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The purpose of the study was to identify children at our institute who possibly suffered abusive head trauma (AHT). A retrospective study of CT imaging of children between one month to three years of age between January 2013 and May 2021 was carried out at a dedicated neurocentre in Southern India. We identified 48 cases of possible AHT. The demographics, clinical features at presentation, imaging and fundus findings were analyzed. Imaging revealed subdural hemorrhage (SDH) in 42 and sub dural effusion (SDE) in 5 cases, one case had only hypoxia. The location of SDH was studied as was hypoxia underlying SDH, global hypoxia and ischemia. Cases of subarachnoid hemorrhage (SAH), parenchymal hematomaintraventricular hemorrhage (IVH) were also noted. Skeletal survey, chest X-ray and CT spine were reviewed. AHT needs to be paid attention to in the Indian scenario. An extensive work up is required to substantiate the claim and to work on preventionmanagement of these cases subsequently.

Background There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health. Methods Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools. Discussion This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India. Trial registration Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).

Background Mild to moderate association between childhood abuse (CA) and intimate partner violence (IPV) is reported among women from community samples. CA and IPV in clinical samples have shown strong association with adult psychopathology. Methods We investigated the association between CA and IPV among women with mood disorders (MD), in comparison with healthy women (HW), at a tertiary mental health centre in India. Women diagnosed with mental health disorders (n=609) and healthy volunteers (n=100), between the ages of 18 to 50 years, were assessed as part of a larger study. For the purpose of this analysis, we have taken a sample of women with MD (n=251) this includes 121 women with unipolar depression, 130 with Bipolar disorder and HW (n=72), with intimate partners. Results Incidences of childhood emotional abuse (χ2 =4.200, p= Limitations No information about the total number of depressive and manic episodes, and also the mood ratings at the entry point. Conclusions CA and IPV have an additive effect which might lead to the expression of severe mental disorders like MD and these factors might also have an impact on course and outcome of mood disorder which needs further studies.

This study examined the contributions of antenatal anxiety, depression, and partner violence to low birth weight (LBW) in infants and to sex-specific birth weight outcomes among mothers from a cohort in urban India. Data from 700 mothers from the PRAMMS cohort (Prospective Assessment of Maternal Mental Health Study) were used. Pregnant women were assessed in each trimester—T1, T2 and T3, for symptoms of anxiety, and depression as well as partner violence. Multivariate analyses were performed for the whole sample and then for male and female infants separately. The final multivariable logistic regression models were each built using a backward selection procedure and controlling for confounders. To accommodate longitudinally measured data, change in scores (T2–T1 and T3–T2) of anxiety and depression were included in the model. Of the 583 women with a singleton live birth, birth weight was available for 514 infants and LBW was recorded in 80 infants (15.6%). Of these, 23 infants were preterm. Overall, higher T1 Depression scores (OR: 1.11; 95% CI 1.040, 1.187) and an increase in both Depression scores (OR: 1.12; 95% CI 1.047, 1.195) from T1 to T2 and Anxiety scores (OR: 1.32; 95% CI 1.079, 1.603) between T2 and T3 were predictors of LBW. Female infants had a higher chance of LBW with increase in maternal anxiety between T1–T2 (OR: 1.69; 95% CI 1.053, 2.708) and T2–T3 (OR: 1.49; 95% CI 1.058, 2.086); partner violence during pregnancy just failed to reach conventional statistical significance (OR: 2.48; 95% CI 0.810, 7.581) in girls. Male infants had a higher chance of LBW with higher baseline depression scores at T1 (OR: 1.23; 95% CI 1.042, 1.452) and an increase in depression scores (OR: 1.25; 95% CI 1.060, 1.472) from T1 to T2. Increasing prenatal anxiety and depressive symptoms in different trimesters of pregnancy were associated with LBW with sex-specific patterns of association in this sample from a Low and Middle Income Country.

Background The increasing rates of divorce in urban India has led to the subsequent parental battle for the child’s custody. This paper discusses the behavioral and emotional issues of these children in relation to their psychosocial environmental factors and other relevant socio-demographic variables. Methods We used samples from parent interviews concerning 52 children aged 7 to 17-years-old, involved in child custody cases in the Family court of urban Bengaluru. The Strengths and Difficulties Questionnaire was used to measure response variables of behavioral and emotional issues in these children. Predictor models of quantile and multiple linear regression were used to assess the influence of psychosocial environmental factors and socio-demographic variables on the response variables. Results The predictor models revealed that risk of child suffering emotional and behavioral issues increased with factors such as excessive parental control, change of academic environment, general unrest at school, frequency of child’s court visit, child’s visitation of non-custodian parent on occasions and vacations, and negatively altered family relationship. The model however intriguingly showed that residing in nuclear household rather than with their grandparents in a non-nuclear household, decreased the risk of mental health issues in these children. Conclusions This study is a novel attempt to understand the influence of the psychosocial issues on the child’s mental health in the context of custody cases in India. Despite the minimum sample size, the findings imply that family-based intervention is the need of the hour in these cases. The implications for clinical practice and research are discussed.

The Research in the field of mental health and educational needs of children with intellectual disabilities has increased over the years. However, the focus on milder disabilities such as mild intellectual disability and borderline intellectual functioning (MBID; intelligence quotient: 50–85) is still limited. The current study aimed at understanding peer victimization and its relationship to the self-esteem of children with MBID in regular and special schools. The study utilized a cross-sectional research design with a sample of 40 children who met the inclusion criteria. On analysis, the results showed that peer victimization was more common in regular schools ( U = 51, p ≤ 0.001), wherein the peer victimization had a significant negative correlation with their self-esteem ( r = −0.536, p ≤ 0.001). Overall, the findings implied the need for promotion of inclusive education in regular schools by sensitization against peer victimization of children with disabilities.

Statement of purpose To review the clinical data, imaging and associated work up of children suspected of AHT at our institute. About a hundred pediatric patients between newborn to 3 years with head injury are attended to annually in our institute. A pilot study done previously had drawn attention to the prevalence of possible AHT in Indian set up. Methods/Approach The admission non contrast CT brain of children (newborn to 3 years) who attended the institute casualty with alleged head trauma and were suspected of AHT between 2016–2020 was reviewed. Of these 18 patients, there were 12 males & 6 females, age ranging from 1m to three years (avg age 14.7 months). Results The imaging findings included: convexity SDH (10/18), tentorial SDH (2/18) interhemispheric fissure SDH (4/18), parenchymal hemorrhage (1/18), sub arachnoid hemorrhage (1/18), hypoxic ischemic injury (2/18), skull fractures (4/18). The clinical history was often misleading. Despite suspecting AHT, the work up for AHT was incomplete and included: CT brain (17/18), chest x-ray (11/18), complete skeletal survey (4/18), MRI brain (6/18), fundoscopy (6/18). Conclusion Based on the clinical profile, imaging findings and related work up a few cases were considered to be possible AHT. The imaging though points to possible AHT, extensive work up is needed to assert or refute AHT. Significance This analysis highlights that when AHT is suspected, the work up of cases to assert or refute AHT needs to be complete. If the clinical & imaging data of all children under 3 years of age, attending our institute and with findings pointing to AHT were evaluated; a much larger number of cases could possibly be identified thus changing the perception that AHT is not as rampant in India. It would then help work on prevention.

This study examined the contributions of antenatal anxiety, depression, and partner violence to low birth weight (LBW) in infants and to sex-specific birth weight outcomes among mothers from a cohort in urban India.Data from 700 mothers from the PRAMMS cohort (Prospective Assessment of Maternal Mental Health Study) were used. Pregnant women were assessed in each trimester-T1, T2 and T3, for symptoms of anxiety, and depression as well as partner violence. Multivariate analyses were performed for the whole sample and then for male and female infants separately. The final multivariable logistic regression models were each built using a backward selection procedure and controlling for confounders. To accommodate longitudinally measured data, change in scores (T2-T1 and T3-T2) of anxiety and depression were included in the model.Of the 583 women with a singleton live birth, birth weight was available for 514 infants and LBW was recorded in 80 infants (15.6%). Of these, 23 infants were preterm. Overall, higher T1 Depression scores (OR: 1.11; 95% CI 1.040, 1.187) and an increase in both Depression scores (OR: 1.12; 95% CI 1.047, 1.195) from T1 to T2 and Anxiety scores (OR: 1.32; 95% CI 1.079, 1.603) between T2 and T3 were predictors of LBW. Female infants had a higher chance of LBW with increase in maternal anxiety between T1-T2 (OR: 1.69; 95% CI 1.053, 2.708) and T2-T3 (OR: 1.49; 95% CI 1.058, 2.086); partner violence during pregnancy just failed to reach conventional statistical significance (OR: 2.48; 95% CI 0.810, 7.581) in girls. Male infants had a higher chance of LBW with higher baseline depression scores at T1 (OR: 1.23; 95% CI 1.042, 1.452) and an increase in depression scores (OR: 1.25; 95% CI 1.060, 1.472) from T1 to T2.Increasing prenatal anxiety and depressive symptoms in different trimesters of pregnancy were associated with LBW with sex-specific patterns of association in this sample from a Low and Middle Income Country.

In India, children in difficult circumstances, like institutionalized children have higher mental health morbidity and complex psychosocial concerns than the non-institutionalized children. To cater to the complex needs of these children referred by the Juvenile Justice System, a specialized service called 'Swatantra Clinic' was initiated by the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neurosciences, India. This article thereby aims to describe the psychosocial characteristics of these children, along with the array of specialized interventions provided during the first year of its inception in June 2018. It was found that majority of these children were girls and were from lower socio-economic, urban background, primarily referred for externalizing or internalizing concerns. The majority of them reported experiences of physical and verbal abuse along with family stressors and almost half of them had a diagnosable psychiatric condition. The nature of the psychosocial services rendered at the clinic mostly comprised of brief, individual and family counseling along with liaison work with various governmental agencies for rehabilitation services. These form the key components of a comprehensive, collaborative, time-bound and holistic care model to cater to the distinct psychosocial issues of this vulnerable population of children in low - middle resource settings. Policy implications are discussed.

This study assessed the prevalence and predictors of suicidality among 462 pregnant women in South India. Women in early pregnancy (

Childhood abuse has been recognized as a precursor and a maintaining factor for adult psychopathology. There are very few studies that have investigated the incidence of childhood abuse in adult women with psychiatric disorders. Hence, this current investigation is an attempt to study and compare the incidence of childhood abuse (physical, emotional and sexual) among women seeking treatment for psychiatric disorders to healthy women. Using consecutive sampling, women seeking treatment for psychiatric disorders (N=609) and a group of age-education matched healthy women (N=100) were recruited for the study from a tertiary mental health-care hospital in India. The participants were screened for childhood abuse using the ISPCAN Child Abuse Screening Tool - Retrospective (ICAST)-R (I-CAST R, International Society for the Prevention of Child Abuse and Neglect (ISPCAN) and The United Nations Children's Fund (UNICEF), 2009). Emotional abuse was significantly more common among women with psychiatric disorders compared with healthy women (p0.05). On overall abuse, there was a trend to significance in women with psychiatric disorders compared with healthy women (p=0.07). There was no statistically significant difference between the two groups on physical and sexual abuse (all p0.13). There was no statistically significant difference in all three types of abuse across disorder categories, though the report was more among women with severe mental disorders. Women with psychiatric disorders reported more emotional and overall abuse compared with healthy women. Sexual and physical abuse was similar in both groups. It is likely that more emotional abuse predisposes these women to psychiatric disorders.

Background: Emotional and behavioral problems place a heavy burden on the adolescents and their families. Many factors are known to influence adolescent mental health. The current study was designed to determine the predictors of emotional and behavioral problems among Indian adolescents. Methods: The parents of adolescents in the age group of 10 to 18 (N = 81) were recruited from the National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India. Alabama Parenting Questionnaire (Parent version), Strength and Difficulty Questionnaire (Parent version) and, the Parent Interview Schedule (PIS) were used to assess the parental practices, emotional and behavioral problems and abnormal psychosocial environment of the adolescents. The data were analyzed with stepwise multiple linear and Quantile regression to find out significant predictors of emotional and behavioral problems among adolescents. Results: Adolescent’s age, parental involvement, and paternal age are the significant predictors of emotional problems. Parental mental disorder or deviance, gender, and inconsistent discipline are the significant predictors for conduct problems. Poor monitoring and supervision, paternal and maternal age are statistically significant predictors of prosocial skills among the adolescents. Inadequate or distorted intrafamilial communication and parental mental disorder are the significant predictors of total difficulties among the adolescents. Conclusion: The study validates the role of abnormal psychosocial environments and negative parenting practices as risk factors for emotional and behavioral problems among the adolescents. A comprehensive analysis which covers all possible variables related to adolescent mental health is mandatory for the health professionals before planning the intervention.

IntroductionChildhood abuse has been reported as a precursor and maintaining factors for adult psychiatric disorders. Childhood physical abuse, neglect and sexual abuse have been independently reported in women with depression. There is a serious dearth of literature on the incidence of childhood abuse among women with depression from India.Objectives & aimsWe investigated and compared the incidence of childhood abuse (overall) – physical, emotional and sexual (individual components)- among women seeking treatment for unipolar depression (UD) compared to healthy women (HW).MethodsWe compared the data of women diagnosed with UD (n = 134) from a larger pool of women seeking treatment for psychiatric disorders from our hospital (n = 609) with HW (n = 100) for the purpose of this study. The participants were screened using the MINI International Neuropsychiatric Interview (MINI) and for childhood abuse using the ISPCAN Child Abuse Screening Tool - Retrospective (ICAST)-R. The incidence of childhood abuse between the two groups was compared using the Chi-squared test.ResultsThe UD women have significantly more childhood emotional abuse than HW (69.5% vs 30.5%; χ2 = 4.819, P < 0.05). There was no statistically significant difference between the two groups on overall abuse, physical or sexual abuse (all P > 0.16).ConclusionsConsistent with world literature, significantly more childhood emotional abuse was seen among Indian women with UD compared to HW. It is likely that that repeated emotional abuse in childhood leads to negative attributions among children, later getting generalised to life events resulting in depression in adulthood.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background/Objectives: Caregivers of persons with schizophrenia experience more stress due to the nature of the symptoms as well as the prolonged duration of illness. The current study is an attempt to understand the subjective components of burden, distress, and social support in caregivers of patients with schizophrenia in Indian context and its linkage with their sociodemographic profile and patient′s illness profile. Methodology: Thirty-two caregivers of patients with schizophrenia from a psychiatric inpatient facility of a multidisciplinary hospital were studied using descriptive research design. Results: The result shows that negative symptoms of patients, subdomains of burden (burden on well-being, marital burden, burden on relations, and burden due to perceived severity) were the predictors of subjective burden. Burden on well-being and respondent′s age were predictors of psychological distress. Conclusion: Inclusive treatment services would enhance the quality of life of the caregivers and would help them in ensuring long-term care for the patients with schizophrenia.