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AWARD PAPER: GC BORAL AWARD PAPER
Validation of hindi version of internalized stigma of mental illness scale
Aakanksha Singh, Sandeep Grover, Surendra K Mattoo
April-June 2016, 32(2):104-114
DOI:10.4103/0971-9962.181089  
Aims: To develop a Hindi translated version of the Internalized Stigma of Mental Illness (ISMI) Scale and evaluate its psychometric properties (test–retest validity, internal consistency, split half reliability, and cross-language equivalence), convergent validity and factor structure. Methodology: The study included 161 patients with severe mental disorders. Thirty-one patients were asked to complete the Hindi version of the ISMI Scale twice within a gap of 4–7 days. Another thirty patients were asked to complete the ISMI Hindi version followed by the English version after 4–7 days. Remaining hundred patients completed the Hindi version of ISMI Scale and Explanatory Model Interview Catalog (EMIC) Stigma Scale was administered by the interviewer at the same assessment. Results: Hindi version of ISMI Scale was found to have a good internal consistency (Cronbach's alpha was 0.863), split-half reliability (Spearman–Brown coefficient-0.661; Guttmann's split-half coefficient-0.645), test–retest reliability and cross-language equivalence for all the items and various domains with almost all the correlations and intraclass coefficients significant atP≤ 0.001, and convergent validity in the form of significant correlations with EMIC Stigma Scale. Factor analysis of the scale yielded five factors, which had significant overlap with the five domains of the scale described by the developer of the scale. Conclusions: The present study suggests that Hindi version of ISMI Scale developed as a part of this study has good psychometric properties.
  8 2,913 384
THEME SECTION: STIGMA IN PSYCHIATRIC DISORDERS: REVIEW ARTICLES
Stigma associated with mental illness: Conceptual issues and focus on stigma perceived by the patients with schizophrenia and their caregivers
Aakansha Singh, Surendra K Mattoo, Sandeep Grover
April-June 2016, 32(2):134-142
DOI:10.4103/0971-9962.181095  
Among the various psychiatric disorders, schizophrenia is considered to be associated with high level of stigma. The stigmatizing experience is not only limited to the patients but is also experienced by their close relatives. This article reviews the conceptual issues in understanding stigma, mainly in relation to schizophrenia. Further, this article reviews the existing literature in terms of extent and correlates of stigma experienced by patients with schizophrenia and their close relatives. Stigma experienced by the patients can be categorized as public stigma and personal stigma. The personal stigma is further understood as perceived stigma, experienced stigma, and self-stigma. Stigma experienced by caregivers of patients with mental illness is called associative or courtesy stigma and affiliate stigma. A number of tools have been developed for assessment of stigma among patients with mental illnesses and their close relatives. Depending on the type of instrument used to assess stigma, the prevalence of stigma among patients with schizophrenia varied from 6% to 87%. Much of the literature on stigma in the patients with schizophrenia is from developed countries. There is limited literature from India and majority from Southern and Central part of the country. Stigma associated with schizophrenia is highly prevalent across regions and varies according to different sociodemographic and clinical correlates. The experience of stigma among patients of schizophrenia is influenced by the type and severity of psychopathology, insight, coping, causal beliefs, depression, social support, self-esteem, self-efficacy, and self-directness. Stigma influences medication compliance, quality of life, and social functioning. Research is scanty with regard to stigma perceived by caregivers of patients with schizophrenia. Besides the caregiver variables, different patient variables uniquely modify the stigma experienced by the caregivers. Different interventions may reduce the stigma experienced by patients and their caregivers. Studies evaluating stigma experienced by patients with schizophrenia and their caregivers suggest that stigma is highly prevalent among patients and their relatives. Data on correlates of stigma are limited. There is a need for further research on stigma for a better understanding of the concept so as to find ways to reduce it and prevent its adverse consequences.
  7 5,989 743
DEBATE
Research on family caregiving for mental illness in India and its impact on clinical practice: Are we doing enough to help families?
Subho Chakrabarti
January-March 2016, 32(1):19-24
DOI:10.4103/0971-9962.176762  
Families of Indian patients with mental illnesses have always been involved in their care. Such involvement arises both from choice as well as the compulsion of being a part of an inadequately resourced mental health system. Regardless, families have had to pay a heavy price for undertaking the task of providing care. An extensive body of Indian research on caregiver burden in a number of mental illnesses shows that providing care for a relative with mental illness is associated with considerable distress and burden for the family caregiver. However, much of this research has not made the shift from the somewhat outmoded concept of caregiver burden to the currently prevalent practice of considering the caregiving experience in its totality. Moreover, most of the research is not driven by contemporary theories of caregiving such as the stress coping model. Indian psychiatry has also had a long tradition of supporting family caregivers while they provide care for their ill members. Nevertheless, the Indian evidence for the efficacy of formal family-based interventions remains inadequate and lacks methodological precision. Finally, day-to-day practice in clinical settings does not seem to have made use of the ample body of research evidence in this area to help families in distress. Despite all these problems, progress is being made in the area of family caregiving for mental illness in India. Despite all these problems, slow but steady progress is being made in the area of family caregiving for mental illness in India. It can be hoped that some day in the near future, this progress would translate into mental health professionals forging a true partnership with families providing care for those with mental illnesses.
  4 3,255 420
SYMPOSIUM (THEME SECTION: CAREGIVING AND CAREGIVERS)
Various aspects for research focus among caregivers: Past, present, and future
Ravinder Singh
January-March 2016, 32(1):40-41
DOI:10.4103/0971-9962.176766  
Do we need any research on caregivers and caregiving and whether research helps the field of care? During last three decades, there has been a tremendous change in health care service delivery, as well as the development of sustainable policies on long-term care. The research identified need for the training of health professionals for psychiatric care, preventing and managing chronic diseases, and developing people-friendly services and health care settings. This review further highlights how to sensitize policy makers to improve the quality of life of persons with mental health problems and to caregivers and how to prioritize our research in the area of caregiving.
  3 1,313 156
VIEWPOINT/PERSPECTIVES (THEMESECTION: MENTAL HEALTH CAREBILL, 2013)
Restraint and seclusion in India
Sudhir K Khandelwal, Koushik Sinha Deb, Vijay Krishnan
July-December 2015, 31(2):141-147
DOI:10.4103/0971-9962.173294  
Psychiatric management in India often includes the practice of restraint and seclusion of violent and difficult to control patients, both in inpatient medical facilities and in places of traditional healing. However, without any informed guidelines and regulation, these practices have flourished from necessary last resort to accepted ways of control. The upcoming draft mental health bill have now provided with a set of basic guidelines for preventing restraint. The scientific literature is also sparse on the subject from India, despite a robust body of evidence being available from the Western literature. This review, summarizes the evidence from India, looks into the causes and outcomes of restraint and seclusion and also discusses methods and stratagems that might be beneficial for reducing restraint and seclusion in the country.
  3 3,478 393
ORIGINAL ARTICLES
Subjective burden, psychological distress, and perceived social support among caregivers of persons with schizophrenia
Elangovan Aravind Raj, Sahana Shiri, Kavita V Jangam
January-March 2016, 32(1):42-49
DOI:10.4103/0971-9962.176767  
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.
  2 3,364 479
Eating attitudes and body shape concerns among medical students in Chandigarh
Nitin Gupta, Rachna Bhargava, Bir Singh Chavan, Pratap Sharan
July-September 2017, 33(3):219-224
DOI:10.4103/0971-9962.214605  
Background/Objectives: Eating disorders are rarely encountered in the Indian subcontinent. Surprisingly, there is sparse literature related to eating attitude distortions and body dissatisfaction in the Indian population. The objective of this study was to explore the eating attitudes and body shape concerns in medical students, with the objectives of determining any gender differences on eating attitudes and body shape concerns, and any predictors of psychological morbidity using demographic and psychosocial parameters. Materials and Methods: Sample comprised medical undergraduate students from all years (I-V) pursuing MBBS course at Government Medical College and Hospital, Sector 32, Chandigarh. It was a prospective, cross-sectional study. Instruments used were socioclinical sheet, acculturation index (AI), eating attitudes test-26 (Hindi version), and body shape questionnaire (BSQ) (Hindi version). Following written informed consent, all the questionnaires were administered in a group setting to each MBBS batch. Statistical analysis was carried out with Statistical Package for the Social Sciences (SPSS) version 17.0 using descriptive analysis (frequency, percentage, mean), univariate analysis (Chi-square, t-test), Pearson's correlational analysis, and binary logistic regression (backward). Results: A total of 250 medical students from 5 batches with mean age of 20.15 +/- 1.32 (18-28) years. And 55% (n = 137) were males and 45% (n = 113) were females. On gender comparison, males were more likely to be Hindu and have higher body weight (actual and ideal); females had significantly higher scores on dieting subscale of eating attitudes test-26 and BSQ (total score). On AI, there were no gender differences on family domain variables, with significantly less females reporting pure Western preference for social/peer domain variables. Correlation and logistic regression analysis showed high score on BSQ (median divide) as the only statistically significant predictor of eating (disorder) morbidity, whereas high score on AI (median divide) approached significance (P = 0.062). Conclusion: High score on BSQ is the mediating (proximate) risk factor for eating (disorder) morbidity. Influence of other/distal risk factors (especially AI) may be mediated through it.
  2 1,625 212
Cost-of-treatment of clinically stable severe mental lilnesses in India
Siddharth Sarkar, K Mathan, Sreekanth Sakey, Subahani Shaik, Karthick Subramanian, Shivanand Kattimani
July-September 2017, 33(3):262-268
DOI:10.4103/0971-9962.214600  
Background and Aims: The cost-of-treatment studies can help to make informed decisions while planning health-care services. This study is aimed to assess direct costs of outpatient treatment of four common chronic severe mental illnesses in a tertiary care hospital in South India. Methods: The patients with ICD-10 diagnoses of schizophrenia, unspecified nonorganic psychosis, bipolar disorder, and recurrent depression were recruited by purposive sampling from a government teaching hospital in South India. The total cost-of-treatment to the patient and the hospital was computed for each disorder as a percentage of the per-capita income of an individual patient. Results: The study comprised a total of 140 patients. The average monthly total cost-of-treatment was Indian Rupees (INR) 770 (95% confidence interval of 725 to 815), or approximately US$ 12.8. The monthly total cost-of-treatment was INR 720 for schizophrenia, INR 750 for unspecified nonorganic psychosis, INR 830 for bipolar disorder, and INR 790 for recurrent depression, with no significant differences between groups. On an average, 22.8% of total cost-of-treatment was borne by the patient, and the rest by the hospital. The patients spent a median of 12% of their per-capita income on treatment related to direct costs. Conclusions: Despite substantial government subsidies, patients do incur some expenses in treatment of chronic psychiatric illnesses. The attempts to reduce treatment and travel costs can facilitate psychiatric care to larger number of individuals.
  2 2,030 157
PERSPECTIVE
Caregiving and caregivers: Challenges and opportunities in India
R Srinivasa Murthy
January-March 2016, 32(1):10-18
DOI:10.4103/0971-9962.176761  
Caregiving of persons with mental illness is challenging as sometimes it is demanding and at other times, it is fulfilling to caregivers. In India, family members are the caregivers for persons with mental illness as there are extremely limited alternative facilities and family members are preferred for caring. The changing social milieu in India such as urbanization and nuclear family is placing significant burden on family members. This article will discuss about the emotional dimensions of caregiving, importance of care receivers, utilizing the caregiving situations to address prevention of mental disorders, promotion of mental health, and fight stigma of mental disorders. In India, majority of the research is on the burden of caregiving on family members and there is less or no research on caregiving in different communities, population groups, and develop programs to make caregiving a positive experience on caregivers and caregiving. In India, there is a need to develop systems of sharing of skills, support, and supervision to caregivers in providing care to the individuals with chronic illnesses. This can minimize the stress of caregiving and maximize the positive feelings of caregiving.
  2 6,896 901
SUB-THEME 2: INCREASING GLOBAL BURDEN OF PSYCHIATRIC DISORDERS: REVIEW ARTICLE
Increasing burden of mental illnesses across the globe: Current status
Murali Thyloth, Hemendra Singh, Vyjayanthi Subramanian
July-September 2016, 32(3):254-256
DOI:10.4103/0971-9962.193208  
Psychiatric disorders cause significant burden to individuals and society across the world, accounting for nearly 13% of the global burden of disease. Eighty percent of people with mental disorders now live in low and middle-income countries. With one million deaths per year, suicide is the major reason for years of life lost due to mental illness. Estimates suggest that the burden due to mental illness is likely to increase over next decade and appropriate interventions are need of the hour. We discuss this increasing burden as a consequence of (1) lack of resources, (2) low budget for mental health in lower and middle income countries, and (3) under-utilization of services and stigma attached to mental illnesses.
  2 2,984 354
SYMPOSIUM (THEME SECTION: CAREGIVING AND CAREGIVERS)
Caregivers as the fulcrum of care for mentally ill in the community: The urban rural divide among caregivers and care giving facilities
RC Jiloha, Prerna Kukreti
January-March 2016, 32(1):35-39
DOI:10.4103/0971-9962.176765  
Illness trends, health beliefs, healthcare pathways, level of awareness, access to health care resources, level of social support, perceived stigma, burden, coping strategies, care giving appraisal, and cultural acceptance of modes of treatment are different in urban and rural settings along with different caregivers profile. This review will highlight these differences in light of their overall characteristics, and health seeking behavior. This further calls for empowering caregivers, understanding and exploring new dimensions of caregiving, and implementing holistic intervention for patients as well as caregiver's well-being.
  2 1,641 192
THEME SECTION: STIGMA IN PSYCHIATRIC DISORDERS: REVIEW ARTICLES
Stigma in dual diagnosis: A narrative review
Yatan Pal Singh Balhara, Arpit Parmar, Siddharth Sarkar, Rohit Verma
April-June 2016, 32(2):128-133
DOI:10.4103/0971-9962.181093  
Stigma has been described as a mark of disgrace associated with a particular person, quality, or a circumstance. Persons with either psychiatric illness or substance use disorders, their family members, caregivers, as well as health professionals engaged in the management of these persons are subject to stigma. Interestingly, there is a high prevalence of substance use disorders among persons with psychiatric disorders and vice versa. However, only a limited literature has focused on stigma in the context of co-occurrence of psychiatric disorders and substance use disorders. The current review is aimed at the presentation of various aspects of stigma in the context of dual diagnosis of psychiatric disorders and substance use disorders. Findings on the published literature on stigma in the context of psychiatric disorders and substance use disorders have been examined separately to develop an understanding into the relevance and implication of addressing stigma in the context of dual diagnosis.
  2 2,403 254
THEME SECTION: STIGMA IN PSYCHIATRIC DISORDERS: SYMPOSIUM
Menace of stigma in psychiatry
Sujata Sethi, Pankaj Sheoran, Suja Kurian
April-June 2016, 32(2):120-127
DOI:10.4103/0971-9962.181090  
Despite major breakthroughs and advances in our knowledge about various psychiatric disorders, stigma toward psychiatry continues to prevail. The stigmatization of people with mental illnesses has been recognized by international agencies such as the World Health Organization and the World Psychiatric Association as an important public health and human rights problem. Individuals with mental illness are devalued and are treated unfairly by others because of their mental health condition. It is not only the general public that views psychiatry and psychiatrists negatively, but medical students, health professionals other than psychiatrists, families of patients and media also have similar views. These negative attitudes not only lead to delay in seeking professional help for the patients but also discriminate against patients and their families, and hinder in the deserved placement of patients in the society. All these further adversely affect the outcome of psychiatric disorders. This symposium addresses these issues as well as measures to combat and prevent stigmatization of patients with psychiatric disorders.
  2 1,652 188
AWARD PAPER: BB SETHI POSTER AWARD PAPER
Recovery among patients with severe mental illness: Factor analysis of recovery assessment scale in Indian setting
Sandeep Grover, Nandita Hazari, Neha Singla, Subho Chakrabarti, Jitender Aneja, Sunil Sharma, Ajit Avasthi
April-June 2016, 32(2):92-103
DOI:10.4103/0971-9962.181088  
Aim: This study aimed to evaluate recovery among patients with severe mental disorders by using Recovery Assessment Scale (RAS). Additionally this study evaluated the, factor structure of RAS in the Indian setting, and assessed the correlates of recovery in severe mental illness. Methodology: Two hundred and eighty-five patients with severe mental illness (bipolar disorder-185 [BD], schizophrenia-100) currently in remission were recruited for the study. Clinical rating scales - Young Mania Rating Scale, Hamilton Depression Rating Scale, and Positive and Negative Syndrome Scale for Schizophrenia were used for assessing remission and residual symptoms. RAS was administered for recovery assessment. Results: Majority of the patients were married males belonging to urban background with no significant difference in sociodemographic profile of schizophrenia and BD groups. On factor analysis of RAS, all 41 items had loaded on one of the factors (compared to 24 items on the old factor structure). Five-factor were obtained with two factors - personal confidence and hope, goal and success orientation being similar to the old factor structure and three new factors being identified as awareness and control over the illness, seeking and relying on social support and, defeated/overcome the illness. Overall recovery measures were higher in BD group, and higher levels of residual depressive symptoms were associated with significantly lower level of recovery in BD. In the schizophrenia group, level of positive symptoms correlated negatively with goal and success orientation (as per the current analysis) and higher level of negative symptoms correlated positively with the domain of “reliance on others” as per the old factor structure. Conclusion: RAS follows a five-factor structure in Indian context, which is different than that reported in the previous study. There are few sociodemographic and clinical correlates of recovery.
  1 2,320 299
EDITORIAL
Demonetization, economic crisis, and social psychiatry: Learning from the past?
Nitin Gupta
January-March 2017, 33(1):1-4
DOI:10.4103/0971-9962.200086  
  1 2,964 458
Stigma toward psychiatric disorders: What can we do about it?
Siddharth Sarkar, Varghese P Punnoose
April-June 2016, 32(2):81-82
DOI:10.4103/0971-9962.181094  
  1 1,492 318
ORIGINAL ARTICLES
Quality of life of senior citizens: A Rural-Urban comparison
VK Usha, K Lalitha
April-June 2016, 32(2):158-163
DOI:10.4103/0971-9962.181104  
Background: The experience of aging is unique to every individual because of the individual differences in personalities, varying social support network, and differing cultures to which one belongs. Quality of life (QOL) of senior citizens is greatly influenced by their previous lifestyle, culture, education, health care beliefs, family strengths, and integration into the communities. Aims: To assess the sociodemographic profile, QOL, and to compare the QOL of senior citizens in rural and urban areas. Methodology: Data were collected from 830 rural senior citizens and 120 urban senior citizens through multistage random sampling technique. The tools used in this study were sociodemographic data sheet and WHO QOL-BREF-26. Results: Majority of senior citizens belonged to the age group 65–75 years in rural (65.3%) and urban (65%) areas and majority were females (rural 61.4% and urban 66.7%). A major percentage (44.7%) of senior citizens in rural areas lived with their spouses and children, whereas 40% of them in urban areas lived with their children and 40% with their spouse and children. Majority of study subjects in rural (90.6%) and urban areas (97.5%) were not involved in any social activities. The senior citizens in urban areas showed better QOL than the senior citizens in rural areas. This was statistically significant in the overall perception of QOL, the overall perception of health, physical health, psychological health, and environment (P < 0.05). Conclusion: This study showed that QOL was poorer among senior citizens in rural areas. In India, the population of senior citizens is greater in rural areas where the health care facilities are minimal. Hence, policies and programs related to senior citizens should be launched in rural areas without neglecting the needs of urban senior citizens. Training of voluntary workers, health care professionals, and family members on the care of senior citizens should be implemented. QOL of senior citizens could be enhanced only with the support of family members.
  1 3,146 290
Knowledge and attitudes of secondary and higher secondary school teachers toward mental illness in Ahmedabad
Nimesh Parikh, Minakshi Parikh, Ganpat Vankar, Chintan Solanki, Girish Banwari, Prateek Sharma
January-March 2016, 32(1):56-62
DOI:10.4103/0971-9962.176770  
Background: Teachers can be trained in early identification of possible mental illness and referral which is well-established in the west and lacking in India. Hence, we attempt to study the knowledge and attitudes of secondary school teachers toward mental illness and probable gender differences in these measures. Materials and Methods: Five hundred and twenty teachers from English medium schools of Ahmedabad city were assessed by a self-reported, predesigned and pretested 25 item questionnaire, the first 15 of which assessed their knowledge about mental illnesses and the remaining 10 pertained to negative attitudes. Results: 79.4% of teachers were 45 years or less, 77.5% were female teachers and 86.9% were married. 76% of teachers scored <7 out of 15 which points toward majority of them having inadequate knowledge. 63.6% scored 5 or more on the negative attitudes questionnaire, which points toward high prevalence of negative attitudes. Females had comparatively more knowledge than males about symptoms and management of mental illness, although there was no significant gender difference in the attitude toward mental illnesses. Conclusion: The knowledge of teachers about mental illness is insufficient, and they hold a lot of stigma against mentally ill as demonstrated by their low score in attitude.
  1 5,661 651
Burden of care in the caregivers of patients with anxiety disorders
Manu Agarwal, Arti Kushwaha, Anil Nischal, Sujita Kumar Kar, Bandna Gupta, Adarsh Tripathi, Anju Agarwal
January-March 2017, 33(1):22-28
DOI:10.4103/0971-9962.200092  
Introduction: Anxiety disorders are one of the frequently encountered psychiatric disorders in psychiatric clinics which have significant impact on the psychosocial well-being of the patient as well as their caregivers. Study Design and Aims: This study is a non- invasive, cross sectional study of 91 patients with anxiety disorder (except obsessive compulsive disorder) aimed to assess the burden of care on their key-relatives and to study various socio demographic and clinical variables of the patient in relation to burden of care on key-relatives. Methodology: Patients diagnosed with anxiety disorders other than obsessive compulsive disorder and their key relatives satisfying the selection criteria were enrolled in the study. Assessment was done on semi-structured proforma, ICD 10 DCR, SCAN (Schedules for Clinical Assessment in Neuropsychiatry), International Personality Disorder Examination (IPDE), Burden assessment schedule, Hamilton Anxiety Rating Scale (HAM-A). Result: Total adjusted burden score in our study was 40.41 which is suggestive of mild burden. It was found that the burden of care was higher in male gender, married individuals, in joint families, among spouses, urban background, in the age group 41 to 50 years, low income group particularly on farmers and laborers. Generalized anxiety disorder was associated with more burden of care in comparison to other anxiety disorders. Conclusion: Key relatives of patients with anxiety disorder have significant burden of care in different domains along the socio-demographic strata.
  1 1,694 191
Does gender discrimination transformed its face over few generations? exploring gender inequalities among under-6 year children in rural Haryana
Kalaiselvi Selvaraj, Anand Krishnan, Sanjeev Kumar Gupta, Chandrakant S Pandav
January-March 2017, 33(1):29-37
DOI:10.4103/0971-9962.200089  
Background: Gender differences can be in any stage in the life cycle including before birth (feticide/sex selective abortions) which have been objectively documented. This study tries to identify the gender differentials among the children which is a basic step in cascade process of female discrimination in the society. Objective: To study the gender differentials among children under 6 years in households of rural Ballabgarh, Haryana in terms of nutrition, health care seeking, social aspects and to see whether they differ by socio economic status. Methods: Two hundred households were selected purposively from four villages (50 households each) by multi stage sampling during Mar – June 2010. Pre tested interview schedule was used to assess gender differences in nutrition (breast feeding, 'z' score); in health care seeking and in social aspects (Expenditure on birth related ceremonies and toys and dresses). Differences are measured in means or proportions. Determinants of Gender differentials were identified by logistic regression. Results: Girls were breast fed for five months lesser than boys (P < 0.02). Even though occurrences of common childhood illnesses were equal between the two, expenditures incurred to treat these illnesses were more among the boys (Boys Vs girls: Rs 181.3 Vs Rs 123.9). Proportion of illnesses treated from health facilities located outside the villages was higher among the boys [boys (22.2%), girls (11.4%)]. Expenditures incurred during birth related social ceremonies were higher for boys (Rs 20311 and Rs 2487.5 respectively for boys and girls). Conclusion: In this patriarchal society, socio cultural norms have produced the gender gap which can have adverse impact on health of the female children.
  1 2,023 178
A gender-specific analysis of suicide methods in deliberate self-harm
Kiran K Kumar, Fiaz Ahmed Sattar, Swapna Bondade, Md. Munnawar S Hussain, Mridula Priyadarshini
January-March 2017, 33(1):7-21
DOI:10.4103/0971-9962.200098  
Background: Deliberate self-harm (DSH) is a major public health concern. Gender differences in suicide methods are a controversial realm with various regional and cultural variations. This study compared and assessed the methods used in DSH attempters as undertaken by men and women, and investigated the possible role of gender and other clinical variables in the selection of suicide method. Materials and Methods: Two hundred subjects fulfilling the inclusion and exclusion criteria were recruited in the study. The sociodemographic details were recorded in the semi-structured pro forma. Detailed assessment of psychiatric morbidity and DSH was done by clinical interview and validated by Mini International Neuropsychiatric Interview-Plus 5.0 and Beck Suicide Intent Scale. Data were analyzed using SAS version 9.2 and SPSS version 17.0. The sample was disaggregated by gender to compare the known correlates of suicide risk on the two most common methods of suicide – poison consumption and drug overdose using multivariate analyses. Results: The analysis revealed that majority of the attempters were in the age group of 11–40 years (91%). Females (63%) outnumbered males (37%); poisoning was the most common type of method (50.5%), followed by drug overdose (35%). There were no statistical differences between the two genders with respect to other sociodemographic variables. Males from urban/semi-urban background (odds ratio [OR] = 4.059) and females living alone (OR = 5.723) had high odds ratio of attempting suicide by poison consumption. Females from urban/semi-urban background (P = 0.0514) and male subjects from nuclear families had an increased odds ratio (OR = 4.482) to attempt suicide by drug overdose. There were no statistical differences when the two genders were compared for other variables such as intentionality, lethality, impulsivity, and number of attempts. Conclusions: It appears that gender differences among DSH attempters appear less pronounced in the Indian setting compared to the worldwide literature on the subject. Nevertheless, the unique, gender-specific characteristics pertaining to DSH attempters in our population emphasize the need for gender-specific interventions in future clinical treatment.
  1 1,873 260
Self-medication hypothesis in substance-abusing psychotic patients: Can it help some subjects?
Susanta Kumar Padhy, Siddharth Sarkar, Debasish Basu, Parmanand Kulhara
October-December 2016, 32(4):325-331
DOI:10.4103/0971-9962.193652  
Background and Objectives: The evidence for gself.medication hypothesish (SMH) in patients with dual diagnosis psychosis has been conflicting, though largely not supported, recently. But, still can SMH be a beneficial one in some patients with dual diagnosis remains a question. Methods: The study was conducted at Drug De.addiction and Treatment Centre, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, a Tertiary Care Hospital in India. This cross.sectional comparative study had psychotic patients with substance use disorder as cases and those without substance use disorder as controls. Demographic details, clinical information, and Brief Psychiatric Rating Scale (BPRS) scores were ascertained for cases and controls. Cases were additionally administered modified Stated Reasons Scale and modified Perceived Effects Scale. Results: Case and controls were comparable on demographic details and duration of psychotic illness, but cases had significantly lower scores on BPRS. The reasons reported for substance abuse in cases were more often nonhedonistic than hedonistic. Perceived effects of major substances of abuse (alcohol, cannabis, and opioids) were different. Alcohol use was associated with perceived decrease in loneliness and cannabis was associated with perceived increase in suspiciousness and delusions. Considerable match was found between reasons for taking the substances and the effects perceived. Interpretation and Conclusions: Incorporating reasons for taking substance and their perceived effects in the treatment regimen would certainly help a subset of such difficult.to.treat patients. India being a low.resource country with a scarcity of experts and specialized dual diagnosis clinics, these findings may have an important implication in the clinical practice.
  1 1,367 145
SUB-THEME 3: ADVANCES IN IT AND SOCIAL PSYCHIATRY: REVIEW ARTICLE
Telepsychiatry in the developing world: Whither promised joy?
Subho Chakrabarti, Ruchita Shah
July-September 2016, 32(3):273-280
DOI:10.4103/0971-9962.193200  
Telepsychiatry, the use of information and communication technologies to provide psychiatric services from a distance, has matured as a mode of service delivery and has expanded its reach since its inception. Telepsychiatry promotes equality of access to high-quality specialized care for underserved users. It enables, empowers and brings about high levels of satisfaction among users. Telepsychiatry can deliver a broad array of clinical services and support several other nonclinical activities. Accumulated evidence demonstrates that clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among patients of all ages, ethnicities, cultures, and diagnostic groups across diverse clinical settings. However, negative attitudes, concerns about the quality of the evidence, doubts about cost-effectiveness, technological vagaries, uncertainty regarding the doctor–patient alliance, and a number of legal, ethical and regulatory hurdles continue to hinder the widespread implementation of telepsychiatric services. A particularly disappointing aspect has been the lack of development of telepsychiatric services in developing countries, where they are required the most because of the large mental-health gap in care with the more traditional forms of services. Problems of costs, lack of infrastructure and connectivity, shortage of trained personnel, sociocultural differences, limited data on effectiveness, and lack of institutional support are the principal challenges to the wider adoption of telepsychiatry in these resource-constrained countries. It is evident that much more effort by all stakeholders, innovative solutions, and hybrid models of care are required before telepsychiatry is able to fulfil its true potential and bring about the promised change in mental health outcomes in the developing world.
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VIEWPOINT/PERSPECTIVES (THEMESECTION: MENTAL HEALTH CAREBILL, 2013)
The curious case of the advance directive in psychiatry
Alok Sarin
July-December 2015, 31(2):119-122
DOI:10.4103/0971-9962.173286  
As discussions around the Mental Health Care Bill 2013 gain pace, one aspect of the bill, which is the Advance Directive, has perhaps not been discussed enough. The present essay is an attempt to explore different aspects of the advance directive in psychiatry, to understand the implications better. The article attempts to look at the conceptualization of the advance directive, questions regarding implementation, and possible unintended consequences. In doing so, it interrogates the larger question of ideology that drives the concept of the advance directive in psychiatry.
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Involuntary admission and treatment
Anirudh Kala, Kunal Kala
July-December 2015, 31(2):130-133
DOI:10.4103/0971-9962.173293  
Provisions for involuntary admission proposed in the Mental Health Care Bill, which is currently before the parliament, are discussed. Concerns about feasibility and cost-effectiveness of the postadmission judicial review, which is a novel feature in the Indian context, are put forward.
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* Source: CrossRef