the area. There is, thus, a need to develop subspecialty of forensic psychiatry. Forensic psychiatric services also need to be developed, properly structured, and supported. There is a need to set up one or more centers of excellence in forensic psychiatry in India. [ABSTRACT FROM AUTHOR]

Context: Retention in treatment can improve the outcomes of patients with substance use disorders. Aims: This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders. Setting and Design: This record‑based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de‑addiction facility in Northern India. Materials and Methods: Patients were classified as being retained in treatment or drop‑outs based on follow‑up records. Statistical Analysis: Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment. Results: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10th grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance‑related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention. Conclusion: Identification of patient characteristics predicting drop‑outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel. Materials and Methods: The first dedicated inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants. We describe the unique challenges faced in the unit, characteristics of this patient population and clinical outcomes. Results: Two hundred and thirty-seven mother-infant pairs were admitted from July 2009 to September 2013. Bipolar disorder and acute polymorphic psychosis were the most frequent primary diagnosis (36% and 34.5%). Fifteen percent of the women had catatonic symptoms. Suicide risk was present in 36 (17%) mothers and risk to the infant by mothers in 32 (16%). Mother-infant bonding problems were seen in 98 (41%) mothers and total breastfeeding disruption in 87 (36.7%) mothers. Eighty-seven infants (37%) needed an emergency pediatric referral. Ongoing domestic violence was reported by 42 (18%). The majority of the mother infant dyads stayed for<4 weeks and were noted to have improved at discharge. However, 12 (6%) mothers had readmissions during the study period of 4 years. Disrupted breastfeeding was restituted in 75 of 87 (86%), mother infant dyads and mother infant bonding were normal in all except ten mothers at discharge. Conclusions: Starting an MBU in a low resource setting is feasible and is associated with good clinical outcomes. Addressing risks, poor infant health, breastfeeding disruption, mother infant bonding and ongoing domestic violence are the challenges during the process. [ABSTRACT FROM AUTHOR]

Background: Eating disorders (EDs) are an emerging concern in India. There are few studies comparing clinical samples in western and nonwestern settings. Aim: The aim was to compare females aged 16-26 years being treated for an ED in India (outpatients n = 30) and Australia (outpatients n = 30, inpatients n = 30). Materials and Methods: Samples were matched by age and body mass index, and had similar diagnostic profiles. Demographic information and history of eating and exercise problems were assessed. All patients completed the qualityof- life for EDs (QOL EDs) questionnaire. Results: Indians felt they overate and binge ate more often than Australians; frequencies of food restriction, vomiting, and laxative use were similar. Indians were less aware of ED feelings, such as, "fear of losing control over food or eating" and "being preoccupied with food, eating or their body." Indians felt eating and exercise had less impact on their relationships and social life but more impact on their medical health. No differences were found in the global qualityof- life, body weight, eating behaviors, psychological feelings, and exercise subscores for the three groups. Conclusion: Indian and Australian patients are similar but may differ in preoccupation and control of their ED-related feelings. [ABSTRACT FROM AUTHOR]

Background: World Health Organization (WHO) is in the process of revising the International Classification of Diseases 10 (ICD.10). For increasing the acceptability of the ICD.11, WHO along with World Psychiatric Association (WPA), conducted a survey of psychiatrists around the world, in which 386 psychiatrists from India participated. Aim: To present the findings of "WPA.WHO Global Survey of Psychiatrists' Attitudes toward Mental Disorders Classification" for Indian psychiatrists who participated in the survey as members of Indian Psychiatric Society. Methodology: The online survey was sent to qualified psychiatrists who are members of Indian Psychiatric Society and are residing in India. Results: Of the 1702 members who were urged to participate in the survey, 386 (22.7%) participated. Most(79%) of the psychiatrists opined that they use formal classificatory systems in their day-to-day clinical practice. ICD. 10 was the most commonly (71%) followed classificatory system. Nearly half (48%) felt the need for only 10.30 categories for use in clinical settings and another 44% opined that 31-100 categories are required for use. Most of the participants (85%) suggested that a modified/simpler classificatory system should be designed for primary care practitioners. Similarly, the same number of participants (89%) argued that for maximum utility of a nosological system diagnostic criteria should provide flexible guidance that allows cultural variation and clinical judgement. About 75% opined that the diagnostic system they were using was difficult to apply across cultures. Conclusion: Findings of the survey suggest that classificatory systems are routinely used in day.to.day practice by most of the participating psychiatrists in India and most expect that future classificatory system should provide flexible guidance that allows cultural variation and clinical judgement. [ABSTRACT FROM AUTHOR]