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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 36 | Issue 4
Page Nos. 267-369

Online since Thursday, December 31, 2020

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EDITORIAL  

Substance abuse in the elderly: A hidden behemoth Highly accessed article p. 267
Subhash Das, Siddharth Sarkar
DOI:10.4103/ijsp.ijsp_394_20  
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N. N. DE ORATION AWARD 2019 Top

Of mice and men.....The unforgettable narrative of how social factors shape substance use, addiction, and recovery p. 270
Debasish Basu
DOI:10.4103/ijsp.ijsp_393_20  
The currently predominant model to explain addiction is the brain disease model of addiction, which emphasizes drug-induced brain changes at the individual level, producing an uncontrollable, chronic relapsing disease. It tacitly de-emphasizes the complex sociocultural, contextual, and other environmental determinants of substance use and addiction. In this oration, I challenge these assumptions with a hop-and-stop tour of five countries: Canada, the USA, India, Vietnam, and Iceland. The journey covers five narratives: isolation, pain, frustration, and then the positive narrative of recovery, and finally the narrative of hope. The socially enriched rats in the “Rat Park” in a laboratory in Canada consumed much less morphine than the isolated, caged rats. People dying of opioid overdose in the worst-ever opioid epidemic in the USA might be using opioids as an escape from broadly defined “pain,” where pain is an emblem of deeper societal isolation and suffering. In Punjab, India, frustrated youths due to complex socio-political-economic reasons are falling easy prey to the profiteering drug mafia. On the positive side of the narratives, most of the Vietnam war veterans who had been using heroin heavily while in Vietnam quit after returning to the comfort of their home, family, and friends, thus providing the narrative of recovery. Finally, the Icelandic Model, a series of pro-social policy measures at the government level targeting the children, the parents, the school, and the environment in Iceland, where teenage substance abuse had been peaking alarmingly in the mid-1990s, demonstrated the preventive prowess of these measures. All in all, this journey teaches us vital lessons not to forget the social psychiatry of addiction. It also teaches us that it would be a wise investment to improve the social determinants of health, including mental health and addiction.
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REVIEW ARTICLE Top

The role of “Attributions” in social psychology and their relevance in psychosocial health: A narrative review Highly accessed article p. 277
Debanjan Banerjee, Chehak Gidwani, TS Sathyanarayana Rao
DOI:10.4103/ijsp.ijsp_315_20  
Assigning motives or reasons to situations and actions have been the basic premise of human existence. Attributing cause to an action makes it logical and easier to comprehend. In social psychology, attribution is the process through which individuals explain the causes of behavior and events. Various theories and models have been proposed to explain this concept, starting from the early works of Fritz Heider in the early 20th century and further advances by Harold Kelley and Bernard Weiner. Attributional concepts can be used in a wide arena of behavioral science ranging from mental health stigma-related interventions to consumerism, corporate and jury psychology, and finally, attributional bias in psychosis and learned helplessness in depression. Attribution theories are viewed as the relevant concepts in the exploration and explanation of a wide repertoire of psychopathologies, especially for culture bound syndromes. Research into the translational use of attributional theories has declined in the recent years, the models being criticized for being mechanistic and reductionistic in approach. Nevertheless, the role of “attributions” in social psychology remains equally important today to explore the various facets of human behavior and reactions. The article explores the relevance of attributions in the fields of psychosocial health. It discusses various theoretical perspectives and frameworks premised on attributional models and narrates the understanding as well as the applications of the relevant theories in the realms of stigma research and consumerism. The criticism and implications in mental health are highlighted thereafter.
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DEBATE/PERSPECTIVE/VIEWPOINT Top

Care of transgender individuals in India: A clinical perspective p. 284
Shiva Prakash Srinivasan, Sruti Chandrasekaran
DOI:10.4103/ijsp.ijsp_88_20  
India is making rapid strides in recent times in recognizing and providing legal supports to the transgender community. An increasing number of individuals are seeking medical assistance for gender-affirming medical interventions. Many medical and surgical practitioners working with transgender clients in the Indian subcontinent face clinical and social challenges. In this article, we highlight some of the common challenges experienced by healthcare professionals and the solutions adopted in providing care for transgender clients.
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ORIGINAL ARTICLES Top

Social media disorder among Indian undergraduate medical students and its association with depression: An institution-based mixed-method study p. 289
Rajib Saha, Manisha Sarkar
DOI:10.4103/ijsp.ijsp_42_20  
Background: Social media disorder (SMD) is the current entity in this decade that leads to different screen-related health problems. Despite of tremendous academic pressure, how social media affects the future doctors, is yet unknown. Aims: The aim is to determine the prevalence of SMD among the undergraduate medical students of a tertiary care hospital in West Bengal and to determine its predictors. Settings and Design: A cross sectional analytical mixed-method study was conducted at a tertiary care center of Bankura. Methodology: During April–June 2019, 216 undergraduate medical students were selected through two-stage sampling method. Data were collected using semi-structured questionnaire, 9-item SMD scale, and Beck's Depression Inventory Scale. Statistical Analysis Used: Data were analyzed using SPSS (version 16) initially through bivariate analysis using Chi-square test and later logistic regression was used to determine the actual predictor(s). Results: The prevalence of SMD was found to be 11.6%. All of the students were found to be social media users and among them the prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity was 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively. However, no significant relationship was obtained between SMD and above health problems. Through logistic regression model, it was found that the students with depression were 6.7 times more prone to develop SMD. Conclusions: Depression being a risk-factor for SMD needs to be addressed as priority by providing appropriate counseling and/or professional consultation.
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Taking therapy beyond clinics – An evaluation of family therapy training program with lay counselors p. 296
Janardhana Navaneetham, Tania Roy
DOI:10.4103/ijsp.ijsp_22_20  
Background: Families have been accommodating the changes to suit the present situation. Indian families even though structurally moving toward nuclear families, still carry on the values of the joint families of connectedness, interfamily influences, extended family influences on decision-making, etc., Subjects and Methods: The study aims at understanding the effectiveness of family training with lay counselors. An interview schedule was prepared to collect sociodemographic profile, knowledge about family therapy (FT), and confidence of practicing FT. The participants were enrolled for training based on ‘first come first serve’; those who completed postgraduation and PG diploma were included for the training program, and most of them were involved in the helping profession either as part of the training or service. This study was of a quasi-experimental design with assessments at two timelines – pre-post training sessions. Results: Most of them expressed that they had previously worked with families with child abuse, academic difficulties in children, marital issues, domestic violence, etc. A test of Wilcoxon's signed-rank test showed the change in the knowledge and confidence level of the trainees. Nearly 48.1% and 46.3% of the participants felt they have high and moderate skills in identifying cases that require family interventions, respectively, 70.4% said that the sessions were high in clarity, while 25.9% reported moderate clarity. Almost 68.5% expressed no difficulty in understanding sessions. This article attempts to share their experience of conducting the dissemination of systemic family intervention for the people in the service sector. It was found that the participants appreciated the training programs and were able to see the benefit of including systemic approach in their family intervention. Conclusion: This article attempts to share the experience of conducting the dissemination of systemic family intervention for the people in the service sector. It was found that the participants appreciated the training programs and were able to see the benefit of including systemic approach in their family intervention.
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Impact of social-emotional learning intervention on emotional intelligence of adolescents p. 303
Shruthi Kothari, Mareena Susan Wesley
DOI:10.4103/ijsp.ijsp_28_20  
Adolescents face a variety of challenges, some of which include social, emotional, cognitive, and interpersonal. In order to help them with their emotions, adolescents should be taught a variety of skills to regulate and handle emotions better. With this intent in mind, a social-emotional learning (SEL) intervention module was developed by the researchers. This module covered aspects related to self-awareness, social awareness, responsibility, empathy and decision-making. These components also form the basis for emotional intelligence (EI) which is defined as the ability to perceive, understand, and regulate emotions of oneself and others. The present study aimed to understand if there arises any difference in scores of EI post the SEL intervention. Second, the gender differences with respect to EI were also be analyzed. The EI Scale (2014) was administered to 80 students between the age group of 13–14 years, from a CBSE school in Chennai. These adolescents were selected through the convenience sampling, and the four subscales were also analyzed. The findings from the study revealed a significant difference in scores from pretest to posttest (t = −4.66, P < 0.05). With respect to gender, no significant difference was found. On the subscales, two of four subscales showed significant difference in understanding emotions (Z = −4.63, P < 0.05) and handling emotions (Z = −4.023, P < 0.05).
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The influence of social environment on children of a commercial sex worker p. 310
V Deepa, MY Manjula
DOI:10.4103/ijsp.ijsp_8_20  
The case study aims to understand the influence of social environment on the course of life of children of a commercial sex worker. The participants of the study were two sons of a commercial sex worker who grew up in different environments. The older sibling who is 19 years of age (case 1) lives with his mother, whereas the younger sibling who is 17 years of age (case 2) lives in a hostel distant from everyday influence of a brothel. The study adopts multiple case study design and in-depth interviews were conducted to gather data. The obtained data were subjected to thematic analysis. Each case was analyzed individually, and then cross comparison of the themes derived was carried out. The themes derived on analyzing case 1 were social categorization, mercenary activity, substance aficionado, complacency in life, and compliance with life while the themes derived on analyzing case 2 were disgust toward commercial sex work, feeling of precariousness, antipathy toward home environment, irrational thoughts and anticipation of a better future. The only overlapping issue that emerged in both cases was being protective about their mother. It was concluded that environmental variance contributes to the difference in experience and perception of the situation and society.
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Medical students and marijuana, attitudes and beliefs: A comparative study p. 317
Gurappa Puttanna Gururaj, Ruth Sneha Chandrakumar
DOI:10.4103/ijsp.ijsp_36_20  
Background and Objectives: Various studies indicating that cannabis is associated with various psychiatric disorders despite which is a controversy existing regarding the legalisation of cannabis by all the promoters and consumers of the substance. Our objective was to find out the knowledge and awareness among the 1st year and final year medical students toward the effects and experiences with the consumption of cannabis. Methodology: It was a cross-sectional study done on first and final year medical students between July 2019 and August 2019 in Sri Devaraj Urs higher education and research center, who are assessed using a structured and validated instrument, Marijuana Effect Expectancy Questionnaire-Brief (MEEQ-B) questionnaire. Results: Both the first-year and final-year medical students in our study had poor awareness and inadequate knowledge about the various adverse effects of cannabis, especially on all the six parameters of the MEEQ questionnaire. Conclusion: Extensive and elaborative teaching regarding substance use, especially of cannabis and its implication must be updated in the curriculum of both UG teaching and PG teaching in other specialities as well.
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Psychological aspects of infertility: A comparative study p. 321
Nigesh Kalorath, Tilottama Mukherjee
DOI:10.4103/ijsp.ijsp_21_20  
Introduction: Psychosocial aspects of infertility in couples are of much relevance. This paper attempts to compare psychological factors that may play a role in couples with and without infertility. The main objectives are to examine the differences concerning marital quality, attachment styles, and defense styles of infertile and fertile couples. Methods: A total of 60 individuals (30 infertile couples and 30 matched fertile couples) were assessed through administering the personal information schedule, Marital Quality Scale, Attachment Style Questionnaire, and Defense Style Questionnaire-40. General Health Questionnaire-28 was administered in the fertile couples to rule out psychiatric morbidity. Results: Statistical analyses revealed that infertile couples differed from fertile couples on marital quality dimensions of understanding, satisfaction, trust, role functioning, despair, and rejection. On the attachment style, component of preoccupation with relationships and the use of immature defenses such as acting out and displacement. Conclusions: This research identified several psychological dimensions related to fertility. Understanding these factors may be helpful for the couples, their family members, and practitioners, with regard to the psychological and social needs related to infertility.
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Explanatory model of mental illness and treatment-seeking behavior among caregivers of patients with mental illness: Evidence from Eastern India p. 327
Vijay Kumar Lilhare, Abhijit Pathak, KJ Mathew, Chittranjan Subudhi
DOI:10.4103/ijsp.ijsp_24_20  
Background: Mental illness does not have a homogeneous definition since its explanation varies across the culture. Caregivers are playing a vital role in the decision-making process of patient treatment. Thus, the objective of this study is to investigate the explanatory models (EMs) about mental illnesses and treatment-seeking behavior (TSB) prevalent among the patients' caregivers in Jharkhand, India. Methods: The present study was conducted among the patients' caregivers from the Hazaribagh district of Jharkhand, India. Two-hundred and forty respondents were selected through a convenient sampling method. A sociodemographic detail sheet used for recording the sociodemographic profile of the respondents and semi-structure interview schedule sheet was used to record the EMs and TSB of the respondents. Results: Most caregivers understand mental illness as a brain dysfunction (50.4%) but unaware of the causation of it (48.3%). Whereas 82.1% of patients' caregivers prefer medical facilities for the treatment; at the same time, 57.5% prefer faith healers or religios practice to cure. Conclusion: It can be inferred from the results that half of the respondents still have other kinds of EMs on the causation of mental illness. Although the high frequency of seeking medical facilities has come in the result, different modes of treatment seeking which are done parallelly by caregivers such as faith and traditional healing cannot be ignored. Therefore, there is a need to raise the mental health literacy in this region in addition to the medical and psychiatric care facilities.
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Family-related factors and its impact on psychosocial health of school-going adolescents of Urban Rishikesh, Uttarakhand p. 333
Jatin Chaudary, Surekha Kishore, Ajeet Singh Bhadoria, Pradeep Aggarwal
DOI:10.4103/ijsp.ijsp_100_20  
Background: Psychosocial problems occur in a wide variety of settings, and they often have a negative impact on adolescents' mental health. The family environment influences the psychosocial development of adolescents in this transitional phase. This study was conducted to find the association between psychosocial problems and the family environment. Materials and Methods: We conducted a cross-sectional study for 6 months among school-going adolescents of urban Rishikesh, Uttarakhand. In this study, a self-administered questionnaire consisting of Youth-Pediatric Symptom Checklist and family-related factors was given to the students. The data were compiled and analyzed using appropriate statistical analysis. Results: A total of 400 adolescent students participated in the study. The prevalence of psychosocial problems was 40.7%. Psychosocial problems were significantly associated with family-related factors which were further divided into three subgroups. First, the family environment which includes problems in the family (61.8%), parents understanding each other (61.8%), and participants feeling happy at home (34.2%). The second subgroup was parent–child relationships such as parents pay attention (27.9%), understanding parents (30.3%), and parents unhappy with participant's academic performance (63.6%). The third subgroup was parenting style such as parents allow children to take their own decisions (23.4%), parents comparing their child with other children (63.6%), parents are strict (63.1%), getting pocket money (35.7%), and interfering parents (64.3%). There was no significant association found between getting pocket money and psychosocial problems. Conclusion: Family-related factors have a significant impact on adolescents' psychosocial health; thus, targeted interventions are required. It is of paramount importance to educate parents, community stakeholders, and schools regarding psychosocial problems in adolescents.
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Internet addiction among college students in relation to five factor personality and loneliness p. 338
Sangram Singh Nathawat, Chaitali Suryakant Gawas
DOI:10.4103/ijsp.ijsp_2_20  
Background: College life is a phase where students face various academic as well as emotional issues. Excessive internet use by students is linked with emotional ill health based on one's personality and isolated behavior. Aims: The present study aimed at investigating the prevalence of internet addiction, comparison among students considering the level of addiction and gender on personality factors and loneliness, and also to explore the association between internet addiction, personality factors, and loneliness measure. Materials and Methods: The sample of 200 college students (100 boys and 100 girls) was administered Internet Addiction Test by Young, University of California, Los Angeles Loneliness Scale (Version 3) by Russell and Neo Five-Factor Inventory by Costa and McCrae. Results: Of a sample of 200 students, 28% were free from internet addiction, 57% fell into the category of mild internet addiction, and 15% fell into the moderate-severe internet-addiction category. 2 × 2 factorial design was employed to see the differences in personality factors and loneliness concerning internet addiction and gender differences along with their joint effects on these measures. Significant differences were observed on two personality factors (neuroticism and extraversion) and loneliness measure in students with different levels of internet addiction. Furthermore, correlation analysis revealed a positive and significant correlation of internet addiction with neuroticism as well as loneliness, whereas other measures of personality were negatively correlated. Neuroticism was positively and significantly correlated with loneliness. However, other personality factors were significantly but negatively correlated. Conclusion: Significant differences were observed among students considering the level of addiction on two personality factors and loneliness measure. In addition, significant associations were seen among internet addiction, personality factors, and loneliness.
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An online survey of education, knowledge and attitude toward homosexuality in adults p. 344
T Siva Ilango, S Karthikeyan, S Sumithra Devi, S Arumuganathan, S Usaid, V Sethumadhavan
DOI:10.4103/ijsp.ijsp_43_20  
Background: People across cultures have negative stereotypes, prejudice, and discrimination toward homosexuality for many years. The concept is changing, and recently in India, the Supreme Court has decriminalized homosexuality and recognized it as natural, with people having no control over it. This study aims to find out if there is any change in knowledge and attitude toward homosexuality in the Indian adult population after the landmark judgment. Methods: The study was designed as an online survey using snowball sampling incorporating the questions from Sex Education, Knowledge about homosexuality questionnaire (SEKHQ), Attitudes toward Homosexuality Questionnaire (AHQ) and relevant sociodemographic details and the data were collected using google form for 3 months. Results: Six hundred and forty-three people over the age of 18 years participated in the study. The mean age of the study participants was 29.12 years. The mean score on SEKHQ was 16.18 ± 4.71, with a median score of 16. The mean score on the “Attitudes toward Homosexuals” questionnaire (AHQ) was 54.04 ± 8.43. On Pearson's correlation test, age of the participants is positively correlated with SEKHQ score (r = 0.014; P = 0.71 at 95% confidence interval and AHQ score (r = 0.151; P ≤ 0.001 at 95% CI) while SEKHQ score is negatively correlated with AHQ score (r = −0.20; P ≤ 0.001 at 95% CI). Conclusion: The participants had better knowledge and positive attitudes towards homosexuality, especially being single, student and from a medical background. The study showed that higher knowledge on SEKHQ scores did not reflect the positive attitudinal change with increasing age. Generation gap exists and explains the open and diverse attitude of the younger generation toward this marginalized population. More large scale studies in the community setting are needed not only to evaluate but also to educate and improve the attitudes of people toward homosexuality.
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Knowledge and understanding of suicide in rural and suburban community of Chandigarh p. 351
Ajeet Sidana, Sakshi Gupta, Raveena Saroye
DOI:10.4103/ijsp.ijsp_46_20  
Background: Communities play a crucial role in suicide prevention. Community knowledge and understanding are essential for planning intervention strategies at community level. Aims and Objectives: To study the knowledge and understanding of people in rural and suburban areas about suicide and its prevention. Methodology: On the basis of convenient sampling, two places in the periphery of Chandigarh were selected. The participants were recruited from among those who were attending the program on suicide prevention on the occasion of World Mental Health Week (2019) and were administered a questionnaire (developed after 2 focused group discussions) after taking their informed consent. Results: There were 90 participants predominantly from rural background (74.4%), males (70%), and in the age range of 40–50 years (37%). Majority of the males from middle socioeconomic status and rural background reported 11–20 cases of suicide every year in their area and which was statistically significant. About 87% agreed that mental illness was not the only cause of suicide, and most of them felt that suicide occurred due to financial problems (34%), stress (33%), depression (22%), mental illness (21%), family disputes (15%), and unemployment (15%). Majority (47%) of the respondents preferred to “talk with friends and near ones” for suicide prevention. Conclusion: Study concluded that there is inadequate knowledge about incidence of suicide in the rural and suburban community of Chandigarh.
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BRIEF COMMUNICATIONS Top

Group meeting in psychiatric inpatient setting: Psychological intervention and outcome difference across gender p. 359
Shreya Manot, Susmita Halder
DOI:10.4103/ijsp.ijsp_75_20  
Being part of a group is likely to increase the affiliation of the members, serving as a source of support in times of crises and distress. Group meetings are part of the therapeutic action provided to a group of individuals, together in their inpatient setup. This enables in developing a rapport with the unit as a whole and resolve any misunderstanding or discrepant information, as far as possible. The present study aims to explore the efficacy of group meetings in a psychiatric inpatient setting in males and females in terms of the process and outcome. In the present study, the total sample consisted of twenty inpatients at a mental health-care unit, of which 9 were females and 11 were males. These two groups consisted of individuals with mixed diagnosis. Group meetings along with individual therapy for each of the patients were conducted separately for both the groups over a span of 15 sessions. Results of the study showed that the group meeting was found to be effective as was reflected in terms of the outcome measures. Further, sex-related differences were found to be present across several measures. Thus, the present study further highlights the importance of group meetings as an adjunct to ongoing intervention in psychiatric inpatient wards and also warrants a customization in the plan and approach for males and females separately.
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Effect of yoga and physical exercises on components of metabolic syndrome among persons with intellectual disability p. 363
Manisha Sharma, Shashi Kumar, BS Chavan
DOI:10.4103/ijsp.ijsp_229_20  
Persons with intellectual disability (ID) are at higher risk of developing metabolic syndrome and have lower level of physical fitness as compared to normal population. The study was carried out to examine the impact of yoga and physical exercises on overweight children with ID. The results demonstrated significant reduction in waist circumference and blood pressure, significant increase in the value of high-density lipoprotein and reduction in the value of LDL in both the groups.
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OBITUARIES Top

Professor BS Chavan: The ever optimist p. 365
Nitin Gupta
DOI:10.4103/ijsp.ijsp_448_20  
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Professor B S Chavan, MD, DHM, FAMS, FIMSA (1961–2020) p. 366

DOI:10.4103/ijsp.ijsp_449_20  
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Prof. B. S. Chavan – A life well lived p. 368
Debasish Basu
DOI:10.4103/ijsp.ijsp_444_20  
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