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Daniel M, Kallakuri S, Gronholm PC, Wahid SS, Kohrt B, Thornicroft G, Maulik PK. Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India. Front Psychiatry 2024; 15:1337662. [PMID: 38356906 PMCID: PMC10864454 DOI: 10.3389/fpsyt.2024.1337662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background The International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership is a multi-country international research program in seven sites across five low- and middle-income countries (LMICs) in Africa and Asia to develop, contextually adapt mental health stigma reduction interventions and pilot these among a variety of target populations. The aim of this paper is to report on the process of culturally adapting these interventions in India using an established framework. Methods As part of this larger program, we have contextualized and implemented these interventions from March 2022 to August 2023 in a site in north India. The Ecological Validity Model (EVM) was used to guide the adaptation and contextualization process comprising eight dimensions. Findings Six dimensions of the Ecological Validity Model were adapted, namely language, persons, metaphors, content, methods, and context; and two dimensions, namely concepts and goals, were retained. Conclusion Stigma reduction strategies with varied target groups, based on culturally appropriate adaptations, are more likely to be acceptable to the stakeholders involved in the intervention, and to be effective in terms of the program impact.
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Affiliation(s)
- Mercian Daniel
- Research Department, George Institute for Global Health, New Delhi, India
| | - Sudha Kallakuri
- Research Department, George Institute for Global Health, New Delhi, India
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Syed Shabab Wahid
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Pallab K. Maulik
- Research Department, George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Department of Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Mukherjee A, Yatirajula SK, Kallakuri S, Paslawar S, Lempp H, Raman U, Essue BM, Sagar R, Singh R, Peiris D, Norton R, Thornicroft G, Maulik PK. Using formative research to inform a mental health intervention for adolescents living in Indian slums: the ARTEMIS study. Child Adolesc Psychiatry Ment Health 2024; 18:14. [PMID: 38245796 PMCID: PMC10800058 DOI: 10.1186/s13034-024-00704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints. METHODS In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed. RESULTS The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application. CONCLUSION The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups. TRIAL REGISTRATION The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022.
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Affiliation(s)
| | | | | | | | - Heidi Lempp
- Centre for Rheumatic Diseases, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Beverley M Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Robyn Norton
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- The George Institute for Global Health, Imperial College London, London, UK.
- University of New South Wales, Sydney , Australia.
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Ali T, Deshmukh S, Kumar S, Chaudhury S, Verma PK, Kelkar P. Assessment of supernatural attitude toward mental health among tribal and non-tribal populations. Ind Psychiatry J 2023; 32:S174-S178. [PMID: 38370964 PMCID: PMC10871431 DOI: 10.4103/ipj.ipj_237_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/30/2023] [Accepted: 07/08/2023] [Indexed: 02/20/2024] Open
Abstract
Background In India, only about 10% of persons with psychiatric illnesses receive evidence-based treatments. Stigma, mistrust in allopathic medicine, allegiance toward faith healers, cultural and traditional practices, and beliefs are some of the major hindrances to the treatment of mentally ill patients. Aim To assess supernatural attitudes toward mental health among tribal and non-tribal populations. Materials and Methods A total of 100 subjects were included in the study after informed consent, 50 of whom were tribal and 50 non-tribal. All were required to fill a self-constructed proforma, the Supernatural Attitude Questionnaire (SAQ), and the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF). The scales were scored, compiled, and statistically analyzed. Results The tribal and non-tribal subjects were well-matched on socio-demographic variables. The score of SAQ was significantly higher in the tribal group as compared to the non-tribal group. On the ATSPPH-SF, the scores of the two groups were not significant. Conclusion Even though the tribal populations of India hold a higher supernatural attitude toward mental illnesses as compared to the non-tribal populations, their treatment-seeking attitude remains unaffected.
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Affiliation(s)
- Tahoora Ali
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Mahashtra, India
| | - Shilpa Deshmukh
- Department of Anesthesiology, Dr. D.Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Mahashtra, India
| | - Santosh Kumar
- Department of Psychiatry, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Mahashtra, India
| | - Pankaj Kumar Verma
- Department of Psychiatric Social Work, Ranchi Institute of Neuropsychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand, India
| | - Parisha Kelkar
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Mahashtra, India
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Semrau M, Gronholm PC, Eaton J, Maulik PK, Ayele B, Bakolis I, Mendon GB, Bhattarai K, Brohan E, Cherian AV, Daniel M, Girma E, Gurung D, Hailemariam A, Hanlon C, Healey A, Kallakuri S, Li J, Loganathan S, Ma N, Ma Y, Metsahel A, Ouali U, Yaziji N, Zgueb Y, Zhang W, Zhang X, Thornicroft G, Votruba N. Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local). RESEARCH SQUARE 2023:rs.3.rs-3237562. [PMID: 37645946 PMCID: PMC10462245 DOI: 10.21203/rs.3.rs-3237562/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care. Methods This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, public awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in five LMICs - China, Ethiopia, India, Nepal and Tunisia - and includes several key components: a stakeholder group workshop; a stepped training programme (using a 'Training of Trainers' approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; awareness-raising activities in the community; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs. Discussion The outcome of this study will be contextually adapted, evidence-based interventions to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The interventions and their delivery will be refined to be acceptable, feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University
| | | | - Ning Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health
| | - Yurong Ma
- The Affiliated Brain Hospital of Guangzhou Medical University
| | | | | | | | | | - Wufang Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health
| | - Xiaotong Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health
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Kafczyk T, Hämel K. Primary mental healthcare for older people in India: between stigmatization and community orientation. DISCOVER MENTAL HEALTH 2023; 3:14. [PMID: 37861873 PMCID: PMC10501019 DOI: 10.1007/s44192-023-00040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Questions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India. METHODS A secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted. RESULTS Four key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education. CONCLUSIONS PMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.
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Affiliation(s)
- Tom Kafczyk
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany.
| | - Kerstin Hämel
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany
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Kunyahamu MS, Daud A, Tengku Ismail TA, Md Tahir MF. Translation, Adaptation, and Validation of the Malay Version of the Barriers to Access to Care Questionnaire for Assessing the Barriers to Seeking Mental Health Care Among the Health Workforce in the East Coast Region of Peninsular Malaysia. Cureus 2023; 15:e41405. [PMID: 37546078 PMCID: PMC10402845 DOI: 10.7759/cureus.41405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Mental health problems among the health workforce are a significant concern worldwide, including in Malaysia. Unfortunately, some health workforce may perceive various barriers or challenges that prevent them from seeking help. Identifying and addressing these barriers is crucial for enhancing mental health services and support. The Barriers to Access to Care Evaluation (BACE-3) questionnaire is a valuable tool that can be used for assessing these barriers among health workers. However, a validated Malay version is needed. Therefore, this study aims to translate, adapt, and validate the original version of Barriers to Access to Care Evaluation (BACE-3) into the Malay version (MBACE). Methods A rigorous process of translation and adaptation was followed to develop the Malay version of the BACE-3 questionnaire (MBACE). A cross-sectional study was conducted to assess the psychometric properties of the questionnaire, with purposive sampling employed to recruit 188 participants from various job categories, including doctors, nurses, pharmacists, and non-clinical staff, such as health assistants and clerks. The analysis was conducted using the R software version 4.2.2 (R Foundation, Vienna, Austria). Construct validity was determined using confirmatory factor analysis (CFA). To assess the convergent validity, internal consistency, and reliability of the instrument, measures such as the average variance extracted (AVE), composite reliability (CR), and Cronbach's alpha values were calculated. Results During the CFA process, two items with a factor loading less than 0.5 (items 15 and 16) were removed to improve the convergent validity and model fit. The CFA results revealed that the 2-factor model MBACE had good construct validity (root mean square error of approximation (RMSEA) = 0.053; comparative fit index (CFI) = 0.939; Tucker-Lewis fit index (TLI) = 0.934). The internal consistency was supported by Cronbach's alpha values ranging from 0.92 to 0.94 for the stigma factor and non-stigma factor. The average variance extracted (AVE) and composite reliability (CR) values further supported the questionnaire's reliability and convergent validity. Conclusion The translated and adapted 28-item MBACE questionnaire is a valid and reliable tool for assessing the barrier to seeking professional mental health care among the Malaysian health workforce. This instrument has the potential to aid in the development of targeted interventions to promote mental health help-seeking behavior and enhance the well-being of the Malaysian health workforce.
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Affiliation(s)
- Muhammad S Kunyahamu
- Department of Community Medicine, Universiti Sains Malaysia School of Medical Sciences, Kota Bharu, MYS
| | - Aziah Daud
- Department of Community Medicine, Universiti Sains Malaysia School of Medical Sciences, Kota Bharu, MYS
| | - Tengku A Tengku Ismail
- Department of Community Medicine, Universiti Sains Malaysia School of Medical Sciences, Kota Bharu, MYS
| | - Mohd F Md Tahir
- Department of Psychiatry and Mental Health, International Islamic University Malaysia, Kuantan, MYS
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Sanghvi P, Mehrotra S, Sharma MK. Development of a Technology-Based Intervention to Improve Help-Seeking in Distressed Non-Treatment-Seeking Young Adults With Common Mental Health Concerns. Cureus 2023; 15:e39108. [PMID: 37332458 PMCID: PMC10271058 DOI: 10.7759/cureus.39108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/20/2023] Open
Abstract
Background There is a dearth of interventions aimed at improving help-seeking for common mental health concerns among distressed young adults, particularly in the urban Indian context. Availability of cost-effective, targeted intervention for improving appropriate help-seeking can pave the way for reducing the treatment gap. This could prove especially beneficial in low-resource settings. This study describes the guiding principles, underlying theory, and development process of a simple technology-based help-seeking intervention for distressed non-treatment-seeking young adults. Methods Several models of professional help-seeking behavior were examined to ascertain a suitable theoretical framework for the development of the intervention to enable help-seeking among distressed non-treatment-seeking young adults. Pilot work was carried out before the development, along with content validation of the intervention by field experts. Results Help-seeking intervention was developed based on the preferences of young adults and literature review. Eight core intervention components and one optional component were developed, which were built on selected theoretical frameworks. These components have been postulated to enhance awareness of common mental health problems, the utility of self-help, and support of significant others, and to increase the skills to understand when it may be appropriate to step up to professional help-seeking. Conclusion Help-seeking interventions delivered beyond the traditional clinic and hospital setups prove useful as low-intensity interventions acting as gateways to seek mainstream mental health services. Further research will evaluate the feasibility, acceptability, and effectiveness of the intervention in reducing perceived barriers and enhancing inclination to seek professional help and help-seeking behavior among distressed non-treatment-seeking young adults.
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Affiliation(s)
- Prachi Sanghvi
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Seema Mehrotra
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Manoj Kumar Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
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Kaur A, Kallakuri S, Mukherjee A, Wahid SS, Kohrt BA, Thornicroft G, Maulik PK. Mental health related stigma, service provision and utilization in Northern India: situational analysis. Int J Ment Health Syst 2023; 17:10. [PMID: 37106395 PMCID: PMC10134673 DOI: 10.1186/s13033-023-00577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Stigma, discrimination, poor help seeking, dearth of mental health professionals, inadequate services and facilities all adversely impact the mental health treatment gap. Service utilization by the community is influenced by cultural beliefs and literacy levels. We conducted a situational analysis in light of the little information available on mental health related stigma, service provision and utilization in Haryana, a state in Northern India. This involved: (a) qualitative key informant interviews; (b) health facility records review; and (c) policy document review to understand the local context of Faridabad district in Northern India. Ethical approvals for the study were taken before the study commenced. Phone call in-depth interviews were carried out with a purposive sample of 13 participants (Mean = 38.07 years) during the COVID-19 pandemic, which included 4 community health workers, 4 people with mental illness, 5 service providers (primary health care doctors and mental health specialists). Data for health facility review was collected from local primary health and specialist facilities while key policy documents were critically analysed for service provision and stigma alleviation activities. Thematic analysis was used to analyse patterns within the interview data. We found poor awareness and knowledge about mental illnesses, belief in faith and traditional healers, scarcity of resources (medicines, trained professionals and mental health inpatient and outpatient clinics), poor access to appropriate mental health facilities, and high costs for seeking mental health care. There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.
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Affiliation(s)
- Amanpreet Kaur
- Jindal School of Psychology & Counselling, O.P. Jindal Global University, Sonipat, India
- The George Institute for Global Health, Delhi, India
| | | | | | - Syed Shabab Wahid
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC USA
- Department of Global Health, Georgetown University, Washington, DC USA
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC USA
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Pallab K. Maulik
- The George Institute for Global Health, Delhi, India
- University of New South Wales, Sydney, Ausralia Australia
- Prasanna School of Public Health, Manipal University, Manipal, India
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Jain R, Rai RS, Jain S, Ahluwalia R, Gupta J. Real time sentiment analysis of natural language using multimedia input. MULTIMEDIA TOOLS AND APPLICATIONS 2023:1-16. [PMID: 37362666 PMCID: PMC10101822 DOI: 10.1007/s11042-023-15213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/19/2022] [Accepted: 03/30/2023] [Indexed: 06/28/2023]
Abstract
Semantics and Sentiments are parts of our daily speech and expressions that helps to convey the message in the tone intended. The accurate interpretation of emotions and actions is prudent as it expresses the true meaning of the message. This interpretation has been studied extensively in the past two decades, where professionals from various disciplines have pondered this question. Every action and expression-whether it's in a speech, in a video or through some written material-helps the recipient understand the intent behind the message. The primary motive in these studies has been to automate the analysis of these sentiments by teaching the computers to do so, using the audio, video and text-based data that has been collected so far. Machine Learning (ML) and Deep Learning (DL) is the discipline that can help us tackle such a problem which requires analysis and recognition of copious amounts of data. Classification based on these multi-media inputs has seen the application of several common and uncommon ML techniques such as Support Vector Machines (SVMs), Bayesian Networks (BNs), Decision Trees (DTs), Convolutional Neural Networks (CNNs) and K-Means Clustering. These techniques, to a certain level of accuracy, can classify a certain part of a message into a different emotion. Through this research, firstly, a comparison is represented between the previously conducted studies and secondly, a system is developed of our own that enables Real Time Sentiment Analysis and helps a user assess his/her day-to-day attitude and get appropriate recommendations for the same.
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Affiliation(s)
- Rishit Jain
- Department of Electronics and Communication Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, 110063 India
| | - Revant Singh Rai
- Department of Electronics and Communication Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, 110063 India
| | - Sajal Jain
- Department of Electronics and Communication Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, 110063 India
| | - Ruchir Ahluwalia
- Department of Electronics and Communication Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, 110063 India
| | - Jyoti Gupta
- Department of Electronics and Communication Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, 110063 India
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Daniel M, Maulik PK. Incentivizing community health workers for scaling up mental health care in rural communities in India: A critical look at principles that work. FRONTIERS IN HEALTH SERVICES 2023; 3:1119213. [PMID: 36926503 PMCID: PMC10012787 DOI: 10.3389/frhs.2023.1119213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
Given the low availability of trained mental health professionals, there is evidence on task sharing where basic mental healthcare can be provided by trained community health workers (CHWs). A potential way to reduce the mental health care gap in rural and urban areas in India is to utilize the services of community health workers known as Accredited Social Health Activists (ASHAs). There is a paucity of literature that have evaluated incentivizing non-physician health workers (NPHWs) vis-à-vis maintaining a competent and motivated health workforce especially in the Asia and Pacific regions. The principles around what works and does not work in terms of a mix of incentive packages for CHWs, while providing for mental healthcare in rural areas have not been adequately evaluated. Moreover, performance-based incentives which are receiving increasing attention from health systems worldwide, though evidence on the effectiveness of these incentives in Pacific and Asian countries is limited. CHW programs that have shown to be effective rely on an interlinked incentive framework at the individual, community, and health system levels. Drawing learnings from the past eight years in implementing the SMART (systematic medical appraisal, referral and treatment) Mental Health Program in rural India, we critically examine some of the emerging principles in incentivizing ASHAs while scaling up mental healthcare in communities using a systems approach.
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Affiliation(s)
- Mercian Daniel
- Research, The George Institute for Global Health, New Delhi, India
| | - Pallab K Maulik
- Research, The George Institute for Global Health, New Delhi, India
- Faculty of medicine, University of New South Wales, Sydney NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Research, The George Institute for Global Health, London, United Kingdom
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Baek CH, Kim HJ, Park HY, Seo HY, Yoo H, Park JE. Influence of Biogenetic Explanations of Mental Disorders on Stigma and Help-Seeking Behavior: A Systematic Review and Meta-Analysis. J Korean Med Sci 2023; 38:e25. [PMID: 36647220 PMCID: PMC9842491 DOI: 10.3346/jkms.2023.38.e25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Biogenetic causal explanations of mental disorders are commonly used for public education and campaigns. However, the influence of biogenetic explanations on the ideas about and attitudes toward mental illness is unclear. We examined the influence of biogenetic explanations on attitudes toward mental disorders using a meta-analytic method accompanied by subgroup analyses. METHODS The protocol for this meta-analysis was registered in PROSPERO (CRD42020158656) in March 2020. Experimental and correlational studies were analyzed separately. Five outcome measures related to attitudes toward mental disorders were included: 'attitude toward help-seeking,' 'blame,' 'perceived dangerousness,' 'prognostic pessimism,' and 'social distance.' Subgroup analyses were performed for the type of mental disorder, population, and geographic region for which a biogenetic explanation was provided. RESULTS A total of 44 studies were included, of which 24 were experimental and 20 were correlational. A positive attitude toward help-seeking was associated with having a biogenetic concept (d = 0.43; 95% confidence interval [CI], 0.18 to 0.67; P < 0.001) in general population and in Eastern countries in particular. Although a biogenetic explanation was associated with a decreased level of blame (d = -0.20; 95% CI, -0.38 to -0.02; P = 0.029) in the general population, it was also associated with significantly higher levels of perceived dangerousness (d = 0.13; 95% CI, 0.03 to 0.23; P = 0.008). A tendency toward a higher level of prognostic pessimism and social distance was associated with a biogenetic concept of mental disorders although there was no statistical significance. CONCLUSION Having a biogenetic concept of the cause of mental disorders was related with a positive attitude toward help-seeking, particularly in the general population and individuals living in Eastern countries. Providing a biogenetic explanation decreased blame toward individuals with mental illness but was associated with increased perceived dangerousness and prognostic pessimism. Therefore, although a biogenetic explanation promotes public use of mental health services, it should be carefully applied to avoid an increase in negative thoughts, such as that mental illness is biologically irreversible and untreatable.
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Affiliation(s)
- Chang Hyeon Baek
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hee Jung Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hye Yoon Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Hwo Yeon Seo
- Public Health Service, Seoul National University Hospital, Seoul, Korea
| | - Heejeong Yoo
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Eun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
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12
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Perceived Wellbeing, Happiness, and Related Challenges among Indian College Students. PSYCHOLOGICAL STUDIES 2023; 68:70-81. [PMID: 36686373 PMCID: PMC9845819 DOI: 10.1007/s12646-022-00705-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/09/2022] [Indexed: 01/19/2023] Open
Abstract
The present study aimed to examine the conceptualisation and determinants of happiness among Indian college students and identify areas in which they require help. The sample consisted of 362 students in the age group of 18 to 30 years (Mage = 20.9, SDage = 2.25) from two locations in North and South India. Online forms, including the Satisfaction with Life Scale (Diener et al., 1985), Positive and Negative Affect Schedule (Watson et al. in J Pers Soc Psychol 54:1063-1070, 1998) and a qualitative survey, were used to collect the data. Results indicated that participants from institutions that offered mental health initiatives reported higher well-being than those who did not. Findings from the qualitative survey suggest that most participants conceptualised happiness in terms of need for satisfaction and well-being. The responses also indicated that leisure activities and time spent with the family determined the participants' happiness. Concerns related to interpersonal relationships made the participants unhappy, and most of them were willing to seek help in this regard. Factors beyond immediate self and interpersonal networks had a limited role in participants' perceived happiness and unhappiness. Study findings could guide the development of customised mental health and well-being promotion initiatives to meet the needs of Indian college students.
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13
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Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review. Epidemiol Psychiatr Sci 2022; 31:e79. [PMID: 36348492 PMCID: PMC9677443 DOI: 10.1017/s2045796022000622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs). METHODS MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results. RESULTS Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations. CONCLUSIONS ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.
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Mukherjee A, Daniel M, Kaur A, Devarapalli S, Kallakuri S, Essue B, Raman U, Thornicroft G, Saxena S, Peiris D, Maulik PK. Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health. Int J Ment Health Syst 2022; 16:42. [PMID: 35974341 PMCID: PMC9379869 DOI: 10.1186/s13033-022-00549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India. METHODS We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings. RESULTS Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project. CONCLUSION Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
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Affiliation(s)
| | - Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
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15
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Yatirajula SK, Kallakuri S, Paslawar S, Mukherjee A, Bhattacharya A, Chatterjee S, Sagar R, Kumar A, Lempp H, Raman U, Singh R, Essue B, Billot L, Peiris D, Norton R, Thornicroft G, Maulik PK. An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums: protocol for the ARTEMIS project. Trials 2022; 23:612. [PMID: 35906663 PMCID: PMC9336093 DOI: 10.1186/s13063-022-06539-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. METHODS The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived-a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. DISCUSSION The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. TRIAL STATUS Protocol version - V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) TRIAL REGISTRATION: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries ( https://www.who.int/clinical-trials-registry-platform/network/primary-registries ) Reference No. CTRI/2022/02/040307 . Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.
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Affiliation(s)
| | | | | | | | | | | | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar
- Dr.A.V. Baliga Memorial Trust, New Delhi, India
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Usha Raman
- University of Hyderabad, Hyderabad, India
| | | | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laurent Billot
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Robyn Norton
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Imperial College, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- University of New South Wales, Sydney, Australia.
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16
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Merzbach R, Bina R. Intention to seek professional and non-professional emotional help among Jewish young adults in Israel. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1462-1473. [PMID: 34142725 DOI: 10.1111/hsc.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
Young adulthood is a major and significant stage in life encompassing various life transitions which may increase the risk of developing emotional crises. Receiving mental health treatment and turning to nonprofessional resources for support can ease such emotional burdens. However, many of those in need of such help do not turn to professional services and, rather, tend to rely on themselves. The aim of this study was to examine the contribution of attitudes towards seeking professional emotional help, self-stigma, anticipated risk, anticipated utility, and social support to the intention to seek professional and nonprofessional emotional help among Jewish young adults in Israel. Participants included 282 Jewish Israeli young adults aged 18-30, recruited in person or online. They filled out a self-report questionnaire, between March and June 2017, regarding intention to seek professional and non-professional emotional help, attitudes towards seeking professional emotional help, self-stigma towards seeking professional emotional help, anticipated risk and anticipated utility of self-disclosure when seeking professional help, perceived social support and sociodemographic questions. A path analysis model was used to analyse the data. Intention to seek professional help was positively associated with positive attitudes towards seeking professional emotional help and anticipated utility and negatively with self-stigma and social support. Intention to seek nonprofessional help was positively associated with anticipated utility and social support and negatively with anticipated risk. In addition, indirect effects were found between religious affiliation and previous mental health treatment, and intention to seek professional help, through the mediating effects of attitudes and anticipated utility. Interventions for increasing intention to seek professional and nonprofessional support are important and should include reference to attitudes, anticipated utility, anticipated risk and self-stigma, and should promote mutual support and highlight the importance of support from close ones. In addition, a model for predicting intention to seek non-professional help should be developed.
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Affiliation(s)
- Rachel Merzbach
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Rena Bina
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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17
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Oshiro M, Kamizato M, Jahana S. Factors related to help-seeking for cancer medical care among people living in rural areas: a scoping review. BMC Health Serv Res 2022; 22:836. [PMID: 35765056 PMCID: PMC9241203 DOI: 10.1186/s12913-022-08205-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Despite the importance of timely diagnosis and access to treatment, previous studies have not adequately explored help-seeking behavior in cancer treatment among rural and remote residents. The barriers preventing help-seeking behavior also remain unclear. To address this research gap, this study conducted a scoping review to suggest a framework for eliminating barriers and facilitating help-seeking for cancer treatment among rural and remote residents. To conduct the scoping review, three English medical databases (PubMed, MEDLINE, and CINAHL) were examined for the keywords "rural," "remote," "cancer," and "help-seeking." The research objectives and study designs, participants, and excerpts describing help-seeking of the selected papers were recorded in a data charting form. Descriptions of help-seeking behavior were organized and summarized according to their meaning and integrated into factors using thematic analysis. All extracted factors related to help-seeking were sorted into four main themes according to the Ecological Model of Health Behavior, the theoretical lens for this scoping review: (1) Intrapersonal; (2) Interpersonal; (3) Groups, culture, and organizations; and (4) Policy/environment. Factors were categorized as barriers and facilitators of help-seeking. A total of 13 papers were analyzed. Intrapersonal factors such as self-reliance, symptom appraisal, and fatalism, were identified as barriers to help-seeking, whereas presentation of abnormal and serious symptoms facilitated help-seeking. Interpersonal factors such as lack of understanding of family members, influence of surrounding people, role obligations, and lack of trust in experts hindered help-seeking, whereas understanding from surrounding people such as family and friends, promoted help-seeking. Groups, cultural, and organizational factors such as prejudice, social stigma, shame, lack of anonymity, and social norms acted as barriers to help-seeking. Policy-related barriers to help-seeking included lack of medical services and physical distance from medical institutions, leading to a time burden. The study discussed the identified factors from a rural context. Future studies should consider the identified barriers and facilitators according to the four main themes in rural areas when formulating interventions to promote help-seeking. Our findings can offer a theoretical foundation to develop actionable policies, preventive strategies, and relevant interventional tools that may facilitate oncological service utilization in rural areas.
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Affiliation(s)
- Mariko Oshiro
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan.
| | - Midori Kamizato
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan
| | - Sayuri Jahana
- Department of Nursing, Okinawa Prefectural College of Nursing, Yogi 1-24-1, Naha City, Okinawa, 902-8513, Japan
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18
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Mukherjee A, Daniel M, Kallakuri S, Kaur A, Devarapalli S, Raman U, Thornicroft G, Essue BM, Praveen D, Sagar R, Kant S, Saxena S, Patel A, Peiris D, Maulik PK. Protocol for process evaluation of SMART Mental Health cluster randomised control trial: an intervention for management of common mental disorders in India. BMJ Open 2022; 12:e058669. [PMID: 35715180 PMCID: PMC9207925 DOI: 10.1136/bmjopen-2021-058669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In India about 95% of individuals who need treatment for common mental disorders like depression, stress and anxiety and substance use are unable to access care. Stigma associated with help seeking and lack of trained mental health professionals are important barriers in accessing mental healthcare. Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health integrates a community-level stigma reduction campaign and task sharing with the help of a mobile-enabled electronic decision support system (EDSS)-to reduce psychiatric morbidity due to stress, depression and self-harm in high-risk individuals. This paper presents and discusses the protocol for process evaluation of SMART Mental Health. METHODS AND ANALYSIS The process evaluation will use mixed quantitative and qualitative methods to evaluate implementation fidelity and identify facilitators of and barriers to implementation of the intervention. Case studies of six intervention and two control clusters will be used. Quantitative data sources will include usage analytics extracted from the mHealth platform for the trial. Qualitative data sources will include focus group discussions and interviews with recruited participants, primary health centre doctors, community health workers (Accredited Social Health Activits) who participated in the project and local community leaders. The design and analysis will be guided by Medical Research Council framework for process evaluations, the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, and the normalisation process theory. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the George Institute for Global Health, India and the Institutional Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Findings of the study will be disseminated through peer-reviewed publications, stakeholder meetings, digital and social media platforms. TRIAL REGISTRATION NUMBER CTRI/2018/08/015355.
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Affiliation(s)
| | - Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | | | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Graham Thornicroft
- Centre for Global Mental Health Centre for Implementation Science, Health Service and Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - D Praveen
- The George Institute for Global Health, Hyderabad, India
- University of New South Wales, Sydney, New South Wales, Australia
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, SydneyAustralia
| | - David Peiris
- The George Institute for Global Health, UNSW Sydney, SydneyAustralia
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, New South Wales, Australia
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19
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Ferrari M, Fazeli S, Mitchell C, Shah J, Iyer SN. Exploring Empathy and Compassion Using Digital Narratives (the Learning to Care Project): Protocol for a Multiphase Mixed Methods Study. JMIR Res Protoc 2022; 11:e33525. [PMID: 35023844 PMCID: PMC8796048 DOI: 10.2196/33525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital stories-first-person, self-made, 2- to 3-minute videos-generate awareness, impart knowledge, and promote understanding on topics such as mental illness. Digital stories are a narrative-based art form often created by individuals without formal training in filmmaking to relate personal experiences. Somewhat like digital narratives, video testimonies created within the social marketing or fundraising campaigns of government agencies and private or public corporations aim to reduce the stigma of mental illness while supporting research and services. In video testimonies, personal stories are captured on camera by professional filmmakers. Sharing critical life events greatly benefits tellers and listeners alike, supporting catharsis, healing, connectiveness, and citizenship. OBJECTIVE This study explores digital stories and video testimonies featuring mental illness and recovery in their ability to elicit empathy and compassion while reducing stigma among viewers. METHODS Using mixed methods, phase 1 will involve a search of Canadian social marketing activities and fundraising campaigns concerning mental illness and recovery. Phase 2 will involve the organization of digital storytelling workshops in which participants will create digital stories about their own experiences of mental illness and recovery. In phase 3, a pilot randomized controlled trial will be undertaken to compare marketing and fundraising campaigns with digital stories for their impact on viewers, whereas phase 4 will focus on knowledge dissemination. RESULTS Ethics approval for this study was received in March 2021. Data on the feasibility of the study design and the results of the controlled trial will be generated. This study will produce new knowledge on effective ways of promoting mental health awareness and decreasing stigma, with practical importance for future social marketing and fundraising campaigns. The anticipated time for completion within the 2-year study period includes 9 months for phase 1 (knowledge synthesis activities identifying social marketing and fundraising campaigns) and phase 2 (storytelling workshops), 11 months for phase 3 (feasibility assessment and data collection: randomized controlled trial), and 2 months for phase 4 (knowledge dissemination). CONCLUSIONS The knowledge generated will have practical implications for the public and for future social marketing and fundraising campaigns promoted by government agencies as well as nonprofit and for-profit organizations by enhancing our understanding of how individuals and societies respond to stories of mental distress and what prompts citizens to help others. TRIAL REGISTRATION ClinicalTrials.gov NCT04881084; https://clinicaltrials.gov/ct2/show/NCT04881084. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/33525.
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Affiliation(s)
- Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sahar Fazeli
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Claudia Mitchell
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Srividya N Iyer
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
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20
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He C, Wu C, Yang T, He Y, Yan J, Lin Y, Du Y, He S, Wu S, Cao B. Trajectories and predictors of social avoidance in female patients with breast cancer. Front Psychiatry 2022; 13:1051737. [PMID: 36506424 PMCID: PMC9732026 DOI: 10.3389/fpsyt.2022.1051737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Social avoidance plays an important role in influencing quality of life among patients with breast cancer. Social avoidance behaviors change with treatment periods. However, the trajectory patterns and the predictive factors have not been fully studied. OBJECTIVE This study examined the growth trajectory of social avoidance and its predictors in patients with breast cancer. MATERIALS AND METHODS A total of 176 patients with breast cancer in a university hospital in Shaanxi Province, China, were followed up four times over 6 months following surgery, and data from the final 144 patients were analyzed. The growth mixed model (GMM) was used to identify the trajectory categories, and the predictive factors of the trajectory types were analyzed by logistic regression. RESULTS The best-fit growth mixture modeling revealed three class models: persistent high social avoidance group (Class 1), social avoidance increased first and then decreased group (Class 2), and no social avoidance group (Class 3), accounting for 13.89, 31.94, and 54.17% of patients, respectively. Single-factor analysis showed that family income per capita, residence, and temperament type were related to the social avoidance trajectory. Logistic regression analysis showed that only temperament type was an independent predictor of the social avoidance trajectory, and patients with melancholia were more likely to have persistent high social avoidance. CONCLUSION Our study proved the heterogeneity of social avoidance behaviors and the influencing effect of temperament type on the development of social avoidance behaviors in Chinese patients with breast cancer. Health professionals should pay more attention to patients who are at higher risk of developing a persistent social avoidance pattern and provide target interventions.
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Affiliation(s)
- Chunyan He
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tianqi Yang
- Department of Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang He
- Department of Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jiaran Yan
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yawei Lin
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanling Du
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shizhe He
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shengjun Wu
- Department of Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Baohua Cao
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
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Naslund JA, Deng D. Addressing Mental Health Stigma in Low-Income and Middle-Income Countries: A New Frontier for Digital Mental Health. ETHICS, MEDICINE, AND PUBLIC HEALTH 2021; 19:100719. [PMID: 35083375 PMCID: PMC8786211 DOI: 10.1016/j.jemep.2021.100719] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Mental health stigma is a major barrier to seeking help, and leads to poor quality of life and social withdrawal for individuals living with mental illness. These concerns are especially severe in low-income and middle-income countries (LMICs) that face a disproportionate share of the global burden of mental illnesses. With growing access to digital technologies in LMICs, there may be new opportunities to address mental health stigma. This review considers the potential for emerging digital technologies to advance efforts to challenge mental health stigma in LMICs. METHODS Promising digital strategies to reduce mental health stigma were identified through searching the peer-reviewed literature. Drawing from the Mental Illness Stigma Framework, these studies of digital strategies were grouped into three categories: 1) protest; 2) education, and 3) contact. RESULTS These three categories align with established stigma reduction programs. Digital strategies could expand the reach of or complement existing efforts. There are challenges with digital stigma reduction strategies, including the need for cultural adaptation of these programs to diverse contexts and settings, consideration of reliable measurement of mental health related stigma, and risks that digital media could perpetuate the spread of misinformation and exacerbate concerns pertaining to mental health stigma. CONCLUSION This review highlights the promise of technology for addressing mental health stigma in LMICs. This is imperative in the face of growing demand for mental health services owing to the economic and social impacts of the COVID-19 pandemic, and the increasing reliance on digital platforms among individuals in most countries.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Davy Deng
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Directly engaging with People with lived experiences of mental illness from the communities in India. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ferris-Day P, Hoare K, Wilson RL, Minton C, Donaldson A. An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting. Int J Ment Health Nurs 2021; 30:1525-1538. [PMID: 34482621 DOI: 10.1111/inm.12929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
The review investigated the barriers and facilitators associated with assessing and engaging with mental health in a rural setting. The aim is to describe and synthesize the literature that examines the experiences of adults who access or attempt to access mental health services in rural settings. A systematic search from 2010 to 2020 was conducted using CINAHL, PsycINFO, Web of Science Core Collection, PubMed, Psychology and Behavioural Sciences Collection, Google Scholar, and Scopus. PRISMA protocols located 32 relevant papers from the overall 573 first selected. Braun and Clarke (Qualitative Research in Psychology, 3:77-101, 2006) thematic analysis methodology was applied to the data resulting in two themes: first theme identified help-seeking with subthemes of stigma and locality of health services. The second theme was connectedness, inclusive of subthemes of support systems and personal identity. The review identified gender-related perspectives concerning accessing mental health support, exposing the need for more research to examine the diverse social connections and support networks in rural communities. The findings suggest the need to further explore the impediments that reduce the likelihood of accessing mental health services in rural communities.
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Affiliation(s)
| | - Karen Hoare
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Rhonda L Wilson
- School of Nursing, Massey University, Palmerston North, New Zealand.,School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Andrea Donaldson
- School of Nursing, Massey University, Palmerston North, New Zealand
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Bansal S, Srinivasan K, Ekstrand M. Perceptions of ASHA workers in the HOPE collaborative care mental health intervention in rural South India: a qualitative analysis. BMJ Open 2021; 11:e047365. [PMID: 34740927 PMCID: PMC8573636 DOI: 10.1136/bmjopen-2020-047365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The main objective of this exploratory study was to investigate the overlooked perspectives and beliefs of Accredited Social Health Activists (ASHA workers) regarding a collaborative care mental health intervention (HOPE: Healthier Options through Empowerment), mental illness and the health of their rural communities. DESIGN Semi-structured, one-on-one, qualitative interviews. SETTING Seven primary health centres (PHCs) in rural Karnataka, India. All PHCs had previously completed the HOPE study. PARTICIPANTS 15 ASHA workers, selected via purposive sampling. ASHAs are high school-educated village women trained as community health workers. ASHAs were included if they had previously participated in the HOPE intervention, a collaborative-care randomised controlled trial that aimed to integrate mental healthcare into existing primary care systems in rural Karnataka. INTERVENTIONS No interventions were introduced. RESULTS ASHA workers mostly had positive interactions with patients, including encouraging them to attend sessions, helping to explain the topics and techniques, and checking on the patients frequently. ASHA workers were able to identify key barriers to treatment and facilitators to treatment. ASHAs claimed that their knowledge about mental illness improved because of the HOPE study, though gaps remained in their understanding of aetiology and treatment. Several expressed interest in receiving additional mental health training. Overall, ASHAs viewed the HOPE study as a necessary and effective intervention, and requested that it expand. CONCLUSIONS This paper discusses the perspectives of ASHAs who participated in a novel effort to extend the collaborative care model to their own communities. ASHA workers help maintain relationships with patients that encourage participation, and the efforts of ASHAs often aid in mitigating common barriers to treatment. ASHA workers' beliefs and knowledge regarding mental illness can be changed, and ASHAs can become effective advocates for patients. Future collaborative care interventions would likely benefit from involving ASHA workers in community outreach efforts.
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Affiliation(s)
- Stuti Bansal
- Department of Molecular and Cellular Biology, University of California Berkeley, Berkeley, California, USA
| | - Krishnamachari Srinivasan
- Division of Mental Health & Neurosciences, St John's Research Institute, Bangalore, Karnataka, India
| | - Maria Ekstrand
- Division of Mental Health & Neurosciences, St John's Research Institute, Bangalore, Karnataka, India
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
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Kallakuri S, Kaur A, Hackett ML, Maulik PK. Operational challenges in the implementation of an anti-stigma campaign in rural Andhra Pradesh, India. J Public Health (Oxf) 2021; 43:ii26-ii34. [PMID: 34622292 DOI: 10.1093/pubmed/fdab314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite of literature available on mental health-related stigma interventions, little is reported about the operational challenges faced during the planning, implementation and evaluation phases. METHODS The Systematic Medical Appraisal, Referral and Treatment Mental Health Project was implemented in 42 villages of the West Godavari district in India. Andersen's Behavioural Model for Health Services Use was adopted to understand the factors influencing anti-stigma campaign delivery and the strategies identified to overcome these challenges. RESULTS The challenges faced during the planning and implementation phase included distance and time taken for travel by the field staff, inadequate mental health services and infrastructure within communities, engagement of community with the field staff and community's poor mental health literacy and knowledge. Strategies used to overcome these challenges were regular engagement with community stakeholders, understanding mental health literacy levels and seeking inputs from the community regarding campaign design, organizing live drama shows at community's preferred time and place and screening of recorded drama video clips where lives shows were difficult. The evaluation phase posed challenges such as non-availability of key stakeholders and inadequate time and funding to evaluate the entire study population. CONCLUSION The reported findings can help in planning and scaling up of the anti-stigma campaign in large trials in similar settings.
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Affiliation(s)
- Sudha Kallakuri
- The George Institute for Global Health, Research and Development, Hyderabad-500082, India
| | - Amanpreet Kaur
- The George Institute for Global Health, Research and Development, Hyderabad-500082, India
| | - Maree L Hackett
- Department of Medicine, The George Institute for Global health, University of New South Wales, Sydney, New South Wales 2050, Australia
- The University of Central Lancashire, United Kingdom
| | - Pallab K Maulik
- The George Institute for Global Health, Research and Development, Hyderabad-500082, India
- Department of Medicine, The George Institute for Global health, University of New South Wales, Sydney, New South Wales 2050, Australia
- Prasanna School of Public Health, Manipal academy of higher education, Karnataka, India
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Pilot Community Mental Health Awareness Campaign Improves Service Coverage in India. Community Ment Health J 2021; 57:814-827. [PMID: 33052548 DOI: 10.1007/s10597-020-00714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low community awareness of mental health problems negatively impacts treatment-seeking for such problems. Despite a shortage of mental health providers, there is scope to improve coverage of mental health services in India. In this study, we examined the impact of a multi-state community-based awareness campaign on knowledge, attitude, treatment-seeking behavior and acceptability. METHODS Campaign activities included educational materials, public meetings, musical announcements, quizzes, and street plays, followed by a mental health screening camp. A rapid, real-world evaluation was conducted using post-intervention surveys (n = 693), field notes and telephonic interviews in five states. RESULTS The campaign, implemented as a public-private partnership between government service providers and community-based organizations, reached ~ 3000 people in 20 new locations across five states. As a result of the campaign, 1,176 persons sought treatment services for mental disorders and 66% received a preliminary diagnosis. Collectively, campaign activities were the first time that ~ 75% of participants reported learning about mental health problems. Participants expressed knowledge that mental disorders are treatable, listed common symptoms and location of available mental health services and attitudes supporting people with mental health problems. CONCLUSION The campaign enabled improved coverage for mental health services, potentially by enhancing knowledge, attitude and treatment-seeking behavior. Future research may develop a quasi-experimental evaluation of the current campaign methodology.
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Sanghvi PB, Mehrotra S. Help-seeking for mental health concerns: review of Indian research and emergent insights. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-02-2020-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this review was to examine Indian research on help-seeking for mental health problems in adults.
Design/methodology/approach
Original Indian research studies on help-seeking for mental health, published from the year 2001−2019 were searched on PubMed, EBSCO, ProQuest and OVID using a set of relevant keywords. After applying exclusion criteria, 52 relevant research studies were identified.
Findings
The reviewed studies spanned a variety of themes such as barriers and facilitators to help-seeking, sources of help-seeking, causal attributions as well as other correlates of help-seeking, process of help-seeking and interventions to increase help-seeking. The majority of these studies were carried out in general community samples or treatment-seeking samples. Very few studies incorporated non-treatment seeking distressed samples. There is a severe dearth of studies on interventions to improve help-seeking. Studies indicate multiple barriers to seeking professional help and highlight that mere knowledge about illness and availability of professional services may be insufficient to minimize delays in professional help-seeking.
Originality/value
Help-seeking in the Indian context is often a family-based decision-making process. Multi-pronged help-seeking interventions that include components aimed at reducing barriers experienced by non-treatment seeking distressed persons and empowering informal support providers with knowledge and skills for encouraging professional help-seeking in their significant others may be useful.
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Daniel M, Maulik PK, Kallakuri S, Kaur A, Devarapalli S, Mukherjee A, Bhattacharya A, Billot L, Thornicroft G, Praveen D, Raman U, Sagar R, Kant S, Essue B, Chatterjee S, Saxena S, Patel A, Peiris D. An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme. Trials 2021; 22:179. [PMID: 33653406 PMCID: PMC7923507 DOI: 10.1186/s13063-021-05136-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. METHODS We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived-a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation. EXPECTED OUTCOMES The primary study outcome is the difference in mean behaviour scores at 12 months in the combined 'high-risk' and 'non-high-risk' cohort and the mean difference in PHQ-9 scores at 12 months in the 'high-risk' cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations. SIGNIFICANCE The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings. TRIAL REGISTRATION Clinical Trial Registry India CTRI/2018/08/015355 . Registered on 16 August 2018.
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Affiliation(s)
- Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- University of New South Wales, Sydney, Australia.
- Prasanna School of Public Health, Manipal, India.
- The George Institute for Global Health, Oxford, UK.
| | | | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | | | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Devarsetty Praveen
- University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal, India
- The George Institute for Global Health, Hyderabad, India
| | - Usha Raman
- University of Hyderabad, Hyderabad, India
| | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- All India Institute of Medical Sciences, New Delhi, India
| | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Susmita Chatterjee
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal, India
| | | | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Tewari A, Kallakuri S, Devarapalli S, Peiris D, Patel A, Maulik PK. SMART Mental Health Project: process evaluation to understand the barriers and facilitators for implementation of multifaceted intervention in rural India. Int J Ment Health Syst 2021; 15:15. [PMID: 33557902 PMCID: PMC7871593 DOI: 10.1186/s13033-021-00438-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Globally, mental health problems are a growing public health concern. Resources and services for mental disorders are disproportionately low compared to disease burden. In order to bridge treatment gaps, The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project was implemented across 12 villages in West Godavari district of the southern Indian state of Andhra Pradesh. This paper reports findings from a process evaluation of feasibility and acceptability of the intervention that focused on a mental health services delivery model to screen, diagnose and manage common mental disorders (CMDs). METHODS A mixed methods evaluation was undertaken using quantitative service usage analytics, and qualitative data from in-depth interviews and focus group discussions were conducted with stakeholders including primary care physicians, community health workers, field staff and community members. Barriers to and facilitators of intervention implementation were identified. Andersen's Behavioral Model for Health Services Use was the conceptual framework used to guide the process evaluation and interpretation of data. RESULTS In all, 41 Accredited Social Health Activists (ASHAs) and 6 primary health centre (PHC) doctors were trained in mental health symptoms and its management. ASHAs followed up 98.7% of screen positive cases, and 81.2% of these were clinically diagnosed and treated by the PHC doctors. The key facilitators of implementation were adequate training and supervision of field staff, ASHAs and doctors, use of electronic decision support, incorporation of a door-to-door campaign and use of culturally tailored dramas/videos to raise awareness about CMDs, and organising health camps at the village level facilitating delivery of intervention activities. Barriers to implementation included travel distance to receive care, limited knowledge about mental health, high level of stigma related to mental health issues, and poor mobile network signals and connectivity in the villages. Lack of familiarity with and access to mobile phones, especially among women, to accessing health related messages as part of the intervention. CONCLUSIONS The evaluation not only provides a context to the interventions delivered, but also allowed an understanding of possible factors that need to be addressed to make the programme scalable and of benefit to policy makers.
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Affiliation(s)
- Abha Tewari
- George Institute for Global Health, New Delhi, India
| | | | | | - David Peiris
- George Institute for Global Health, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Anushka Patel
- George Institute for Global Health, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India. .,University of New South Wales, Sydney, Australia.
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Naslund JA, Tugnawat D, Anand A, Cooper Z, Dimidjian S, Fairburn CG, Hollon SD, Joshi U, Khan A, Lu C, Mitchell LM, Muke S, Nadkarni A, Ramaswamy R, Restivo JL, Shrivastava R, Singh A, Singla DR, Spiegelman D, Bhan A, Patel V. Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in India: Protocol for a three-arm randomized controlled trial. Contemp Clin Trials 2021; 102:106267. [PMID: 33421650 DOI: 10.1016/j.cct.2021.106267] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Training non-specialist health workers (NSHWs) at scale is a major barrier to increasing the coverage of depression care in India. This trial will test the effectiveness of two forms of digital training compared to conventional face-to-face training in changing the competence of NSHWs to deliver a brief evidence-based psychological treatment for depression. METHODS This protocol is for a three-arm, parallel group randomized controlled trial comparing three ways of training NSHWs to deliver the Healthy Activity Program (HAP), a brief manualized psychotherapy for depression, in primary care. The arms are: digital training (DGT); digital training combined with individualized coaching support (DGT+); and conventional face-to-face training (F2F). The target sample comprises N = 336 government contracted NSHWs in Madhya Pradesh, India. The primary outcome is change of competence to deliver HAP; secondary outcomes include cost-effectiveness of the training programs, change in participants' mental health knowledge, attitudes and behavior, and satisfaction with the training. Assessors blind to participant allocation status will collect outcomes pre- (baseline) and post- (endpoint) training to ascertain differences in outcomes between arms. Training program costs will be collected to calculate incremental costs of achieving one additional unit on the competency measure in the digital compared to face-to-face training programs. Health worker motivation, job satisfaction, and burnout will be collected as exploratory outcome variables. DISCUSSION This trial will determine whether digital training is an effective, cost-effective, and scalable approach for building workforce capacity to deliver a brief evidence-based psychological treatment for depression in primary care in a low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04157816.
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Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | | | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Azaz Khan
- Sangath, Bhopal, Madhya Pradesh, India
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Abhijit Nadkarni
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Sangath, Alto Porvorim, Goa, India
| | - Rohit Ramaswamy
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juliana L Restivo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Daisy R Singla
- Department of Psychiatry, University of Toronto and Sinai Health System, Toronto, Canada
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Kaur A, Kallakuri S, Kohrt BA, Heim E, Gronholm PC, Thornicroft G, Maulik PK. Systematic review of interventions to reduce mental health stigma in India. Asian J Psychiatr 2021; 55:102466. [PMID: 33249319 PMCID: PMC7116814 DOI: 10.1016/j.ajp.2020.102466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stigma is a barrier for help-seeking, mental health service access, and contributes to the mental health treatment gap. Because the mental health treatment gap is greatest in low- and middle-income countries, it is vital to identify effective strategies to reduce stigma in these settings. To date, there has been a lack of synthesis of findings from interventions to reduce stigma related to mental disorders within India. METHOD A systematic review was conducted to provide an overview of the characteristics and effectiveness of stigma reduction interventions studies in India. PubMed, Embase and PsycINFO databases were searched for literature published up to 30th June 2020. RESULTS From a total of 1,984 articles identified, only 9 were eligible for final inclusion, published between 1990-2020. No study was found from North, North-East, Central or East India. Most stigma-reduction interventions were multi-level, that is, using a combination of intra-personal, inter-personal and community level strategies to target changes in outcomes of individuals, environments and community groups. Three studies focused on health and stigma-related changes at the organisational/institutional level. No interventions focused on the governmental/structural level. There were only two randomised controlled trials, and two studies focused on all three stigma components of knowledge, attitudes and behaviour. Most interventions were delivered to community members. None focused on mental health professionals as intervention delivery target. CONCLUSION There is a need for the development of comprehensive, culturally acceptable evidence-based interventions that act at multiple levels, and involve a mixture of various stigma reducing strategies with multiple target groups.
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Affiliation(s)
| | | | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA.
| | - Eva Heim
- Department of Psychology, University of Zurich, Zurich, Switzerland.
| | - Petra C Gronholm
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Graham Thornicroft
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Pallab K Maulik
- George Institute for Global Health, India; University of New South Wales, Sydney; Prasanna School of Public Health, Manipal University.
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32
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Gaiha SM, Taylor Salisbury T, Koschorke M, Raman U, Petticrew M. Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations. BMC Psychiatry 2020; 20:538. [PMID: 33198678 PMCID: PMC7667785 DOI: 10.1186/s12888-020-02937-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, 20% of young people experience mental disorders. In India, only 7.3% of its 365 million youth report such problems. Although public stigma associated with mental health problems particularly affects help-seeking among young people, the extent of stigma among young people in India is unknown. Describing and characterizing public stigma among young people will inform targeted interventions to address such stigma in India, and globally. Thus, we examined the magnitude and manifestations of public stigma, and synthesised evidence of recommendations to reduce mental-health-related stigma among young people in India. METHOD A systematic review and meta-analysis of observational studies was conducted. Nine electronic databases were searched and 30 studies (n = 6767) met inclusion criteria. RESULTS Most studies (66%) focused on youth training to become health professionals. One-third of young people display poor knowledge of mental health problems and negative attitudes towards people with mental health problems and one in five had actual/intended stigmatizing behavior (I2>=95%). Young people are unable to recognize causes and symptoms of mental health problems and believe that recovery is unlikely. People with mental health problems are perceived as dangerous and irresponsible, likely due to misinformation and misunderstanding of mental health problems as being solely comprised of severe mental disorders (e.g. schizophrenia). However, psychiatric labels are not commonly used/understood. CONCLUSION Public education may use symptomatic vignettes (through relatable language and visuals) instead of psychiatric labels to improve young people's understanding of the range of mental health problems. Recommended strategies to reduce public stigma include awareness campaigns integrated with educational institutions and content relevant to culture and age-appropriate social roles.
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Affiliation(s)
- Shivani Mathur Gaiha
- Indian Institute of Public Health- Hyderabad, Public Health Foundation of India, Hyderabad, India.
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Mirja Koschorke
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Usha Raman
- Department of Communication, Sarojini Naidu School of Arts & Communication, University of Hyderabad, Hyderabad, India
| | - Mark Petticrew
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Jeong JS, Kim SY, Kim JN. Ashamed Caregivers: Self-Stigma, Information, and Coping among Dementia Patient Families. JOURNAL OF HEALTH COMMUNICATION 2020; 25:870-878. [PMID: 33238810 DOI: 10.1080/10810730.2020.1846641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The number of people living with dementia increases almost every year, and the majority of the care system for these individuals is often made up of close family members. This study investigates the relationship between family caregivers' cross-checking of information with healthcare providers and patient health outcomes. Specifically, we examined whether this relationship was mediated by caregivers' enhanced coping efficacy. We also tested the moderation effect of family caregivers' affiliate stigma on information cross-checking, coping efficacy, and coping outcomes. Using a survey of 226 family caregivers of dementia patients in South Korea, this study tested the moderated mediation model with the PROCESS macro. Results indicate that low affiliate stigma moderates coping efficacy on the relationship between information cross-checking and dementia patients' health outcomes. Further implications for family caregiving and general dementia care are discussed.
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Affiliation(s)
- Jae-Seon Jeong
- Debiasing and Lay Informatics (Dali) Lab, Center for Applied Social Research, University of Oklahoma, Norman, OK, USA
| | - Soo Yun Kim
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeong-Nam Kim
- Gaylord Family Endowed Chair for Strategic Communication, Professor, Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK, USA
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Core components of mental health stigma reduction interventions in low- and middle-income countries: a systematic review. Epidemiol Psychiatr Sci 2020; 29:e164. [PMID: 32883399 PMCID: PMC7503169 DOI: 10.1017/s2045796020000797] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics. METHODS Seven databases were searched with a strategy including four categories of terms ('stigma', 'mental health', 'intervention' and 'low- and middle-income countries'). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A 'best fit' framework synthesis was used to organise data, followed by a narrative synthesis. RESULTS Fifty-six studies were included in this review, of which four were ineffective and analysed separately. A framework was developed which presents a new categorisation of stigma intervention components based on the included studies. Most interventions utilised multiple methods and of the 52 effective studies educational methods were used most frequently (n = 83), and both social contact (n = 8) and therapeutic methods (n = 3) were used infrequently. Most interventions (n = 42) based their intervention on medical knowledge, but a variety of other themes were addressed. All regions with LMICs were represented, but every region was dominated by studies from one country. Components varied between regions for most categories indicating variation between cultures, but only a minority of studies were developed in the local setting or culturally adapted. CONCLUSIONS Our study suggests effective mental health stigma reduction interventions in LMICs have increased in quantity and quality over the past five years, and a wide variety of components have been utilised successfully - from creative methods to emphasis on recovery and strength of people with mental illness. Yet there is minimal mention of social contact, despite existing strong evidence for it. There is also a lack of robust research designs, a high number of short-term interventions and follow-up, nominal use of local expertise and the research is limited to a small number of LMICs. More research is needed to address these issues. Some congruity exists in components between cultures, but generally they vary widely. The review gives an in-depth overview of mental health stigma reduction core components, providing researchers in varied resource-poor settings additional knowledge to help with planning mental health stigma reduction interventions.
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Chen S, Lu Q, Bai J, Deng C, Wang Y, Zhao Y. Global publications on stigma between 1998-2018: A bibliometric analysis. J Affect Disord 2020; 274:363-371. [PMID: 32469828 DOI: 10.1016/j.jad.2020.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the development process and structural relationships of scientific achievements on stigma over the past two decades and to provide insights for researchers and policy makers to drive policy decisions and identify future research needs. METHODS Quantitative analysis of publications was directly interpreted and graphed through Web of Science and ORIGIN 2017. The co-occurrence and collaboration analysis between authors, countries and keywords were conducted through VOSviewer. Keyword burst was detected through CiteSpace. RESULTS The retrieved 2,799 publications showed a trend of increasing annual publications between 1998 and 2018. The United States made the greatest contribution to global publications regarding stigma. Four keyword clusters indicating research hotspot were identified through the default clustering method in VOSviewer. Meta-analysis and internalized stigma were detected as keyword bursts in recent years. CONCLUSIONS The growth trend of publications indicated increased research interest in stigma, especially common stigma types, including HIV stigma and obesity stigma. Future research should focus on other types of stigma and should include more elaborate intervention programs, mechanism exploration, and research on internalized stigma. Scientific research on stigma requires an extensive collaborative endeavor, both domestically and internationally, among diverse researchers, institutions, and countries.
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Affiliation(s)
- Shixiang Chen
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China.
| | - Qi Lu
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China.
| | - Jinbing Bai
- NHW School of Nursing, EMORY UNIVERSITY, 1520 Clifton Road, Atlanta, USA.
| | - Cuiyu Deng
- Oncology Department, The Second Hospital of Tianjin Medical University, Tianjin, China.
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China.
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Abstract
Adolescents living in low-resource settings lack access to adequate psychological care. The barriers to mental health care in low- and middle-income countries (LMIC) include high disease burden, low allocation of resources, lack of national mental health policy and child and adolescent mental health (CAMH) professionals and services, poverty, illiteracy and poor availability of adolescent friendly health services. WHO has recommended a stepped task shifting approach to mental health care in LMIC. Training of non-mental health specialists like peers, teachers, community health workers, paediatricians and primary care physicians by CAMH and framing country-specific evidence-based national mental health policies are vital in overcoming barriers to psychological care in LMIC. Digital technology and telemedicine can be used in providing economical and accessible mental health care services to adolescents.
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Affiliation(s)
| | - Merrian J Brooks
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
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Stigma Resistance and Its Associated Factors among Patients with Mood Disorder at St. Paul's Hospital and Millennium Medical College, Addis Ababa, Ethiopia, 2019. PSYCHIATRY JOURNAL 2020; 2020:7429567. [PMID: 32566638 PMCID: PMC7301189 DOI: 10.1155/2020/7429567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
Background Stigma resistance is described as the capacity to counteract or remain unaffected by the stigma of mental illness. Patients who have high stigma resistance have shown good treatment outcome, so working on this issue is crucial since little is known about the stigma resistance level among patients with mood disorders. Objectives To determine the magnitude and determinant factors of stigma resistance among patients with mood disorder attending at St. Paul's Hospital. Methods A cross-sectional study design was conducted on 238 study samples, and systematic random sampling was used to get the study participants. Internalized Stigma of Mental Illness Scale was used to measure stigma resistance. Data was entered using EpiData 3.1 and exported to the Statistical Package for Social Science 22.0 for analysis. Linear regression analysis (P < 0.05) was used to identify a significant association between the outcome and predictor variable. Results Out of 238 study samples, 235 patients took part with a 99% response rate. The overall percentage of stigma resistance was 49.5%. Low educational status (B = −1.465, 95% CI (-2.796, -0.134), P ≤ 0.031), disability (B = −0.064, 95% CI (-0.102, -0.026), P ≤ 0.001), nonadherence due to stigma (B = −1.365, 95% CI (-2.151, -0.580), P ≤ 0.001), duration of treatment (B = 0.091, 95% CI (0.042, 0.141), P ≤ 0.001), internalized stigma (B = −2.948, 95% CI (-3.642, -2.254), P ≤ 0.001), and self-esteem (B = 1.859, 95% CI (0.812, 2.906), P ≤ 0.001) were significantly associated with stigma resistance. Conclusion This study found that only half of the patients had stigma resistance. Low educational status, high self-stigma, low self-esteem, disability, and short duration of treatment were negatively associated with stigma resistance, so working on those modifiable identified factors with focal stakeholders will be crucial to promote the stigma resistance level of patients with mood disorder.
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De Sousa A, Mohandas E, Javed A. Psychological interventions during COVID-19: Challenges for low and middle income countries. Asian J Psychiatr 2020; 51:102128. [PMID: 32380441 PMCID: PMC7195042 DOI: 10.1016/j.ajp.2020.102128] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/25/2022]
Abstract
At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from China has spread to the world. There have been increasing numbers of confirmed cases and deaths around the globe. The COVID-19 pandemic has paved the way for considerable psychological and psychosocial morbidity among the general public and health care providers. An array of guidelines has been put forward by multiple agencies for combating mental health challenges. This paper addresses some of the mental health challenges faced by low and middle income countries (LMIC). It is worthwhile to note that these are challenges at the current stage of the pandemic and may change with the course of the pandemic itself.
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Affiliation(s)
- Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India.
| | - E Mohandas
- Sun Medical and Research Centre, Trichur, Kerala, India
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
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Johnson JA, Devdutt J, Mehrotra S, Bhola P, Sudhir P, Sharma A. Barriers to Professional Help-seeking for Distress and Potential Utility of a Mental Health App Components: Stakeholder Perspectives. Cureus 2020; 12:e7128. [PMID: 32257673 PMCID: PMC7105026 DOI: 10.7759/cureus.7128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction A high prevalence of common mental disorders and the associated treatment gap, particularly in low and middle-income countries such as India, calls for novel mental health approaches with widespread reach. There is a need to enhance our understanding of the barriers experienced by distressed persons as well as to utilize these insights for breaking such barriers. Despite the rise in the use of technology-based solutions in the field of mental health, there is a dearth of app-based interventions that help in breaking barriers to seeking professional help for mental health concerns in distressed persons. The present study aimed at exploring the perspectives of distressed persons concerning barriers to seeking professional help for mental health concerns. It also sought to understand their perspectives on the perceived utility of proposed app components for breaking these barriers. Methods The study utilized a cross-sectional exploratory design. The sample included two groups of distressed participants who could be considered potential users (and thereby the stakeholders) of a mental health app under development for common mental health concerns: distressed treatment seekers (D-TS) and distressed non-treatment seekers (D-NTS). The D-TS group included 10 individuals (average age: 33 years; six men) with self-reported or clinician-reported depressive and anxiety symptoms at intake who were seeking help from mental health professionals. The D-NTS group included 10 distressed individuals (average age: 23 years; five men) who were recruited from the local community through an announcement. The announcement called for participants who were experiencing anxiety and low mood but had not yet sought help for their distress. A semistructured interview schedule was used to explore the nature of barriers encountered and the perceived utility of the content of the proposed app. The questions that aimed at understanding the perceived barriers were open-ended. The perceived utility of various components of the proposed app was explored via 11 items, with a 5-point Likert scale. Results Personal barriers frequently reported by both groups were doubts about treatment and fear of social consequences. The role of inadequate self-awareness about one’s mental health concerns as a barrier to reaching out for professional help was articulated more frequently by the D-TS group than the D-NTS group. Proposed app components such as self-assessment with individualized feedback, informative videos by mental health professionals, testimonials from mental health service users, and a platform for an online connection with a professional were rated as potentially useful in reducing barriers to professional help-seeking. Insights based on stakeholder perspectives have implications for further research and are being utilized for the development of a mental health app for common mental health concerns.
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Affiliation(s)
- Jemimah A Johnson
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Janhavi Devdutt
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Seema Mehrotra
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Poornima Bhola
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Paulomi Sudhir
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, IND
| | - Amit Sharma
- Technology for Emerging Markets, Microsoft Research India, Bengaluru, IND
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Maulik PK, Devarapalli S, Kallakuri S, Bhattacharya A, Peiris D, Patel A. The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India. J Med Internet Res 2020; 22:e15553. [PMID: 32130125 PMCID: PMC7068463 DOI: 10.2196/15553] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/28/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022] Open
Abstract
Background Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial.
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Affiliation(s)
- Pallab K Maulik
- George Insitute for Global Health, New Delhi, India.,University of New South Wales, Sydney, Australia.,George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | | | | | | | - David Peiris
- University of New South Wales, Sydney, Australia.,George Institute for Global Health, Sydney, Australia
| | - Anushka Patel
- University of New South Wales, Sydney, Australia.,George Institute for Global Health, Sydney, Australia
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Mascayano F, Toso-Salman J, Ho YCS, Dev S, Tapia T, Thornicroft G, Cabassa LJ, Khenti A, Sapag J, Bobbili SJ, Alvarado R, Yang LH, Susser E. Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries. Transcult Psychiatry 2020; 57:140-160. [PMID: 31856688 DOI: 10.1177/1363461519890964] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality-most only included evaluations after intervention or short follow-up periods (1-3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jaime Sapag
- IMHPR, Centre for Addiction and Mental Health
- Mental Health, Catholic University of Chile
- Dalla Lana School of Public Health, University of Toronto
| | | | | | | | - Ezra Susser
- Columbia University
- New York University College of Global Public Health
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Hartog K, Hubbard CD, Krouwer AF, Thornicroft G, Kohrt BA, Jordans MJD. Stigma reduction interventions for children and adolescents in low- and middle-income countries: Systematic review of intervention strategies. Soc Sci Med 2019; 246:112749. [PMID: 31978636 DOI: 10.1016/j.socscimed.2019.112749] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Abstract
Stigmatisation and discrimination are common worldwide, and have profound negative impacts on health and quality of life. Research, albeit limited, has focused predominantly on adults. There is a paucity of literature about stigma reduction strategies concerning children and adolescents, with evidence especially sparse for low- and middle-income countries (LMIC). This systematic review synthesised child-focused stigma reduction strategies in LMIC, and compared these to adult-focused interventions. Relevant publications were systematically searched in July and August 2018 in the following databases; Cochrane, Embase, Global Health, HMIC, Medline, PsycINFO, PubMed and WorldWideScience.org, and through Google Custom Search. Included studies and identified reviews were cross-referenced. Three categories of search terms were used: (i) stigma, (ii) intervention, and (iii) LMIC settings. Data on study design, participants and intervention details including strategies and implementation factors were extracted. Within 61 unique publications describing 79 interventions, utilising 14 unique stigma reduction strategies, 14 papers discussed 21 interventions and 10 unique strategies involving children. Most studies targeted HIV/AIDS (50% for children, 38% for adults) or mental illness (14% vs 34%) stigma. Community education (47%), individual empowerment (15%) and social contact (12%) were most employed in child-focused interventions. Most interventions were implemented at one socio-ecological level; child-focused interventions mostly employed community-level strategies (88%). Intervention duration was mostly short; between half a day and a week. Printed or movie-based material was key to deliver child-focused interventions (37%), while professionals most commonly implemented adult-focused interventions (53%). Ten unique, child-focused strategies were all evaluated positively, using a diverse set of scales. Children and adolescents are under-represented in stigma reduction in LMIC. More stigma reduction interventions in LMIC, addressing a wider variety of stigmas, with children as direct and indirect target group, are needed. This systematic review is registered under International Prospective Register of Systematic Reviews PROSPERO, reference number #CRD42018094700.
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Affiliation(s)
- Kim Hartog
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
| | - Carly D Hubbard
- London School of Hygiene and Tropical Medicine, Keppel St., Bloomsbury, London, WC1E, 7HT, United Kingdom.
| | - Angelica F Krouwer
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands.
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute for Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, United Kingdom.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA.
| | - Mark J D Jordans
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
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Luitel NP, Garman EC, Jordans MJD, Lund C. Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal. BMC Public Health 2019; 19:1350. [PMID: 31640647 PMCID: PMC6806507 DOI: 10.1186/s12889-019-7663-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/20/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. METHODS The repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). RESULTS The proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes. CONCLUSION The study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.
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Affiliation(s)
- Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
| | - Emily C Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark J D Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Brizuela V, Bonet M, Souza JP, Tunçalp Ö, Viswanath K, Langer A. Factors influencing awareness of healthcare providers on maternal sepsis: a mixed-methods approach. BMC Public Health 2019; 19:683. [PMID: 31159751 PMCID: PMC6547516 DOI: 10.1186/s12889-019-6920-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers' knowledge, perception of enabling environments, and perception of severity of maternal sepsis. METHODS We used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ2. Logistic regressions were performed to adjust for selected variables. RESULTS Analysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities. CONCLUSIONS Awareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.
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Affiliation(s)
- Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Klik KA, Williams SL, Reynolds KJ. Toward understanding mental illness stigma and help-seeking: A social identity perspective. Soc Sci Med 2019; 222:35-43. [DOI: 10.1016/j.socscimed.2018.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/05/2018] [Accepted: 12/01/2018] [Indexed: 11/16/2022]
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Maulik PK, Devarapalli S, Kallakuri S, Tripathi AP, Koschorke M, Thornicroft G. Longitudinal assessment of an anti-stigma campaign related to common mental disorders in rural India. Br J Psychiatry 2019; 214:90-95. [PMID: 30681052 PMCID: PMC6420138 DOI: 10.1192/bjp.2018.190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stigma related to mental health and lack of trained mental health professionals is a major cause for an increased treatment gap, particularly in rural India. The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project delivered a complex intervention involving task sharing, an anti-stigma campaign and use of technology-based, decision-support tools to empower primary care workers to identify and manage depression, anxiety, stress and suicide risk.AimsThe aim of this article is to report changes in stigma perceptions over three time points in the rural communities where the anti-stigma campaign was conducted. METHOD A multimedia-based anti-stigma campaign was conducted over a 3-month period in the West Godavari district of Andhra Pradesh, India. Following that, the primary care-based mental health service was delivered for 1 year. The anti-stigma campaign was evaluated in two villages and data were captured at three time points over a 24-month period (N = 1417): before and after delivery of the campaign and after completion of the health services delivery intervention. Standardised tools captured data on knowledge, attitude and behaviour towards mental health as well as perceptions related to help seeking for mental illnesses. RESULTS Most knowledge, attitude and behaviour scores improved over the three time points. Overall mean scores on stigma perceptions related to help seeking improved by -0.375 (minimum/maximum of -2.7/2.4, s.d. 0.519, P < 0.001) during this time. Loss to follow-up was 10%. CONCLUSIONS The data highlight the positive effects of an anti-stigma campaign over a 2-year period.Declaration of interestNone.
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Affiliation(s)
- Pallab K. Maulik
- Deputy Director and Director of Research, Research and Development, George Institute for Global Health, India and Senior Research Associate, George Institute for Global Health, University of Oxford, UKand Associate Professor, Faculty of Medicine, University of New South Wales, Australia,Correspondence: Pallab K. Maulik, George Institute for Global Health, 311–312 Elegance Tower, Jasola, New Delhi 110025, India.
| | | | - Sudha Kallakuri
- Research Assistant, Research and Development, George Institute for Global Health, India
| | | | - Mirja Koschorke
- Visiting Lecturer, Centre for Global Mental Health and Centre for Implementation Science Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, Chisholm D, Collins PY, Cooper JL, Eaton J, Herrman H, Herzallah MM, Huang Y, Jordans MJD, Kleinman A, Medina-Mora ME, Morgan E, Niaz U, Omigbodun O, Prince M, Rahman A, Saraceno B, Sarkar BK, De Silva M, Singh I, Stein DJ, Sunkel C, UnÜtzer JÜ. The Lancet Commission on global mental health and sustainable development. Lancet 2018; 392:1553-1598. [PMID: 30314863 DOI: 10.1016/s0140-6736(18)31612-x] [Citation(s) in RCA: 1110] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Vikram Patel
- Harvard Medical School, Boston, MA, USA; Harvard TH Chan School of Public Health, Boston, MA, USA; Sangath, Goa, India; Public Health Foundation of India, New Delhi, India.
| | - Shekhar Saxena
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London UK
| | - Florence Baingana
- WHO Sierra Leone, Freetown, Sierra Leone; Makerere University School of Public Health, Kampala, Uganda
| | - Paul Bolton
- Department of International Health and Department of Mental Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dan Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Pamela Y Collins
- University of Washington School of Medicine and School of Public Health, Seattle, WA, USA
| | - Janice L Cooper
- The Carter Center, Monrovia, Liberia; Emory University, Atlanta, GA, USA
| | - Julian Eaton
- CBM International, Bensheim, Germany; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Herrman
- Orygen, National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; World Psychiatric Association, Melbourne, VIC Australia; WHO Collaborating Centre in Mental Health, Melbourne, VIC Australia
| | - Mohammad M Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Jerusalem, Palestine; Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA
| | - Yueqin Huang
- National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Mark J D Jordans
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Research and Development, War Child, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Arthur Kleinman
- Department of Anthropology, Harvard University, Cambridge, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Ellen Morgan
- Templeton World Charity Foundation, Nassau, The Bahamas
| | - Unaiza Niaz
- Psychiatric Clinic and Stress Research Centre, Karachi, Pakistan; University of Health Sciences, Lahore, Pakistan; Dow University of Health Sciences, Karachi, Pakistan
| | - Olayinka Omigbodun
- College of Medicine and Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria
| | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Atif Rahman
- University of Liverpool, Liverpool, UK; Human Development Research Foundation, Islamabad, Pakistan
| | - Benedetto Saraceno
- School of Medical Sciences, University Nova of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Bidyut K Sarkar
- PRIDE Project, Sangath, India; Public Health Foundation of India, New Delhi, India
| | | | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Groote Schuur Hospital, Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Charlene Sunkel
- South African Federation for Mental Health, Johannesburg, South Africa; Movement for Global Mental Health, Johannesburg, South Africa
| | - JÜrgen UnÜtzer
- Department of Psychiatry and Behavioral Sciences and the Advancing Integrated Mental Health Solutions Center, University of Washington, Seattle, WA, USA
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Kallakuri S, Devarapalli S, Tripathi AP, Patel A, Maulik PK. Common mental disorders and risk factors in rural India: baseline data from the SMART mental health project. BJPsych Open 2018; 4:192-198. [PMID: 29988932 PMCID: PMC6034434 DOI: 10.1192/bjo.2018.28] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/05/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND About 10% Indians suffer from stress, depression or substance use disorders. Few receive care for these problems, especially in rural areas. AIMS As part of a broader initiative to deliver technology-enabled mental health services for rural communities (adults ≥18 years), information was collected about the prevalence of depression, anxiety and suicide risk. METHOD The study was conducted in 12 villages in the West Godavari district of Andhra Pradesh. Depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Additionally, data were collected about sociodemographic factors and stressful events, among others. RESULTS Anxiety, depression and suicidal ideation affected 10.8, 14.4 and 3.5% of participants, respectively (N = 22 377). These were more common among women, and among those who were aged 30-59 years, uneducated, or divorced/ separated/ widowed. Stress due to financial loss was significant. CONCLUSIONS The study identified a significant number of people at risk of depression, anxiety and suicide, and needing care. DECLARATION OF INTEREST None.
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Affiliation(s)
- Sudha Kallakuri
- Research Assistant, George Institute for Global Health, New Delhi, India
| | | | | | - Anushka Patel
- Chief Scientist, George Institute for Global Health, Sydney, Australia and Professor of Medicine, University of New South Wales, Sydney, Australia
| | - Pallab K Maulik
- Deputy Director and Head of Research, George Institute for Global Health, New Delhi, India, and Associate Professor, Faculty of Medicine, University of New South Wales, Sydney, Australia and Senior Research Associate, George Institute for Global Health, University of Oxford, Oxford, UK
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Rathod S, Irfan M, Bhargava R, Pinninti N, Scott J, Mohammad Algahtani H, Guo Z, Gupta R, Nadkarni P, Naeem F, Howells F, Sorsdahi K, Thorne K, Osman-Hicks V, Pallikadavath S, Phiri P, Carr H, Graves L, Kingdon D. Multinational comparative cross-sectional survey of views of medical students about acceptable terminology and subgroups in schizophrenia. BMJ Open 2018; 8:e021461. [PMID: 29880569 PMCID: PMC6009566 DOI: 10.1136/bmjopen-2017-021461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM The aim of this study was to inform thinking around the terminology for 'schizophrenia' in different countries. OBJECTIVES The objective of this study was to investigate: (1) whether medical students view alternative terminology (psychosis subgroups), derived from vulnerability-stress models of schizophrenia, as acceptable and less stigmatising than the term schizophrenia; (2) if there are differences in attitudes to the different terminology across countries with different cultures and (3) whether clinical training has an impact in reducing stigma. DESIGN This is a cross-sectional survey that examined the attitudes of medical students towards schizophrenia and the alternative subgroups. SETTING The study was conducted across eight sites: (1) University of Southampton, UK; (2) All India Institute of Medical Science, India; (3) Rowan University, USA; (4) Peshawar Medical College, Pakistan; (5) Capital Medical University, China; (6) College of Medicine and Medical sciences, Bahrain; (7) Queens University, Kingston, Canada and (8) University of Cape Town, South Africa. METHOD This study extended an initial pilot conducted by the Royal College of Psychiatrists on the term schizophrenia and psychosis subgroups to assess whether the subgroup terminology might have an effect on the attitudes of a convenience sample of medical students from eight different countries and potentially play a role in reducing stigmatisation. RESULTS 1873 medical students completed a questionnaire recording their attitudes to schizophrenia and the psychosis subgroups. A reduction in negative perceptions were found for the psychosis subgroups, especially for the stress sensitivity psychosis and anxiety psychosis subgroups. Negative perceptions were found for drug-related psychosis. Participants who had undergone clinical training had overall positive attitudes. Differences across different countries were found. CONCLUSION The attitudes towards psychosis subgroups used in this study have shown mixed results and variation across countries. Further research is warranted to investigate acceptability of terminology. Methods of reducing stigma are discussed in line with the findings. ETHICS The study received ethical approval from ERGO (Ethics and Research Governance Online; ID: 15972) and subsequently from the ethics committee at each site.
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Affiliation(s)
- Shanaya Rathod
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, UK
| | | | - Rachna Bhargava
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narsimha Pinninti
- School of Osteopathic Medicine, Rowan University, Stratford, New Jersey, USA
| | - Joseph Scott
- Maine Behavioural Health Organization, Biddeford, Maine, USA
| | | | - Zhihua Guo
- Capital Medical University, Beijing, China
| | - Rishab Gupta
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Fleur Howells
- Translational Neuroscience Group, Division of Psychopharmacology and Biological Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahi
- Division of Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kerensa Thorne
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Victoria Osman-Hicks
- Department of Psychiatry, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sasee Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, UK
| | - Peter Phiri
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Hannah Carr
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Lizi Graves
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
| | - David Kingdon
- Clinical Trials Facility, Tom Rudd Unit, Southern Health NHS Foundation Trust, Hampshire, UK
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Maulik PK, Kallakuri S, Devarapalli S. Operational challenges in conducting a community-based technology-enabled mental health services delivery model for rural India: Experiences from the SMART Mental Health Project. Wellcome Open Res 2018; 3:43. [PMID: 29806039 PMCID: PMC5941243 DOI: 10.12688/wellcomeopenres.14524.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational strategies used to facilitate the implementation of the intervention. Method: Key components of the SMART Mental Health Project included delivering an anti-stigma campaign, training of primary health workers in screening, diagnosing and managing stress, depression and increased suicide risk and task sharing of responsibilities in delivering care; and using mobile technology based electronic decision support systems to support delivery of algorithm based care for such disorders. The intervention was conducted in 42 villages across two sites in the state of Andhra Pradesh in south India. A pre-post mixed methods evaluation was done, and in this paper operational challenges are reported. Results: Both quantitative and qualitative results from the evaluation from one site covering about 5000 adults showed that the intervention was feasible and acceptable, and initial results indicated that it was beneficial in increasing access to mental health care and reducing depression and anxiety symptoms. A number of strategies were initiated in response to operational challenges to ensure smoother conduct of the project and facilitated the project to be delivered as envisaged. Conclusions: The operational strategies initiated for this project were successful in ensuring the delivery of the intervention. Those, coupled with other more systematic processes have informed the researchers to understand key processes that need to be in place to develop a more robust study, that could eventually be scaled up.
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Affiliation(s)
- Pallab K Maulik
- George Institute for Global Health India, New Delhi , 110025, India.,Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.,George Institute for Global Health, University of Oxford, Oxford, OX1 3QX, UK
| | - Sudha Kallakuri
- George Institute for Global Health India, New Delhi , 110025, India
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