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Background: From whichever culture a family belongs to, scientific evidence shows the role of family functioning and relationships on the child's health and well-being. A family can either be a source of an issue or a resource for preventing the problem, especially in a diverse country like India. The foremost step to understanding these aspects is to develop an awareness of the transitional nature of family functioning in the new millennium. Objectives: The study proposes to explore the dynamics of family functioning from the conceptualization of parents of Generation Z and intents to analyze the subsequent outcomes on the health of children and adolescents, presenting it as qualitative network construction. Methods: Rich descriptive data was collected from 60 parents by a semi-structured interview schedule consisting of 4 predecided questions. The analyses were done by ATLAS.ti7 version 7.5.16, Computer-Assisted Qualitative Data Analysis Software (CAQDAS). Results: As an upshot, 2 structural networks were constructed. One network depicts the 3 aspects of family functioning, cohesion, flexibility, and communication, studied according to Indian families of the new millennium. The psychological, socioemotional, and physical impact of the functioning accumulated in the second network. The study revealed the underlying aspects, the level, and quality of all the 3 dimensions and the thought-provoking aftermath for Generation Z. Conclusion: The study offers intriguing information about the Indian family functioning of the new millennium and its descriptive association with the health of children and adolescents. [ABSTRACT FROM AUTHOR]

Background: India has a significant prevalence of people with intellectual disabilities. Despite their higher prevalence, they receive poor support. Therefore, this review aims to explore the experiences of family carers in providing care for children with intellectual disabilities in India., Methods: A qualitative evidence synthesis was undertaken, searching databases such as MEDLINE, CINAHL, Web of Science, and PsycInfo up to October 2023. Grey literature was also searched for unpublished studies, with two reviewers assessing methodological quality. Eleven eligible studies, mostly qualitative in design, were included in the review. The data synthesis followed a thematic approach., Results: The synthesis found five themes representing family carers' experiences and perspectives. These were 'resilience and acceptance', 'parental response', 'care dynamic', 'preparing for transition to adulthood' and 'parental advocacy'., Conclusion: Family carers hold diverse views, while almost all consider providing care complex and challenging, with few positive experiences., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Cross-cultural psychosis research has mostly focused on outcomes, rather than patient and family experiences. Therefore, our aim was to examine differences in patients' and families' experiences of their treating teams in early intervention services for psychosis in Chennai, India [low- and middle-income country] and Montreal, Canada [high-income country]., Methods: Patients (165 in Chennai, 128 in Montreal) and their families (135 in Chennai, 110 in Montreal) completed Show me you care, a patient- and family-reported experience measure, after Months 3, 12, and 24 in treatment. The measure assesses the extent to which patients and families view treating teams as being supportive. A linear mixed model with longitudinal data from patient and family dyads was used to test the effect of site (Chennai, Montreal), stakeholder (patient, family), and time on Show me you care scores. This was followed by separate linear mixed effect models for patients and families with age and gender, as well as symptom severity and functioning as time-varying covariates., Results: As hypothesized, Chennai patients and families reported more supportive behaviours from their treating teams (β=4.04; β= 9, respectively) than did Montreal patients (Intercept =49.6) and families (Intercept=42.45). Higher symptom severity over follow-up was associated with patients reporting lower supportive behaviours from treating teams. Higher levels of positive symptoms (but lower levels of negative symptoms) over follow-up were associated with families reporting lower supportive behaviours from treating teams. There was no effect of time, age, gender and functioning., Conclusions: The levels to which treating teams are perceived as supportive may reflect culturally shaped attitudes (e.g., warmer attitudes towards healthcare providers in India vis-à-vis Canada) and actual differences in how supportive treating teams are, which too may be culturally shaped. Being expected to be more involved in treatment, Chennai families may receive more attention and support, which may further reinforce their involvement. Across contexts, those who improve over follow-up may see their treating teams more positively., Competing Interests: Declaration of Competing Interest The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: A substantial proportion of persons with psychosis (PWP) remain untreated in the community across the world. Factors that preclude them from accessing psychiatric treatment are poorly studied. In this study, we explored the factors that prevented persons with schizophrenia and their caregivers from accessing psychiatric treatment using an interview schedule specifically developed for this purpose., Methods: We identified individuals with schizophrenia and related disorders who had never accessed psychiatric treatment. We interviewed 67 such individuals and their family members using a validated tool, the Schedule of Factors Influencing Access to Treatment (SOFIAc) and analysed the data using descriptive statistics., Results: The M ( SD ) number of factors reported to preclude individuals with psychosis and families from seeking psychiatric treatment was 10 (3.32). No PWP/family reported any single factor as the sole reason for not accessing treatment. Distance to the nearest psychiatric centre (97%), PWP's/family members' knowledge and attitude towards symptoms of psychosis and treatment (92.5%), financial problems (91%), lack of insight and active resistance to efforts towards treatment (86.6%), lack of support from the family (83.6%) and family issues and dynamics (79.1%) were reported to be the commonest factors that precluded them from accessing psychiatric treatment., Conclusions: The reason for individuals with psychosis and their family members not accessing psychiatric treatment was invariably multifactorial, involving, on average, 10 factors. Programmes that target the reduction of the treatment gap should be cognizant of the multifactorial nature of the challenge of reaching psychiatric treatment for persons with psychoses.

Introduction: Family caregivers with schizophrenia struggle with psychological, social, and other challenges due to stigma, lack of adequate information, and maladaptive coping strategies. We aimed to explore the experiences of caregivers of persons with schizophrenia (PwS) to comprehend the emotional challenges and other burdens and coping strategies utilized., Methods: We subscribed to a phenomenological approach and interviewed nine caregivers in-depth. Audio-recorded interviews were transcribed and translated from Hindi to English. Thematic analysis was performed using the seven-step Colaizzi's method. ATLAS.ti.22 was used for the analysis of the data., Results: Five themes emerged from the data: 1) general understanding of schizophrenia, 2) emotional burden, 3) Disruption in personal and socio-occupational life, 4) challenges in caregiving, and 5) coping strategies. Caregiving adversely affected the quality of life socially and financially. Schizophrenia stigmatized families, trapped them in their homes, and left them no choice but to get support from informal networks. Also, caregivers experienced a lack of healthcare facilities in the vicinity and reported a substandard level of formal care., Conclusion: Giving care to PwS entails financial, social, emotional, and physical burden. Feelings of frustration, helplessness, uncertainty, and loss are common. Transformation of personal, professional, and social life are usual consequence of caregiving. Generally, caregivers cope through addictions or spiritual means. Significant perceived requirements include a lack of knowledge about the condition and how to manage it as well as inadequate support services. Emotional and financial support and community support services near home may ease the burden of caregiving for PwS., Competing Interests: Declaration of competing interest The authors report no disclosure relevant to the manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Migraine is a disabling primary headache disorder characterized by recurrent episodes of headache. Migraine not only imposes a burden on the sufferer but also imposes a burden on their family members too. A holistic approach is more essential in the management of migraine and family members should also be included in the management of migraine. There are no published studies done in India so far to look for the impact of migraine on partners and adolescent children (IMPAC). This pilot study was done to assess the IMPAC., Objective: The objective of the study was to study the IMPAC., Materials and Methods: In this descriptive study, 130 chronic migraine patients were observed in a row during 9 months. The impact of migraine on family members as well as migraine disability and Migraine-specific Quality of Life (MSQoL) was evaluated using validated questionnaires., Results: One hundred and thirty chronic migraine patients were studied as part of this study. The mean age of the study population was 34.43 ± 9.002 years, and two-third of the participants were female. The majority of the participants had a moderate-to-severe disability due to migraine and had negatively impacted their MSQoL. The impact of migraine on family members was moderate-to-severe grade in most of the participants and affected their family life negatively both with children and spouses. The males were more significantly affected than females in terms of MSQoL, anxiety, depression, and also on migraine's impact on family members., Conclusion: Migraine not only affects the sufferers, it also significantly affects their family members., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Juvenile Idiopathic Arthritis (JIA) causes caregiver burden on families with children affected with it. Our study aimed to explore this multifaceted burden in the Indian context. In this cross-sectional study, we administered the Hindi translated CAREGIVER questionnaire to adult caregivers in the families of JIA patients ≤ 18 years. The responses to the 28 items were used to calculate the burden scores in various dimensions. The relationship of the global burden scores with demographic and socioeconomic factors were analysed. Non parametric tests were used. Two hundred twenty-one caregivers participated with a median age of 39 years (IQR 32-45). This included 116 fathers, 50 mothers, 32 brothers, 18 uncles, three grandfathers, one sister, and one grandmother. The JIA patients had a median age of 15 (12-17) years, and the male-to-female ratio was 3.2:1. Enthesitis-related arthritis was the predominant subtype (72.4%). Most caregivers (70.6%) expressed sadness at diagnosis, and 29.9% continued to express sadness. Nearly two-thirds (65.6%) had to borrow money from others. More than half (59.3%) of the caregivers neglected their health, and 9.0% became sick. Male gender of the child, systemic JIA subtype, low socioeconomic status, high disease activity, extra-articular damage, high parent-reported disease activity and poor quality of life were associated with higher global caregiver burden. JIA has a significant emotional, social, economic, and labour impact on caregivers. Economic and psychosocial support needs to be given to family caregivers caring for children with JIA., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up., Methods: Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers., Results: The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up., Conclusion: This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Due to the paucity of reliable data to determine the components of family-based comprehensive care for cancer in India, we explored the familial implications of gynaecological and breast cancer diagnosis and treatment through a mixed-method study., Methods: The mixed method study included 130 women aged above 18 with a confirmed diagnosis of gynaecological or breast cancer recruited from three selected tertiary hospitals in Kerala, India. Information on quality of life (36-Item Short Form Survey (SF-36)), psychological distress (distress thermometer), and the familial, interpersonal, social, and community impacts of cancer (semi-structured interview guide) were elicited. Linear regression was used to identify the factors associated with distress and the factors were explored further using thematic analysis., Results: Patients included in the study (n = 130; mean age 57.5 years) had moderate or mild (66.9%) to severe (25.4%) distress. Concerns about work (93%), difficulty in; home care and housing (82%), care for dependents (65%), unempathetic family (87.6%), isolation (70%), and body image (65%) were major reasons for their distress. Physiological, social, and family-related stressors among the respondents included challenges in physical functioning, intense physical symptoms like fatigue, loss of appetite and sleep, role restrictions, alterations in family responsibilities, functional dependency, inadequate family support, challenges in social and interpersonal interactions, and an unsupportive work environment., Conclusion: Cancer is a health crisis that involves psychological, social, and economic distress, compelling professionals to design multifaceted individualized care packages rather than only concentrating on medical management to alleviate their distress., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Stigma poses significant challenges to tuberculosis control efforts worldwide. India, bearing a substantial burden of tuberculosis cases, grapples with pervasive stigmatizing attitudes towards the disease, hindering timely diagnosis and treatment. This study aims to assess the prevalence and manifestations of tuberculosis-related stigma, shedding light on a critical yet overlooked aspect of tuberculosis management., Methods: After obtaining informed consent, 314 participants were taken and stratified equally into three groups: patients, family members, and healthcare workers. A pre-designed questionnaire was used to calculate prevalence and assess tuberculosis stigma across various domains. Data were compiled in MS-Excel and analyzed using EPI-Info 7 by the CDC., Results: Among all 314 participants, the prevalence of stigma in this study was 26.75%. A statistically significant correlation was found between stigma experienced and marital status (p = 0.013) and level of knowledge regarding tuberculosis (p < 0.001). Among the patients of tuberculosis, the odds of facing stigma are 13.25 (C.I. 95% 4.14, 42.41) times higher in females and 3 (C.I. 95% 1.005, 8.95) times higher in patients with unsatisfactory knowledge about tuberculosis compared to males and patients with satisfactory knowledge, respectively., Conclusion: Tuberculosis is stigmatized due to its deviation from societal norms. Societal norms dictate what is deemed acceptable or unacceptable. Females with tuberculosis encounter more stigma than males, and knowledge about tuberculosis affects stigma significantly. Patients mostly experience enacted and perceived stigma, while family members face perceived and secondary stigma. Healthcare workers tend to exhibit secondary stigma., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mustansir Abbas Ali reports financial support was provided by Indian Council of Medical Research. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Caregiving in the South Asian context is often assumed by family automatically for the person with cancer (PWC). In this paper, we applied the disclosure decision-making model (DD-MM) to understand the motives behind cancer prognosis disclosure (or not) by caregivers to the PWC. Fifty caregivers participated in semi-structured interviews; and data were analyzed using Framework Approach. For the disclosing caregivers, some of the themes that emerged were consistent with the DD-MM framework while others were not. In particular, the theme "recipient assessment" was part of the DD-MM framework, while others such as unmet communication needs, caregiver self-reflection, and family support were outside of the framework. In contrast, for the non-disclosing caregivers, the reasons for nondisclosure fit very concisely into the DD-MM framework, particularly with information assessment, recipient assessment, and (non) disclosure efficacy. This study has significant implications for development of communication skills trainings around holding family meetings in India.

Narrative therapy is a respectful and culturally relevant form of psychotherapy. Internationally, there is an increasing use of narrative therapy with diverse populations; however, there is limited documentation within the Indian context. The intention of the study was to understand experiences of children and their families during their participation in narrative therapy at Ummeed Child Development Center in Mumbai, India. Twelve participants were recruited for individual interviews: four children, who received counseling at Ummeed Child Development Center for a minimum of 6 months, and eight family members. Thematic analysis of data revealed three themes: Working In Partnership reflected the value of therapy being a collaborative process; Practices That Open Up Possibilities highlighted skills of children and their families that became visible through counseling; and Taking Control And Advocacy revealed how families experienced a sense of control over their own lives and an interest in advocating for others with similar lived experiences. The study has brought to light how narrative therapy can make possible change in lives of children and their families and wider society. In an international context, these findings serve to document narrative therapy as a beneficial modality for mental health practitioners to use with children experiencing developmental disabilities and their families.

Introduction: Stigma towards alcohol use disorders is prevalent in India and can lead to social exclusion and hamper treatment access and outcomes. Family members of individuals with dependent drinking are often their primary caregivers and play a key role in decisions around help-seeking, treatment and recovery. The nature and role of stigma in caregiving, and the consequent burden on family caregivers of those with dependent drinking, has not been qualitatively studied in India., Methods: We conducted in-depth interviews with: (i) men with probable alcohol dependence (n = 11); (ii) family caregivers (n = 12); and (iii) doctors with experience of treating alcohol dependence (n = 13) in community settings in Goa. Data were analysed using inductive thematic analysis., Results: Two primary themes were identified from the data: (i) stigma in the form of ignorance, prejudice and discrimination; and (ii) the impact of this stigma on caregiving decisions and the mental health of caregivers., Discussion and Conclusions: We found that stigma functioned as a barrier to a proper course of treatment and care, as well as a detrimental factor for caregiver's mental health and caregiving decision-making. Stigma towards dependent drinking in the forms of ignorance, prejudice and discrimination is prevalent within homes, workplaces and health systems and might exacerbate the caregiving burden among female family caregivers. Policies, educational programs and campaigns aimed at preventing stigma in these forms would likely enable access to more inclusive and appropriate health services, benefit the health of family caregivers and improve the treatment outcomes of drinkers., (© 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction., Methods: Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis., Results: Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner., Conclusions: Primary care providers' willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis., Competing Interests: The authors have declared no competing interests.

Introduction: Cancer is a major life-threatening disease and has an impact on both patients and their family members. Caring for cancer patients may lead to several levels of stress which may affect their own health as well as their quality of life., Aim: To assess the perceived stress and burden of family caregivers of head and neck cancer patients (HNC) attending cancer care centre at a tertiary care centre, Tamil Nadu., Objectives: To assess the perceived stress and the burden among caregivers of patients with head and neck cancer using the Perceived Stress Scale (PSS) and Caregiver Strain Index (CSI) respectively., Materials and Method: A Cross-sectional study was carried out for a period of three months among the caregivers of head and neck cancer patients at a cancer care centre, Madurai. A total of 200 caregivers were selected by Convenience sampling method. Data was collected using a pretested, self-structured, closed-ended questionnaire by face to face interview method., Results: The study population consisted of Caregivers aged 21-60 years, mostly females (80%), spouses (54%), employed (57%) and uneducated (66%). Most of the caregivers were from lower socioeconomic status (66%) and those who are providing care for 1 to 6 months were more in number. In this study, 82% of caregivers reported high caregiver burden (CSI ≥7) and 67% of caregivers reported high stress (PSS ≥ 26 - 40)., Conclusion: Caregivers are experiencing significant burden, particularly with respect to their physical and psychological well-being, economic circumstances, social and personal relationships., Competing Interests: None

Background: Leprosy and leprosy-related stigma can have a major impact on psychosocial wellbeing of persons affected and their family members. Resilience is a process that incorporates many of the core skills and abilities which may enable people to address stigma and discrimination. The current study aimed to develop and pilot an intervention to strengthen individual and family resilience against leprosy-related discrimination., Methodology: We used a quasi-experimental, before-after study design with a mixed methods approach. The 10-week family-based intervention was designed to strengthen the resilience of individuals and families by enhancing their protective abilities and capacity to overcome adversity. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. Persons affected and their family members were included using purposive sampling. Two questionnaires were used pre-and post-intervention: the Connor-Davidson Resilience Scale (CD-RISC, maximum score 100, with high scores reflecting greater resilience) and the WHOQOL-BREF (maximum score of 130, with higher scores reflecting higher quality of life). In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in the Odisha cohort again at six months after completion. Paired t-tests measured differences pre- and post- intervention. Qualitative data were thematically analysed., Findings: Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in CD-RISC scores for persons affected and family members from Odisha state (baseline 46.5, first follow-up 77.0, second follow-up 70.0), this improvement was maintained at six-month follow-up. There was no increase in CD-RISC scores post-intervention among participants from Telangana state. WHOQOL-BREF scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. No families dropped out of the study. In the qualitative feedback, all participants described drawing benefit from the programme. Participants especially appreciated the social dimensions of the intervention., Conclusion: This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life. A large-scale efficacy trial is necessary to determine the effectiveness and long-term sustainability of the intervention., Competing Interests: The authors have declared that no competing interests exist.

Background: Parents of dying children face unique challenge and expect compassionate support from health care providers (HCPs). This study explored the experiences of the parents and HCPs about the end-of-life care and breaking bad news and related positive and negative factors in Indian context., Methods: This qualitative exploratory study was conducted at paediatrics department of a tertiary care hospital in Delhi. In-depth interviews with the parents (n = 49) and family members (n = 21) of the children died at the hospital and HCPs (6 doctors, 6 nurses and 4 support staffs) were conducted. Also events and communication around death of eight children were observed. Data were inductively analysed using thematic content analysis method to identify emerging themes and codes., Results: Doctors were the lead communicators. Majority of parents perceived the attitude, communication and language used as by resident doctors as brief, insensitive and sometimes inappropriate or negative. They perceived that the attitude and communication by senior doctor's as empathetic, positive and complete. Parents recalled the death declaration by resident doctors as non-empathetic, blunt and cold. Most parents received no emotional support from HCPs during and after death of their child. All doctors expressed that death of their patients affected them and their emotions, which they coped through different activities. The overcrowded wards, high workload, infrastructural limitation and no formal communication training added to the emotional stress of the HCPs., Conclusions: Majority of the communication by the HCPs during the hospitalisation and end-of-life period were perceived as suboptimal by the parents. The HCPs were emotionally affected and faced end-of-life communication challenges. The study highlights the communication by HCPs and support for parents during the end-of-life communication and breaking bad news. It suggests adoption of context specific communication protocol and materials and training of HCPs in communication to improve the quality of care., Competing Interests: The authors have declared that no competing interests exist.

Objectives: In March 2020, lockdown was imposed in India to combat spread of Coronavirus, which was extended till 31st May. Implementation of lockdown and limited outdoor activities resulted in changes in routines of children with diabetes. The aim of this study was to assess the impact of lockdown on glycemic control, weight and body mass index (BMI) patterns of children with type 1 diabetes (T1DM) from different socio-economic (SE) classes., Methods: This observational study included 77 children and youth (5-20 years) with T1DM having disease duration of ≥6 months. Demographic data and investigations were recorded at two time points (post lockdown when the children came for follow up, pre lockdown data from medical records)., Results: Glycemic control improved (pre lockdown HbA1C 79.4±19.2 vs. post lockdown Hba1C 74.5±16.9 mmol/mol, p<0.05) and there was weight gain post lockdown (pre lockdown weight z-score -0.4±0.8 vs. post lockdown weight z-score -0.2±0.8, p<0.05) without any significant change in BMI and insulin requirements. Improved glycemic was seen in the lower SE group control post lockdown (p<0.05), whereas in higher SE group, it remained unchanged. Children whose parents were at home during lockdown showed an improved glycemic control (p<0.05) as compared to children whose parents continued to work during lockdown (p>0.01)., Conclusions: During coronavirus lockdown, glycemic control was adequately maintained in children with T1DM, highlighting importance of stronger family support system leading to more steady daily routine., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Objectives: Views on who bears how much responsibility for supporting individuals with mental health problems may vary across stakeholders (patients, families, clinicians) and cultures. Perceptions about responsibility may influence the extent to which stakeholders get involved in treatment. Our objective was to report on the development, psychometric properties and usability of a first-ever tool of this construct., Methods: We created a visual weighting disk called 'ShareDisk', measuring perceived extent of responsibility for supporting persons with mental health problems. It was administered (twice, 2 weeks apart) to patients, family members and clinicians in Chennai, India ( N  = 30, 30 and 15, respectively) and Montreal, Canada ( N  = 30, 32 and 15, respectively). Feedback regarding its usability was also collected., Results: The English, French and Tamil versions of the ShareDisk demonstrated high test-retest reliability ( r s = .69-.98) and were deemed easy to understand and use., Conclusion: The ShareDisk is a promising measure of a hitherto unmeasured construct that is easily deployable in settings varying in language and literacy levels. Its clinical utility lies in clarifying stakeholder roles. It can help researchers investigate how stakeholders' roles are perceived and how these perceptions may be shaped by and shape the organization and experience of healthcare across settings.

Background: HIV serostatus disclosure plays an important role in reducing the risk of HIV transmission. However, its negative effects may include rejection, assault, separation, divorce, stigma, and discrimination., Objectives: This study was undertaken to find out the proportion of HIV-positive serostatus disclosure to any family member and different factors influencing disclosure among people living with HIV/AIDS (PLWHA)., Methods: A cross-sectional study was conducted among all patients aged 18-49 years with confirmed HIV infection registered at the antiretroviral therapy center of a tertiary care hospital in eastern part of Uttar Pradesh, India, for the duration of 1 year, from July 2017 to June 2018., Results: Most of the respondents were aged 30-49 years (79.9%), male (63.2%), married (85.4%), rural residents (60.4%), Hindu (96.5%), literate (84%), employed/driver (61.8%), and belonged to lower/lower middle class (62.6%). The rate of disclosure of HIV-positive status to any family member was quite high in this study (238/288 or 82.6%), among which 92.9% (221/238) to the spouse only. The number of sexual partners before disclosure, educational status, and socioeconomic status of the respondents were found to be independent predictors of disclosure of HIV-positive status to any family member (P < 0.05)., Conclusions: This study indicates the need of giving more emphasis on creating awareness regarding the importance of HIV serostatus disclosure to any family member, especially to spouse, and encourage all PLWHA in the community to disclose their status. Effective strategies also need to be evolved that will target those not likely to disclose their status to anybody., Competing Interests: None

Theoretical analyses by anthropologists suggest that food and water insecurity exhibit multiple conceptual parallels, hold similar consequences for wellbeing, and lead to analogous coping strategies aimed at mitigating those consequences. However, these deductions largely originate from studies conducted separately on either food or water insecurity. Thus, these similarities may not bear out when examined in populations facing high rates of both. In particular, some researchers argue that food and water insecurity exert independent but nonetheless iterative effects on mental wellbeing. Others hypothesize that food insecurity mediates the relationship between water insecurity and mental health, especially in agricultural communities. However, relevant studies are limited, and none test this hypothesis in urban areas. Moreover, no data exist on water insecurity and mental wellbeing in adolescents, which hampers comparative analyses of youth resource insecurity. In addition, resource buffering-a long-discussed coping strategy-remains contested with respect to food insecurity and effectively untested with respect to water insecurity. The buffering hypothesis suggests that adults cushion younger household members against resource inadequacies via tradeoffs that yield gender- and age-based disparities in intrahousehold resource distributions. For example, adults may forgo food quality, quantity, or variety in favor of children. It stands to reason that adults similarly buffer children against water scarcity, but, again, this has not been examined. Conducted December 2016-April 2017, this cross-sectional survey included 650 mothers, fathers, boys, and girls living in the slums of Jaipur, India. When controlling for food insecurity, the relationship between water insecurity and psychosocial stress (Perceived Stress Scale-10) was eliminated; water insecurity's effect on anxiety and depression (Hopkins Symptom Checklist-10) remained significant for fathers only. These findings are consistent with the mediation hypothesis. Moreover, pursuant to the buffering hypothesis, parents generally reported more severe resource scarcity than their children; however, girls reported slightly worse water insecurity than fathers., (Copyright © 2019. Published by Elsevier Ltd.)

On June 10, 2019, Mohammed Sayeed, a 75-year-old patient was admitted to the Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal (1). He died that night due to a cardiac arrest and this led to a scuffle between the patient's family and duty doctors. In retaliation, the doctors refused to discharge the body, asserting that since the family claimed it was a suspicious death, a post-mortem was required. A mob arrived, and in the confrontation, a doctor was injured. The medicos struck work. Doctors and medical associations across the country have voiced unanimous support for the doctors, and called for protective legislation against the violence of the public. As a consequence of these nationwide doctors' protests, the Supreme Court has now proposed a law that protects doctors by severely punishing those who attack them (2). Meanwhile, it does seem as if such attacks are increasing.

Purpose of Review: To review the evolution of family support movement for schizophrenia in India and to report perspectives of family caregivers who are running family support groups across the country in the backdrop of recent legislations in India., Recent Findings: Family support movement started in the 1990s, mostly by family caregivers independently in multiple cities across the country. Apart from periodic support meetings, they have successfully influenced recent legislations to address the felt needs of families. Mental health professionals need to gain skills to work collaboratively with assertive family caregivers to develop services to support those diagnosed with mental illness. Though there is a need for such movement, funding is poor and very few caregivers of persons with schizophrenia are forthcoming to participate. The formation of national federation with government and non-government partnership could help give the required impetus to the family support movement for persons with schizophrenia in India.

Objective: To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence., Design: Pre-experimental study with pretest-posttest design., Settings: Two public hospitals in Mumbai, India., Sample: In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Post-intervention analyses were carried out with 142 women at 6 weeks post-delivery; 13 women were not contactable., Methods: The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre- and post-intervention data., Main Outcome Measures: Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health., Results: Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60-65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (P-value 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status post-intervention., Conclusions: Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health., Funding: This study was funded by The John D. and Catherine T. MacArthur Foundation., Tweetable Abstract: Improving coping strategies, safety and health of pregnant women who reported domestic violence by providing counselling in antenatal care setting., (© 2019 Royal College of Obstetricians and Gynaecologists.)

Background: The caregivers of patients with first episode psychosis (FEP) experience significant distress. It is important to understand their needs to plan adequate interventions for them., Aim: The aim of this study was to explore the needs of caregivers of young patients with FEP in India, using a qualitative approach., Methods: The study was conducted in two phases. In phase I, a script for conducting focus group discussions (FGDs) with caregivers was developed, based on literature search and expert opinion generated from FGD with mental health professionals. In phase II, five FGDs were conducted with 30 caregivers of young patients with FEP having minimal of 6 participants in each FGD. Data was analyzed using principles of grounded theory., Results: Seven broad themes and subthemes of the needs of caregivers emerged from the FGDs. The final themes, which highlighted the needs of caregivers of young patients with FEP, were (in order of ranking) as follows: information regarding treatment, information regarding illness, services provided by the government, optimum quality of care from treatment facility, management of psychosocial issues related to patient's illness, availability and accessibility of treatment, and identification and recognition of mental health and physical problems in family members., Conclusion: Qualitative method was useful to identify the needs of the caregivers of young patients with FEP in multiple domains.

The present three-study investigation examined cultural influences on the internalization of social expectations. Testing the claim of self-determination theory that lesser internalization of social expectations is linked to socialization practices that portray social expectations as in conflict with autonomy, in Study 1 we undertook a content analysis of the views of social expectations portrayed in American and Indian storybooks. Results indicated that only American and not Indian storybooks more frequently portrayed characters as displaying negative emotions when behaviors were socially expected as compared with spontaneous. In Study 2 (n = 120), we undertook a vignette-based experiment, which showed that American parents viewed social expectations as incompatible with agency whereas Indian parents viewed them as compatible with agency. In Study 3 (n = 224), we undertook a related vignette based experiment among 7- and 10-year-old children in the United States and India. Results indicated that younger children shared a view of social expectations as compatible with agency, with qualitative developmental change occurring among American children who come to view social expectations as in conflict with autonomy with age, and quantitative developmental change occurring among Indian children who deepen their earlier understandings of social expectations with age. Our results point to the presence of early relational outlooks that young children use in assimilating cultural variable messages communicated in socialization practices. Challenging simple "fax" models of cultural learning, our results indicate that children do not passively absorb cultural messages but actively interpret them in integrating them with their emerging sense of self. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Motor neuron disease (MND) is a progressive neurodegenerative disease. Ideal management plan in MND includes palliative care initiated from the time of diagnosis. At present, most of the neurodegenerative conditions are cared for at home. Neuropalliative care is an emerging concept in India and social workers are integral team members in this process. The primary aims of the study were to explore (a) the caregivers' experiences of the end-of-life stage, and (b) the sources of support for individuals and their caregivers with MND at the end-of-life stage. In-depth interviews were conducted with seven bereaved caregivers of individuals with MND from a national tertiary referral care center for neuropsychiatry in South India. Interviews were conducted either in person or by telephone. Thematic analysis was done using the constant comparative method. Major themes derived from the interviews were: (1) Transition from person to patient, (2) support, (3) death, and (4) impact on the caregivers. Mapping of themes identified "Support received during advanced stages" as the central theme influencing all other themes. The need for a care manager seems evident and is a role that can be effectively fulfilled by the care teams' social workers.

Background: Family-centered care (FCC), based on collaborative participation of the family along with a team of health care providers, is found to increase the well-being of sick infants in neonatal critical care units. Over the last 4 years, the neonatal unit of Dr. Ram Manohar Lohia Hospital in Delhi has innovated and developed an implementation framework for FCC. This qualitative study assessed the acceptability of family-centered care among providers and family members of neonates to identify gaps and challenges in implementation., Methods: In-depth interviews were conducted among a purposive sample of twelve family members of admitted neonates and six providers to examine their perceptions and experiences regarding FCC., Results: Family members and providers expressed a positive perception and acceptance of FCC based on the competencies and knowledge acquired by parents and other caregivers of essential newborn care. Family members reported being satisfied with the overall health care experience due to the transparency of care and allowing them to be by their baby's bedside. Limitations in the infrastructure or lack of facilities at the public hospital did not seem to dilute these positive perceptions. Providers also perceived FCC as a good practice to be continued in spite of concerns around sharing of nursery space with parents, the need for constant vigilance of parents' practices in handling of their newborns, and the need for separate, designated nursing staff for FCC., Conclusion: Both providers and receivers of neonatal care found FCC to be an acceptable form of care. Providers identified challenges and suggested possible solutions, such as need of periodic provider sensitization on FCC, improved staff organization, and provision of mother-friendly facilities to enable her to provide around-the-clock care by her baby's bedside. Overcoming these challenges would allow for better integration of FCC within general clinical care in neonatal care units.

Introduction: Palliative care coverage and opioid consumption in India are relatively low compared with global data. The literature suggests commonplace concealment and collusion in withholding information, but these hypotheses lack evidence., Objectives: This study aimed to develop an explanatory evidence-based model of stigma, communication and access to cancer palliative care in India that can be used to develop, test and implement future interventions., Design: This cross-sectional qualitative study sampled advanced cancer patients (n=10), their family caregivers (n=10) and oncologists (n=10). Grounded theory procedures were utilised to analyse transcripts, and a theoretical model generated., Setting: A tertiary teaching hospital in South India., Results: The model explains how stigma associated with communicating a diagnosis of advanced cancer is enacted by treating oncologists, family members and community. This leads to patient expectations of cure and futile treatment uptake. Patients commonly only present needs with respect to pain, not within psychological, social or spiritual domains, likely due to the lack of patients' insight into their diagnosis and prognosis. As a result of oncologists' and families' unwillingness to disclose the prognosis, and patient focus on pain due to their lack of insight, palliative care clinicians view their services as under-utilised, and patients perceive palliative care as a pain management service that is not 'different' from other clinical services. Advanced care needs and purchase of futile treatments lead to lost employment among families, increased family debt and high care costs, which are rarely disclosed due to their unwillingness to discuss their needs., Conclusion: Our novel theoretical model is an essential first step to ensure that complex interventions are plausible, with mechanisms of action that address the needs of relevant stakeholders. A family-centred approach with an oncology workforce skilled in communication and an enabled patient population could increase access to palliative care, and improved outcomes may be attainable., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Caring for a family member with a psycho-social disability can be both rewarding and burdensome. This study analyses the experiences of caregivers of people with psychosocial disabilities (PPSDs) in rural communities in North India using relational gender theory. In-depth interviews with 18 female and male caregivers of PPSDs probed the social, emotional and health impacts of their caregiving role. Nine themes were identified that were grouped under three meta-themes: intra-personal, inter-personal and institutional impacts. Under the intra-personal meta-theme, all caregivers experienced high tension, with women describing almost overwhelming stress. Women minimised their role as caregivers, and felt negative and hopeless about their futures, while men had a more positive view of the future and themselves. Embodied experiences of psychological and social distress were consistently described by women, but not by men. Within the interpersonal meta-theme, men experienced opportunity for social connection and social support that was seldom available to women. Interpersonal violence with other household members was described by both men and women. Within the institutional meta-theme, both men and women described strength in unity, and gestures leading to the reordering of gender relations. These findings underline the significant and diffuse impacts of a gender order that values males and disadvantages females as caregivers of PPSDs, with the asymmetry of a greater burden for women. The findings point to the urgent need for global mental health policies that support and empower caregivers and that strengthen gender equality.

Purpose: A multiphase model for experiences of family members of persons with mental illness that considers both positive and negative aspects is proposed., Design and Methods: Mixed methods (semistructured interviews, life history timelines, focus group discussions, and the Experience of Caregiving Inventory) were used with caregivers accessing outpatient services of a nongovernmental organization in urban and rural locations around Chennai, India., Findings: Based on our results, we constructed a multiphase model, which we named The Banyan model of caregiver experiences. The phases are (1) manifestation of symptoms, (2) seeking help, (3) helplessness and attribution, (4) relative control and insight, (5) loss and worries, and (6) finding new meaning., Practical Implications: Our multiphase model allows us to identify in more detail the needs of caregivers at various stages., (© 2018 Wiley Periodicals, Inc.)

Purpose: To determine the prevalence of poor food knowledge and food restrictions among families of children with cancer and assess their impact on nutritional outcomes., Methods: In this cross-sectional study of 700 families of children with cancer who attended a referral cancer clinic, parents were asked 9 questions about nutritional knowledge ("Knowledge score") and 12 questions about food restrictions ("Restriction score"). Secondary outcomes included the nutritional status of children and possible socio-demographic associations of poor food knowledge., Findings: Commercial foods were considered more nutritious than homemade foods. Restriction of protein and energy-rich foods was frequent. Low knowledge scores were associated with rural background, poverty, and illiteracy. Low parental knowledge scores were associated with low weight and low height of the child. High restriction scores were associated with low weight but not low height., Conclusions and Implications: Harmful perceptions are widely prevalent in parents of children with cancer and targeted educational interventions may have a role in improving malnutrition in these children.

Background: Self-management is an essential component of prevention and treatment of type 2 diabetes. Social and family support has been shown to influence self-management behaviors as well as glycemic control and complications. This study was conducted to assess whether diabetes family support improves diabetes self-management and glycemic control in a typical urban population in India., Methods: A cross-sectional study using a questionnaire that had items from the Summary of Diabetes Self Care Activities Scale (SDSCA), the Diabetes Family Behavior Checklist (DFBC) and some sociodemographic and diabetes related clinical data was conducted. The participants were consecutively sampled from the diabetes outpatient department in a tertiary care hospital in Chennai, south India., Results: A total of 200 consecutive patients from the diabetes outpatient department were interviewed. Diabetes self-management practices were good with respect to avoiding fatty foods and carbohydrates and undergoing regular blood testing for glucose. But the self-management with respect to exercise and foot related care was rare. It was observed that a vast majority of the patients did not report receiving any support from their families. However, in the small proportion who did receive good family support, there is an association between diabetes self-management and diabetes family support (β = 0.527; p = 0.015). Further, the path model showed that there is a positive statistically significant association between family support score and the diabetes self-management score (β = 0.254, p < 0.001). However, the negative association between the diabetes self-management score and the mean plasma glucose did not reach statistical significance (β = - 46.378, p = 0.082)., Conclusions: In the urban south Indian setting, family support was significantly associated with better self-management activities, but better self-management did not reflect as better glycaemic control.

Introduction: Despite the large burden of a relative's drinking on their family members, the latter's perspectives and experiences are largely neglected. The aims of this article are to assess the coping strategies used by affected family members (AFMs) in Goa, India, and to examine the nature of the support they have for dealing with their drinking relative., Method: In-depth interviews were conducted with adult AFMs selected through purposive and maximum variation sampling. Data was analyzed using thematic analyses., Results: The commonly used coping strategies included accommodating to the relative's behavior, financially adapting to their means, self-harm, attempting to reason with the drinking relative, covert intervening, and avoiding fights and arguments. There was a general reluctance to seek support, and the type and quality of support that was available was also limited. Support from neighbors or relatives was primarily through providing a "listening ear" or financial support. Religious and spiritual pursuits were commonly used to seek solace, and to manage negative thoughts and feelings. Formal support was sought for themselves or the relative through existing health services and Al-Anon, and occasionally from the police., Discussion: AFMs experience a considerable amount of strain in relation to their relative's drinking, and have to rely on different ways of coping and social support, as is available to them. Although there is a universality to the experiences of families affected by addictions, this must be interpreted with caution, as it is also accompanied by variations in cultural factors related to these experiences. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Informal caregivers are unpaid individuals who help friends or family members who cannot fully care for themselves. However fulfilling the act of helping debilitated individuals, exposure to another person's traumatic experiences often results in psychological distress. Caregiver's stigma towards HIV worsens this. Hence, this study aims to assess the effect of stigma on the mental health of caregivers so that their needs for support can be determined. A cross sectional hospital based study was carried out in Mangalore, India on 150 informal caregivers of PLHIV. The HIV Stigma Scale was used to assess stigma and DASS-21 was used to assess depression, anxiety and stress. Of the 150 caregivers, 20% marked one or more items on the stigma scale. Frequency of depression, anxiety and stress was 46%, 27% and 8% respectively. Most caregivers who had stigma and anxiety were of those patients diagnosed for a shorter duration of time (≤5 years) n = 20, p = 0.05 and n = 26, p = 0.03 respectively. Spouses of PLHIV (n = 31, p = 0.005), sero-positive caregivers (n = 25, p = 0.03) and those living with patients (n = 39, p = 0.01) suffered most from anxiety. Stress was significantly associated with depression (83%, p = 0.007) and anxiety (66.6%, p = 0.001) in caregivers. In conclusion, more of depression and anxiety was observed among the participants than stress. Stigma was seen in 20% of the participants. Stigma was not significantly associated with depression anxiety and stress.

Context: Family accommodation (FA) is the phenomenon whereby caregivers assist or facilitate rituals or behaviours related to obsessive compulsive disorder (OCD). There is a need for a self-rated instrument to assess this construct in resource-strained clinical settings of India., Aim: To explore the factor structure of Hindi version of Family Accommodation Scale-Self Rated version (FAS-SR) and compare its validity with the gold standard Family Accommodation Scale-Interviewer Rated (FAS-IR) scale., Material & Methods: The Hindi version of FAS-SR scale and FAS-IR scale was applied on 105 caregivers of patients with OCD., Results: The initial factor analysis yielded three-factor models with an eigenvalue of >1 and the total variance explained by these factors was 72.017%. The internal consistency of the 19-item scale was 0.93 indicating good inter-item correlation. There was a significant positive correlation between FAS-IR scale total score and all the factors of the FAS-SR Scale. The average measure ICC was 0.889 with a 95% confidence interval from 0.783 to 0.981 (F (62,84)=37.547, p<001) indicating high degree of reliability between the Hindi version of FAS-SR and the FAS-IR scale., Conclusions: FAS-SR is a practical alternative to FAS-IR and has the potential to be used widely in an Indian setting., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: Intellectual disability in a child places great stress on a family and caregiver and this leads to significant socio-occupational dysfunction and impaired quality of life for caregivers. This study aimed to assess socio-demographic characteristics, burden, and psychiatric morbidity of the caregivers of persons with intellectual disability, as well as to determine the variables that correlated with burden and psychiatric morbidity., Methods: An observational study was carried out in an outpatient psychiatric unit of a tertiary care teaching hospital in India from October 2014 to April 2015. A total of 100 caregivers of intellectually impaired individuals were assessed for burden and psychiatric morbidity., Results: In all, 39% of the caregivers had a high burden score, 46% perceived mild-to-moderate burden severity, and 15% perceived no to mild burden. Mild-to-moderate depressive symptoms were present in 23% and 16% had severe-to-extremely severe depressive symptoms. Mild-to-moderate anxiety symptoms were evident in 19% of caregivers and a further 19% had severe-to-extremely severe anxiety symptoms., Conclusion: Routine assessment of burden and psychiatric morbidity in the caregiver will help to reduce their burden and thus help them care for their children more appropriately and efficiently.

Suicide as a public health problem is studied worldwide and association of psychiatric and genetic risk factors for suicidal behavior are the point of discussion in studies across different ethnic groups. The present study is aimed at evaluating psychiatric and genetic traits among primary relatives of suicide completer families in an urban Indian population. Bi-variate analysis shows significant increase in major depression (PHQ and Hamilton), stress, panic disorder, somatoform disorder and suicide attemptamong primary compared to other relatives. Sib pair correlations also reveal significant results for major depression (Hamilton), stress, suicide attempt, intensity of suicide ideation and other anxiety syndrome. 5-HTTLPR, 5-HTT (Stin2) and COMT risk alleles are higher among primary relatives, though statistically insignificant. Backward conditional logistic regression analysis show only independent variable, Depression (Hamilton) made a unique statistically significant contribution to the model in primary relatives., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

This study was conducted to explore the decision-making processes regarding sites for delivery of infants among women, their husbands, and mothers-in-law in a rural area of northern Karnataka state, south India. Qualitative semi-structured, individual in-depth interviews were conducted in 2010 among 110 pregnant women, new mothers, husbands and mothers-in-law. Interviews were conducted by trained local researchers in participants' languages and then translated into English. Decisions were made relationally, as family members weighed their collective attitudes and experiences towards a home, private or public delivery. Patterns of both concordance and discordance between women and their families' preferences for delivery site were present. The voice of pregnant women and new mothers was not always subordinate to that of other family members. Still, the involvement of husbands and mothers-in-law was important in decision-making, indicating the need to consider the influence of household gender and power dynamics. All respondent types also expressed shifts in social context and cultural attitudes towards increasing preference for hospital delivery. An appreciation of the interdependence of family members' roles in delivery site decision-making, and how they are influenced by the socio-cultural context, must be considered in frameworks used to guide the development of relevant interventions to improve the utilization and quality of maternal, neonatal and child health services.

Unlabelled: Summary To maximise successful completion of multi-drug therapy (MDT) and optimise treatment outcomes for people with leprosy, it is vital to understand the relative importance of perceived factors which prevent them from completing the required number of doses in time., Objective: To explore personal, family, social, community, attitudinal, practical, geographical, cultural and traditional factors which may influence adherence to treatment, a two-phase study was undertaken comprising issue identification via focus groups, and a ranking exercise via individual interview., Study Design: The perspectives of 895 respondents (320 people affected by leprosy who were not able to complete treatment, 302 of their 'operational heads of family', and 273 of their nearby community members) across four states of India namely i.e. Andhra Pradesh (Salur), Chhattisgarh (Chandkhuri), Maharashtra (Kothara) and Uttar Pradesh (Barabanki) were collected, using a checklist interview method., Results: Findings suggest that seeing positive changes in their symptoms as well as not seeing improvement can lead to non-completion of MDT. Problems with scheduling and travel expenses were also key issues. Better management of the expectations of people affected by leprosy and reducing the burden of treatment may be important strategies. The importance of stigma and poverty were noted through a number of issues, none of which were particularly highly ranked., Conclusions: The nature and diversity of perceived issues identified across respondent type and particularly region, suggest that the determinants of adherence are complex and multi-factorial. More community based approaches with greater coordination at the community level are recommended.

This study examined whether the death of family members intensifies the survivors' posttraumatic stress and behavioral changes. Data were collected by interviewing 416 adult survivors from nine habitations of the Nagapattinam district in the state of Tamil Nadu in India 14 months after the 2004 tsunami. Compared to those nonbereaved, bereaved survivors reported more posttraumatic stress disorder, depression, anxiety, negative affect, deteriorated mental health, adverse physical health symptoms, alcohol consumption, family conflicts, and fear. When a tsunami trauma includes death of a loved one, psychological, physical, and behavioral ramifications are especially severe.

In HIV prevention and care programmes, disclosure of status by HIV-positive individuals is generally encouraged to contain the infection and provide adequate support to the person concerned. Lack of disclosure is generally framed as a barrier to preventive behaviours and accessing support. The assumption that disclosure is beneficial is also reflected in studies that aim to identify determinants of disclosure and recommend individual-level measures to promote disclosure. However, in contexts where HIV infection is stigmatised and there is fear of rejection and discrimination among those living with HIV, concealment of status becomes a way to try and regain as much as possible the life that was disrupted by the discovery of HIV infection. In this study of HIV-positive women and children in India, concealment was considered essential by individuals and families of those living with HIV to re-establish and maintain their normal lives in an environment where stigma and discrimination were prevalent. This paper describes why women and care givers of children felt the need to conceal HIV status, the various ways in which people tried to do so and the implications for treatment of people living with HIV. We found that while women were generally willing to disclose their status to their husband or partner, they were very keen to conceal their status from all others, including family members. Parents and carers with an HIV-positive child were not willing to disclose this status to the child or to others. Understanding the different rationales for concealment would help policy makers and programme managers to develop more appropriate care management strategies and train care providers to assist clients in accessing care and support without disrupting their lives.

Background: Not much is known about factors that contribute to resilience among women facing intimate partner violence (IPV), particularly from countries where patriarchy predominates. This qualitative study aimed to gather the perspectives of Indian women self-identified as resilient in the face of IPV and tried to understand the strategies and resources that helped them to maintain or regain resilience., Materials: Data were collected from 16 consenting women who reported IPV and whose husbands were being treated for alcohol problems at a psychiatric centre in Bangalore, India. A semi-structured guided interview format that aimed at understanding factors that enabled them to feel resilient despite IPV in their challenging circumstances was used to gather narratives from the participants., Discussion: Six themes were identified using QSR NVivo software. They were as follows: the support of women, men and family; personal attributes; dignity and work; being strong for the children; and faith in God. Among these women, supportive social networks, personal attributes and aspirations were major clusters contributing to resilience., Conclusion: Attention to these factors may provide an important, strengths-based perspective for interventions to enhance women's resilience when facing IPV., (© The Author(s) 2013.)

Objective: Several studies have reported abnormal heart rate variability (HRV) in schizophrenia patients, suggesting a pathophysiological link between central autonomic dysfunction and symptoms of schizophrenia and that these could be heritable. This study aimed at evaluating cardiac autonomic response to mental arithmetic stress in first-degree relatives of schizophrenia patients (FDRS) employing HRV analysis., Methods: HRV measures were computed for 25 healthy FDRS and 25 age- and gender-matched controls during rest, mental arithmetic stress task and recovery period. Subtracting serial sevens from 700 for five minutes formed the stress task. Recovery period lasted five minutes starting from the termination of the stress task., Results: Both groups showed similar alterations during the stress task. After stress termination, recovery to the basal values was observed in controls but not in patients' relatives, maintaining a pattern similar to that during the stress task., Conclusions: Poor recovery from cardiac autonomic functions (CAF) alterations induced by arithmetic stress may be a heritable trait marker of schizophrenia. Our report supports endophenotypic potential of HRV in schizophrenia research.

Background: Family caregivers experience significant burden in taking care of their patients with schizophrenia. Research on predictors of caregiver burden in India, where families are the primary caregivers of schizophrenia patients, is lacking., Aim: To study the predictors of burden experienced by the family caregivers of first admission in-patient schizophrenia patients in India., Methods and Materials: Family caregivers of 137 schizophrenia patients admitted to an in-patient facility of a hospital in south India were interviewed using the Burden Assessment Schedule. The coping, knowledge about schizophrenia, perceived social support of the caregivers and illness severity, psychopathology and disability experienced by the patients were also assessed., Statistical Analysis: Bivariate correlation and multivariate regression analysis were used to study the association of different factors on burden., Results: Duration of illness and levels of psychopathology and disability had significant direct correlation with total burden score; perceived social support had significant inverse correlation with total burden score. There was a high correlation between psychopathology and disability (p<0.001). Two separate regression analyses, each including total PANSS score (psychopathology) or total IDEAS score (disability) showed that duration of illness and perceived social support were significant predictors of burden in addition to psychopathology and disability., Conclusion: During the first hospitalization, in addition to symptom reduction and disability limitation, focus should be on enhancing social support in order to reduce caregiver burden among family members of schizophrenia patients., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Leprosy stands tall among the oldest and most misunderstood diseases of man. Today leprosy is easily treated; unfortunately, persistent misconceptions result in unnecessary stigmatization. Thus the present study aims to assess the knowledge and attitudes regarding leprosy in people with and without leprosy, factors affecting the same; and to study their relationship with treatment status in leprosy patients. Detailed knowledge and attitude questionnaires were administered to 260 subjects (100 leprosy patients, 60 family members of leprosy patients and 100 people with non-leprosy skin diseases) at AIIMS, New Delhi. Crude scores based on subject responses were used for inter-group comparisons. Leprosy patients had significantly higher knowledge scores than family members who in turn scored significantly higher than people with other skin diseases. Leprosy patients had fair knowledge about common symptoms, but awareness about MDT was low. Delayed diagnosis and non-compliance were common. Attitudes did not differ between groups. Fear of the leprosy-affected and reluctance for physical contact, food sharing and marriage were prominent. Treated leprosy patients had the highest knowledge scores. Higher education and greater knowledge scores were positive predictors of attitude. Knowledge and attitude scores showed significant positive correlation. Knowledge and attitude towards leprosy are unsatisfactory. Improving knowledge may help to improve attitudes. In the post-elimination era, we must incorporate education about the disease into routine care of leprosy patients and focus on community education about leprosy.