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   2017| July-September  | Volume 33 | Issue 3  
    Online since September 14, 2017

 
 
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ORIGINAL ARTICLES
A study to assess the prevalence and pattern of substance use among male adolescents in suburban area of Delhi
Liza Thankam Daniel, Ganesh Krishnan, Sandhya Gupta
July-September 2017, 33(3):208-212
DOI:10.4103/0971-9962.214596  
Aim of the Study: To assess the prevalence and pattern of substance use among male adolescents in Sunder Nagari, New Delhi. Materials and Methods: A cross-sectional survey was designed to assess the prevalence and pattern of substance use among male adolescents in New Delhi. One hundred and ten adolescents were conveniently selected from Sunder Nagari, New Delhi. Adolescents aged more than 11 years and able to read and write Hindi or English were included in the study. A structured questionnaire for demographic variables was developed by researchers. To assess the prevalence and pattern of substance use, a structured questionnaire was prepared with the reliability coefficient of 0.94 (test-retest reliability) with a content validity index of 0.90 between the experts. Data were collected from the subjects after getting their written consent. Data analyzed using statistical package SPSS version 17.0. The level of significance was set as P < 0.05. Results: The study findings revealed that nearly more than half (55.6%) of the male adolescents reported the use of one or more substances in their lifetime. About 44.26% of the adolescents started to use substances before 13 years of age. Most common reason specified by the subjects to take substance were to be liked by friends (57.38%), to feel like an adult (24.6%), and few of them reported: “like the feeling of substances” (13.11%) as reason for taking substances. Common substances used by the subjects were any kind of tobacco (77.05%), inhalants (26.23%), and alcohol (11.47%). Most of the subjects were getting substances from their friends (85.25%) and only a few (14.75%) by themselves. Association analyses revealed that adolescents who studied less than 10th standard reported more usage of any kind of substances than who studied more than 10th standard. More prevalence of substance use was seen among adolescents who were from nuclear family. Subjects who had less than two siblings reported more substance use. Conclusion: Early onset of substance use is seen among adolescents. Low educational status and the nuclear family are associated with their substance use. Friends are the key source of substances and their initiation of substance use. Based on these findings, following recommendations can be considered. (i) Maintaining the substance use control through legislation by which controlling of selling substances under 18 years of age and prohibition of substance use in public places seem to be effective and (ii) early onset of substance use calls for effective measures directed against the younger age groups. Therefore, educational intervention at the school level appears to be the most feasible measure to prevent the initiation of substance use among adolescents.
  3,671 410 -
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.
  1,881 155 1
A study of the stressor, family environment and family burden in dissociative (conversion) disorder patients
Kamal K Verma, Om P Solanki, Girish C Baniya, Shrigopal Goyal
July-September 2017, 33(3):196-201
DOI:10.4103/0971-9962.214593  
Background: Dissociative disorder is a stress-related disorder usually present in adolescent and younger age group. It is also accompanied with significant impairment in activity of daily living and family relationship. Family environment plays important role in initiation and maintenance of symptoms and this put significant burden on family. Aim and Objective: To study presence of stressor, family environment, and assessment of family burden in dissociative disorder patients. Material and Method: This was a cross-sectional observational study in which 100 dissociatives disorder patients were included after fulfilling inclusion criteria from both inpatients and outpatient department of psychiatry. Results: In our study major part of the sample were women 60 (60%), among them most of were housewife and educated up to primary school. According to a stressor, 63 (63%) patients had family stress/problem and out of them, 35 (58.4) were women. Seventy-four (74%) patients had dissociative convulsion and out of them, 45 (75%) were women. The dissociative disorder patients cause a considerable degree of burden over other family members in both men and women. There is a significant difference found in the family environment in term of personal growth dimension, relationship dimension in both men and women. Conclusion: Present study concludes that dissociative disorder patients cause a considerable degree of burden over other family members in term of leisure, physical, mental, financial, and routines family interrelationship domains. The family environment in term of personal growth dimension, relationship dimension has a casual effect on symptoms of dissociative disorder patients.
  1,562 241 -
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.
  1,533 209 2
Experiences of bullying in relation to psychological functioning of young adults: An exploratory study
Kangkana Bhuyan, M Manjula
July-September 2017, 33(3):240-249
DOI:10.4103/0971-9962.214604  
Background: The young adult undergoes a vast number of experiences while socializing with his/her peers, bullying is one such experience. Though there have been increasing instances of bullying, it is a poorly understood phenomenon in the Indian setting. Undergoing experiences of bullying often result in long-term psychological consequences which may have an impact on individual's well-being. Keeping this background in mind, the present study was an attempt to explore the experiences of bullying in young adults in the Indian setting and to assess his/her psychological functioning so as to make an attempt to understand the interplay between the two variables. This may further help in planning interventions and prevention strategies for the same. Methodology: The sample consisted of 311 students, both males and females. They were assessed on Retrospective Bullying Questionnaire and Achenbach's Adult Self-report. Results: Around 22.2% of the sample had been both bullies and victims of bullying, while 13.2% were only victims and 3.5% were only bullies. Males had higher incidence of bullying and victimization experiences compared to females. Assessing for psychological functioning had shown higher reports of depression and antisocial personality problems in young adults. Overall findings suggest that people with bullying experiences tend to have more psychological problems compared to people who had no experiences of bullying. Conclusion: The findings suggest that bullying experiences lead to long-term consequences for the victims. There is a need to identify such instances at school level and plan interventions at various stages.
  1,536 171 -
UNARV: A district model for adolescent school mental health programme in Kerala, India
R Jayaprakash, S Sharija
July-September 2017, 33(3):233-239
DOI:10.4103/0971-9962.214591  
Background: About a half of life time cases of mental disorders start by 14 years of age. First sign of mental illness or emotional distress can emerge in school environment. So schools are to be viewed as the potential place for recognition of mental health problems, but an unexplored area. This study describes the working of a new model for district adolescent school mental health programme, UNARV in Kerala. Methods: A descriptive study of adolescents referred from schools, seen at UNARV clinic over a period of 5 years (2007–2012). Study sample consisted of students with behavioral and scholastic problems who were referred by trained teachers from Government and Government aided High School (8th to 10th class) and Higher Secondary School (11th and 12th class) under aegis of District Panchayath, Thiruvananthapuram, Kerala. They were evaluated and given psychosocial and pharmacological interventions by child mental health expert. Results: Total 2432 students attended UNARV clinic during the period. Most common problems observed were involvement in physical fights (38.3%), viewing and showing pornography to others (21.8%), poor scholastic performance (20.7%), skipping classes (19.1%), alcohol abuse (19%), smoking (14.2%), and engaging in love affair (8.5%). Common mental disorder diagnosed was conduct disorder (36.4%). UNARV helped in reintegration of such students back in to schools and stalled the trend of such students from being dismissed or suspended from class. Conclusion: UNARV forms a sustainable alternative district model in a resource poor environment. School teachers were trained as primary counselors and expert intervention was ensured.
  1,480 222 -
The WHOQOL-BREF: Translation and validation of the odia version in a sample of patients with mental illness
Nilamadhab Kar, Sarada P Swain, Suravi Patra, Brajaballav Kar
July-September 2017, 33(3):269-273
DOI:10.4103/0971-9962.214599  
Background: The World Health Organization Quality of Life–BREF (WHOQOL-BREF) is a well-validated, cross-cultural, generic instrument to measure the quality of life, which is available in many languages. Objective: It was intended to translate and validate the WHOQOL-BREF in Odia, an Indian language. Materials and Methods: WHOQOL translation methodology was adopted that included forward and backward translation and contribution from bi- and monolingual individuals. A sample of adult patients attending psychiatric unit and their caregivers without mental illness completed the questionnaire. Psychometric properties of the Odia version including reliability, validity, and item's correlation with their assigned domains were assessed. Results: A total of 150 individuals were included in the study, comprising 91 patients and 59 caregivers as healthy controls. Validity as measured by known group's comparison produced significant result in all the four domains (physical health, psychological health, social relationships, and environment), overall quality of life and health. There was significant correlation of the questionnaire items with their original assigned domain scores. The internal consistency reliability was acceptable; Cronbach's alpha value for the whole scale was 0.81 and that for individual domains were physical health: 0.71, psychological health: 0.70, social relationships: 0.65, and environmental health: 0.71. Conclusion: The study presents the preliminary findings on the psychometric properties of the Odia version of WHOQOL-BREF and suggests that it has acceptable reliability and validity for use in clinical settings involving patients with mental illness.
  1,433 142 -
Loss of coping resources and psychological distress in spouses of alcohol dependents following partner violence
Ottilingam Somasundaram Ravindran, Shica Ann Joseph
July-September 2017, 33(3):202-207
DOI:10.4103/0971-9962.214594  
Background and Objectives: A study to assess the psychological distress of married women due to their spousal violence under alcohol dependence. This study is aimed at studying partner violence, various coping styles and psychological distress among spouses of men with alcohol dependence and to explore the association between partner violence and coping behaviour. Materials and Methods: The study was conducted on 50 wives of alcohol dependent individuals in the age range of 20-50 years, who were divided into two groups based on the duration of drinking of their husbands. They were assessed by GHQ-12, Measure of Wife Abuse, Coping with Drinking Questionnaire and Depression Anxiety and Stress Scale. Results: Partner alcohol use was associated with increased psychological distress in their spouses and they have used both adaptive and maladaptive coping strategies. Conclusion: Alcohol plays a role in partner violence and spousal mental distress resulting in loss of their coping resources.
  1,346 183 -
The trailing trials of humiliation: Legal, social, and medical perspectives of women facing domestic violence in India
Kumuda Rao, K Shambu Sharma, Shreesha U Kumar, K Vighnaraj Bhat, Subhas G Babu
July-September 2017, 33(3):274-279
DOI:10.4103/ijsp.ijsp_53_16  
Globally, violence within the home is universal across culture, religion, class, and ethnicity. Despite its widespread prevalence, such violence is not customarily acknowledged and has remained invisible-a problem thought unworthy of legal or political attention. The social construction of the divide between public and private life underlies the major problem of addressing the hidden nature of domestic violence against women. Legal jurisprudence has historically considered the domain of the house to be within the control and unquestionable authority of the male head of household. Thus, acts of violence against members of the household, whether wife or child, were perceived as discipline and essential for maintaining the rule of authority within the family. Except for sensational cases, the fear of social isolation and inhibition has caused the insidious everyday violence experienced by huge numbers of women to be hidden in the private domain. In this review, we make an attempt towards briefing the legal, social, and medical perspectives of women facing domestic violence.
  1,378 140 -
Burden and coping styles among caregivers of patients with major mental disorders and hypertension attending a Nigerian tertiary hospital
AF Osundina, FO Fatoye, OO Akanni, JO Omoreagba, A Akinsulore, IO Oloniniyi
July-September 2017, 33(3):189-195
DOI:10.4103/0971-9962.214603  
Background: Previous research on caregiver burden in Nigeria has focused mainly on caregivers of patients with mental disorders. None of these studies compared the level of burden among the caregivers of patients with chronic mental disorders with caregivers of those with chronic medical illnesses. Furthermore, previous studies on caregiver burden in Nigeria did not examine the relationship between caregiver burden and coping style. Objectives: The objective of the study was to compare the level of burden and the coping styles used by the caregivers of patients with major mental disorders with that of caregivers of patients with hypertension, and also to determine any relationship between the caregiver burden and coping style. Methods: Four hundred caregivers were recruited from the psychiatry and cardiology clinics of a tertiary hospital. Psychiatric diagnosis was confirmed with the MINI-International Neuropsychiatric Interview (MINI). Caregivers completed a semistructured sociodemographic questionnaire, the Zarit Burden Interview, and the Coping Orientation to Problems Experienced Inventory. Results: There was a statistically significant difference in the level of burden experienced by the caregivers of patients with major mental disorders and hypertension. Overall, both groups of caregivers adopted similar coping styles except in the use of denial coping style, which was used significantly by caregivers of patients with major mental disorders. There was no significant relationship between the caregiver burden and coping style. Conclusions: This study found that caregivers of patients with major mental illnesses experienced a considerable burden than caregivers of patients with hypertension and also found that both groups of caregivers made use of similar coping styles.
  1,242 245 1
Psychosexual disorders: A cross-sectional study among opioid-dependent individuals
MI Singh Sethi, Himanshu Sareen, Bhuwan Sharma, Pradeep Atter
July-September 2017, 33(3):256-261
DOI:10.4103/0971-9962.214602  
Context: Punjab is in hold of a drug abuse-related epidemic, and the prevalence of opioid misuse is increased in the last few decades. A large-scale epidemiological data on sexual disorders among opioid users are lacking in literature. Aim: The aim of this articles was to study the prevalence of sexual disorders in patients with opioid dependence. Settings and Design: A cross-sectional study was conducted at a de-addiction clinic of a tertiary care centre from Punjab, India. Methods and Materials: A total of 109 consecutive patients attending the de-addiction clinic and fulfilling the eligibility criteria were assessed for sexual dysfunction by a predesigned, pretested, semistructured questionnaire. International Index of Erectile Function (IIEF-15) was administered to all patients to explore various aspects of sexual dysfunction. Statistical Analysis: Collected data were analyzed by SPSS version 20 using appropriate statistical test. Results: Mean age of participants was 29.9 years, 67% were married and heroin was the opioid of choice for 81.7%. Impaired sexual desire (59.6%) was the commonest psychosexual problem, followed by decreased orgasmic function (57.8%), erectile dysfunction (56.4%), decreased overall satisfaction (52.2%), and decreased intercourse satisfaction (46.7%). Conclusions: The prevalence of all types of sexual dysfunction was found to be statistically significant with more than 1 year of opioid use. These findings can be used to motivate the patients to enter a rehabilitation program at an earlier stage of opioid dependence. Opioid-dependent individuals should be thoroughly investigated for sexual dysfunction and its treatment should be made an integral part of de-addiction and rehabilitation program.
  1,075 123 -
EDITORIAL
How mental illness affects the family - Different worlds, similar suffering
Naresh Nebhinani, BN Subodh
July-September 2017, 33(3):187-188
DOI:10.4103/ijsp.ijsp_65_17  
  969 171 -
ORIGINAL ARTICLES
Help-seeking behaviors in the relatives of mentally Ill persons at a Tertiary Care Hospital
Korem Anusha, Bogaraju , Anand , L. V. R. Usha
July-September 2017, 33(3):250-255
DOI:10.4103/0971-9962.214597  
Background: There are few studies in Indian context on factors affecting generalized help-seeking behaviors in the relatives of persons with mental illness. Hence, the present study was undertaken. Materials and Methods: This is a cross-sectional, purposive sampling, comparative study. Sociodemographic profile, illness details, treatment, compliance, reactions to mental illness scale, and cope inventory scores were compared between the low and high help-seeking groups on General Help-seeking Questionnaire divided on the lower 25th and upper 75th quartiles, respectively, for the groups. The data were statistically analyzed on SPSS-17. Results: Out of a total of 100 patients, 25 and 28 subjects in the low and high help-seeking groups, respectively, were included in the study. In the low help-seeking group, drug compliance was good and caregivers' education level was higher compared to the high help-seeking group. High help-seeking group was characterized by higher scores of hope and compassion on reactions to mental illness scale and the coping mechanisms of humor, denial, use of instrumental and emotional support, acceptance, and planning were frequently used. Conclusions: There is a need to develop awareness about mental illness in the general population and improve the available social support systems to the patients with mental illness and their family members. The help-seeking behaviors could be improved by training the personnel at primary health centers about the treatment of mental illness and importance of drug compliance and regular follow-up.
  994 135 -
Concept of depression in rural community of Chandigarh
BS Chavan, Sukhtej Sahni, Subhash Das, Ajeet Sidana
July-September 2017, 33(3):225-232
DOI:10.4103/0971-9962.214589  
Background: Lack of awareness about mental illness prevents patients from getting appropriate mental health care. This is more so in places where there is dearth of adequate mental health professionals. These factors highlight the importance of conducting research to assess public knowledge and attitudes toward mental illness. Hence, the aim of the present study was to assess the prevailing concept of depression in the community. Methods: Two villages in the periphery of Chandigarh were selected and local “Panchayat” of the villages were told to select the local members in the community who were regarded as socially responsible. A total of 48 members were selected and a workshop was conducted by the experts in mental health and the cohort was asked about prevailing concept of depression in the local community. The whole workshop was videotaped and the verbatim of the same was recorded. Results: It was found that majority had beliefs that depression is caused by stressful circumstances or substance use and the depressed individual has decreased interaction, fights and sleeps less. It was also noted that the prevalence was perceived to be low. The first treatment preferences were religious/faith healers or the local practitioners. Reasons for treatment gap were cited as ignorance and misguidance in the community. Conclusions: It was interpreted that depression is mainly linked with stressful events and symptoms being behavioural only. The understanding of somatic and biological symptoms was lacking along with the endogenous risk factors and its causes. Treatment gap exists at the grass root level and reasons such as ignorance and misguidance emerged during the discussion with the community leaders.
  999 116 -
Changing pattern of clinical profile of first-contact patients attending outpatient services at a general hospital psychiatric unit in India over the last 50 years
Mamta Sood, Rajeev Ranjan, Rakesh Kumar Chadda, Sudhir Kumar Khandelwal
July-September 2017, 33(3):213-218
DOI:10.4103/0971-9962.214595  
Introduction: Over the last five decades, general hospital psychiatric units (GHPUs) have become important mental health service setups in India. The present study reports on the changing clinical profile of the patients attending the GHPUs over the last five decades. Methodology: A total of 500 subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semistructured proforma. A comparison was made with similar studies conducted in GHPU settings over the last five decades. Results: In the present study, neurotic, stress-related and somatoform disorders formed the commonest diagnostic group (33%) followed by psychotic disorders (17%) and mood disorders (15%). The diagnostic distribution is broadly similar to the studies done at different times in the last 5 decades, though there were lesser number of patients with mental retardation and organic brain syndrome. About 15% of the subjects did not have a psychiatric diagnosis. Conclusion: GHPUs in India attend to a broad range of patients with psychiatric disorders.
  791 115 -
LETTER TO EDITOR
Psychosocial intervention in a case of attempted suicide
Sujoy Ray, Sheena Varughese, Anvar Sadath
July-September 2017, 33(3):280-281
DOI:10.4103/0971-9962.214592  
  616 130 -
BOOK REVIEW
A book of light: When a loved one has a different mind
Shikha Tyagi, Monica Munjial Singh
July-September 2017, 33(3):282-283
DOI:10.4103/ijsp.ijsp_23_17  
  622 103 -