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Background: Perinatal depression (PD) has important implications for maternal and infant well-being but largely goes undetected. There is a need to develop low-intensity psychosocial interventions applicable to obstetric health care facilities. Objective: To assess the effectiveness of a brief psychological intervention for mild to moderate PD delivered by a nurse as compared to treatment-as-usual (TAU). Methods: This study is a randomized, open-label, parallel-group, multicentric trial being conducted in four sites of India. A total of 816 pregnant women with mild to moderately severe depression (Patient Health Questionaire-9 score of 5–19) are being assessed for the effectiveness of the intervention. Participants are randomly allocated to two groups of trial intervention (psychological intervention given by nurse) and TAU. The primary outcome is to compare the proportion of women reporting improvement across both groups. Participants are serially followed-up in each trimester and at 6, 10, 14 weeks, and 6 months postpartum. Secondary outcomes include pregnancy outcomes, feeding practices, physical growth, and immunization status of the infants. Conclusion: It is a prospective pregnancy birth cohort with a robust design and long-term follow-up. This is one of the largest studies utilizing non-specialist health workers for the screening and management of PD. This study also holds promise to cast light on the course and outcome of depression during pregnancy in different parts of India. It is envisaged to help in developing a sound screening and referral-based protocol for obstetric settings.

Background There is a critical gap between needs and available resources for mental health treatment across the world, particularly in low- and middle-income countries (LMICs). In countries committed to increasing resources to address these needs it is important to conduct research, not only to assess the depth of mental health needs and the current provision of public and private mental health services, but also to examine implementation methods and evaluate mental health approaches to determine which methods are most effective in local contexts. However, research resources in many LMICs are inadequate, largely because conventional research training is time-consuming and expensive. Adapting a hackathon model may be a feasible method of increasing capacity for mental health services research in resource-poor countries. Methods To explore the feasibility of this approach, we developed a ‘grantathon’, i.e. a research training workshop, to build capacity among new investigators on implementation research of Indian government-funded mental health programmes, which was based on a need expressed by government agencies. The workshop was conducted in Delhi, India, and brought together junior faculty members working in mental health services settings throughout the country, experienced international behavioural health researchers and representatives of the Indian Council for Medical Research (ICMR), the prime Indian medical research funding agency. Pre- and post-assessments were used to capture changes in participants’ perceived abilities to develop proposals, design research studies, evaluate outcomes and develop collaborations with ICMR and other researchers. Process measures were used to track the number of single-or multi-site proposals that were generated and funded. Results Participants (n = 24) generated 12 single- or multi-site research grant applications that will be funded by ICMR. Conclusion The grantathon model described herein can be modified to build mental health services research capacity in other contexts. Given that this workshop not only was conceptualised and delivered but also returned results in less than 1 year, this model has the potential to quickly build research capacity and ultimately reduce the mental health treatment gap in resource-limited settings.

Middle East Current Psychiatry 2011, 18:29–36 Introduction For many years, researchers have suggested that abnormalities in circadian rhythms may underlie the development of mood disorders, such as major depression. The objectives behind this study were to investigate whether cortisol circadian rhythm could be considered as a biomarker for major depression, to identify whether different circadian rhythm alterations in patients with major depression is interrelated with syndrome presentation (either with or without psychotic features) and symptom profile (typical and atypical depressive symptoms) and to investigate whether there are alterations in the cortisol circadian rhythm and whether it could be a possible endophenotype among first-degree relatives of patients. Methods Fourteen patients, aged between 25 and 50 years, in a major depressive episode or in a depressed phase of bipolar disorder, six controls and six first-degree relatives were screened using psychometric questionnaires, and a blood sample was withdrawn from consenting participants at four time points during the day, for the assessment of plasma cortisol secretion. The patients were diagnosed by a clinical psychiatric interview and a semistructured psychiatric interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria for diagnosis, and a psychometric assessment was made. Serum cortisol levels were assayed using a validated commercial kit. Results There was a statistically significant difference between serum cortisol levels of the three studied groups at four consecutive sampling points over 24 h. The elevated plasma cortisol levels of patients correlated positively with phenotypic features, such as suicidality (P=0.029), positive family history of psychiatric disorder (P=0.024), chronotype of the patients (P=0.017) and their scores on Beck Depression Inventory (P=0.029) and Hamilton Depression Rating Scale (P=0.05). In addition, there is no statistically significant difference between patients and their first-degree relatives on the scores of Bipolar Affective Disorder Dimension Scale. Conclusion The increase in cortisol secretion and shift in its circadian phase and chronotypes of depressed patients and their first-degree relatives suggest that cortisol level is probably a state marker in mood disorder. In addition, different phenomenology and symptomatology of depression was closely interrelated to cortisol levels. Further genetic studies are recommended to establish its predictive significance.

Depression is common among hemodialysis patients. Even in developed countries, the prevalence of depression and its relation to health-related quality of life (HRQOL) in dialysis patients has only been poorly investigated. Furthermore, similar reports from many developing countries such as Egypt are scarce. This might be due to cultural and social concerns. This study is intended to address this important issue. This cross-sectional study was conducted at the dialysis unit of the Urology and Nephrology Center, Mansoura University, Egypt. Data of 76 chronic hemodialysis patients (mean age 43.2 ± 15 years; 54 males and 22 females) were retrieved. Psychiatric interview and psychometric assessment of depression and HRQOL (using an Arabic-adapted Beck Depression Inventory II and Short Form scale, respectively) were performed. Depression was diagnosed in 58 patients (76.3 %). Of them, 18 (23.7 %), 15 (19.7 %) and 25 patients (32.9 %) were suffering from mild, moderate and severe depression, respectively. Depressed dialysis patients group was comparable to the non-depressed group except for a higher prevalence of peripheral neuropathy (46.7 vs. 11.5 %; p = 0.034) and a less frequent use of iron therapy (52.7 vs. 86.7 %; p = 0.017). Except for role limitation due to physical problems, all HRQOL aspects were significantly worse among the whole group of depressed patients compared to the non-depressed group. Depression is common among our Egyptian hemodialysis patients. It seems to adversely affect almost all aspects of HRQOL. Therefore, a regular combined nephrology/psychiatry approach should be central to the medical care of hemodialysis patients in order to accurately assess for depression among them. Moreover, large national studies to delineate the prevalence and impact of depression among Egyptian hemodialysis patients are needed.

Background The 20th century ended with the conviction that drug abuse was a global problem, and thus global solutions were required. Adolescence represents a critical time to prevent alcohol and other drug use. Early initiation and regular use is often associated with negative consequences. Research on adolescents focuses increasingly on features of the family in predicting and preventing substance use, such as parenting style, parental monitoring, and parental substance use. Although there is an increasingly alarming phenomenon of drug abuse demonstrated in the Egyptian community, there has been no study that estimated the prevalence and risk factors of substance abuse in adolescents in Egypt recently. Aim of the work The current study aimed at exploring the effect of various familial risk factors on the development and severity of substance use in adolescent Egyptians. Participants and methods The current study included two groups: the patient group, which included 100 adolescents (92 male and eight female) from Mansoura, Egypt, between 10 and 19 years of age who were diagnosed as being substance abusers or substance dependants according to the DSM-IV-TR criteria; and the control group, which included 100 (86 male and 14 female) age and sex matched participants with no current psychiatric or neurological disorders. Tools of assessment used were as follows: Mini International Neuropsychiatric Interview for children and adolescents (MINI KID), the Teen Addiction Severity Index (T-ASI) scale, and a scale for measuring family socioeconomic status for health research in Egypt. Familial assessment was carried out with Parental Monitoring Questionnaire and parenting style questionnaire. Results The incidence of substance use was higher in male (92%) than in female (8%) adolescents. The most commonly abused substances were tramadol (97%), followed by cannabis (94%) and sedatives and hypnotics (38%), and the least commonly abused substance was anticholinergic (12%). The majority of the studied addicts were abusing more than one drug (92%). The results of the study indicated a highly significant difference between substance users and controls on all familial risk variables. Conclusion The substance use disorders are a major health problem among youth, and it is more prevalent in male sex in Egyptian population. Tramadol dependency is at the top of all substances abused in Egypt, followed by polysubstances. The findings highlight how family influences subsequent adolescent substance use.