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Giri NA, Bhangale A, Gaikwad NN, Manjunatha N, Raigond P, Marathe RA. Comparative study on effect of pomegranate peel powder as natural preservative and chemical preservatives on quality and shelf life of muffins. Sci Rep 2024; 14:10307. [PMID: 38705878 DOI: 10.1038/s41598-024-61085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/30/2024] [Indexed: 05/07/2024] Open
Abstract
This research aims to investigate the potential of utilizing pomegranate peel powder (PPP) as a natural preservative in muffin preparation. Pomegranate peel is a rich source of bioactive compounds, including phenolics, flavonoids, and tannins, which possess high antioxidant and antimicrobial properties. The In-Vitro antifungal activity of pomegranate peel powder (8% PPP), potassium sorbate (0.1% PS) and calcium propionate (0.5% CP) was assessed against Penicillium sp. and Aspergillus sp. using poison food technique. The PPP showed the anti-fungal activity by delaying the growth of microorganism on media plate similar to the PS and CP. The effect of utilization of PPP on quality characteristics of muffins were compared with the muffins with chemical preservatives (0.1% PS and 0.5% CP). The viscosity and specific gravity of batter significantly increased from 7.98 to 11.87 Pa s and 1.089-1.398 respectively on addition of 8% PPP. The optical microscopic structure of PPP added batter revealed the decrease in the number of air cells from 24 to 12 with radius range of 6.42-72.72 μm and area range of 511.03-15,383.17 µm2. The functional properties of flour with PPP had higher water absorption capacity, foaming stability, emulsification activity and emulsion stability than others. The addition of PPP significantly increase the weight (32.83 g), and decrease the height (31.3 mm), volume (61.43 cm3), specific volume (1.67 cm3/g) and baking loss (10.19%). The 418.36% increase in fibre content, 14.46% and 18.46% decrease in carbohydrates and energy value was observed in muffin with 8% PPP as compared to control respectively. The total phenols was increased from 0.92 to 12.5 mg GAE/100 g, total tannin from 0.2 to 8.27 mg GAE/100 g, In-vitro antioxidant activity by DPPH from 6.97 to 29.34% and In-vitro antioxidant activity by FRAP from 0.497 to 2.934 mg AAE/100 g in muffins added with 8% PPP. The muffin with PPP was softer than control and muffin with 0.1% PS. The addition of PPP resulted to improve in muffin texture but taste slightly bitter. During the storage of muffins at room temperature (27-30 °C), the moisture content of muffin with PPP was reduced from 17.04 to 13.23% which was higher than the rest of the treatments. Similarly, the hardness of sample with PPP was higher than the sample with 0.5% CP, but lowers than control and sample with 0.1% PS throughout the storage period. The results suggest that pomegranate peel powder can be successfully used as a natural preservative in place of chemical preservatives in muffins, to extend the shelf life. This study provides the opportunity to use PPP as functional ingredient and natural preservative in different bakery products.
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Affiliation(s)
- Namrata Ankush Giri
- ICAR-National Research Centre on Pomegranate, NH-65, Solapur-Pune Highway, Kegaon, Solapur, 413 255, Maharashtra, India.
| | - Aditi Bhangale
- ICAR-National Research Centre on Pomegranate, NH-65, Solapur-Pune Highway, Kegaon, Solapur, 413 255, Maharashtra, India
| | - Nilesh N Gaikwad
- ICAR-National Research Centre on Pomegranate, NH-65, Solapur-Pune Highway, Kegaon, Solapur, 413 255, Maharashtra, India
| | - N Manjunatha
- ICAR-National Research Centre on Pomegranate, NH-65, Solapur-Pune Highway, Kegaon, Solapur, 413 255, Maharashtra, India
| | - Pinky Raigond
- ICAR-National Research Centre on Pomegranate, NH-65, Solapur-Pune Highway, Kegaon, Solapur, 413 255, Maharashtra, India
| | - R A Marathe
- ICAR-National Research Centre on Pomegranate, NH-65, Solapur-Pune Highway, Kegaon, Solapur, 413 255, Maharashtra, India.
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Chandna AS, Suhas S, Patley R, Dinakaran D, Manjunatha N, Rao GN, Gururaj G, Varghese M, Benegal V. Exploring the enigma of low prevalence of post-traumatic stress disorder in India. Indian J Psychiatry 2023; 65:1254-1260. [PMID: 38298881 PMCID: PMC10826864 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_830_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition associated with significant distress and dysfunction. While worldwide estimates of prevalence range from 3.9% to 24%, little research has been conducted to identify the prevalence of PTSD in the general population of India. This study analyzes data from the National Mental Health Survey 2015-2016, a comprehensive epidemiological study of mental health disorders in India, to explore the unique characteristics and prevalence of PTSD in the Indian population. Materials and Methods The National Mental Health Survey 2015-2016 employed a multiple-stage, stratified, cluster-sampling methodology, covering 39,532 individuals in 12 states of India. The Mini-International Neuropsychiatric Interview (MINI) version 6.0.0 was used to diagnose psychiatric disorders, including PTSD. A detailed analysis of sociodemographic profiles, prevalence patterns, comorbidities, economic and social impact, and treatment-seeking behavior was conducted. Firth penalized logistic regression was employed to identify associated sociodemographic factors. Results The study revealed a low prevalence of PTSD in India at 0.2%, significantly lower than global averages. Factors associated with PTSD included female gender, middle age (40-49 years), and urban residence. The study also highlighted a high rate of comorbid mood and anxiety disorders, substantial disability, poor treatment-seeking behavior, and significant suicidal risk among individuals with PTSD. Conclusion Our findings underscore the need for culturally informed diagnostic and management programs to accurately identify and address PTSD in the Indian population. Cultural nuances, stigma, and the use of Western-derived diagnostic instruments likely contribute to the underidentification and undertreatment of PTSD in India. The study emphasizes the importance of recognizing and addressing these challenges to improve mental health outcomes in India.
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Affiliation(s)
- Ateev S. Chandna
- Department of Psychiatry National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Damodharan Dinakaran
- Department of Psychosocial Support in Disaster Management, NIMHANS, Bengaluru, Karnataka, India
| | | | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Jayasankar P, Suhas S, Nirisha LP, Philip S, Manjunatha N, Rao GN, Gururaj G, Varghese M, Benegal V. Current prevalence and determinants of generalized anxiety disorder from a nationally representative, population-based survey of India. Indian J Psychiatry 2023; 65:1244-1248. [PMID: 38298878 PMCID: PMC10826860 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_824_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/02/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Generalized anxiety disorder (GAD) is one of the common anxiety disorders leading to impairment and burden. However, GAD remains the least studied anxiety disorder. There is a need for nationally representative epidemiological data of GAD to understand the current burden and plan the mental health policies and programs to attain their unmet needs. Hence, this study focuses on epidemiology, socio-demographic correlates, disability, and treatment gap of GAD from India's National Mental Health Survey (NMHS) 2016. Materials and Methods NMHS 2016 was a nationally representative epidemiological survey of adult respondents from 12 states of India. NMHS is a multi-stage, stratified, random cluster sampling with random selection based on probability proportional to size at each stage. The Mini-International Neuropsychiatric Interview 6.0.0 used to diagnose psychiatric disorders. Sheehan disability scale was used to assess the disability. The current weighted prevalence of GAD was estimated. Association between GAD and socio-demographic factors was done using Firth's penalized logistic regression. The treatment gap and disability in GAD also calculated. Results The current weighted prevalence of GAD is 0.57%. The male gender and higher education groups have significantly lesser odds with current GAD. Urban metro and the married group have significantly higher odds with current GAD. The most common comorbid psychiatric disorders are depression (15.8%) followed by agoraphobia (9.4%). Among respondents with current GAD in the past 6 months across three domains, around 2/5th has mild and moderate disability, 1/10th has a severe disability, and 1/20th has an extreme disability. The overall treatment gap of current GAD is 75.7%. Conclusion NMHS 2016 has provided valuable insights into the epidemiology and burden of GAD among the general population. The available findings provide a glimpse of the current scenario in GAD to aid policymakers in targeting interventions.
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Affiliation(s)
- Pavithra Jayasankar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Lakshmi P. Nirisha
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sharad Philip
- Department of Psychiatry, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Suhas S, Jayasankar P, Patley R, Manjunatha N, Rao GN, Gururaj G, Varghese M, Benegal V. Nationally representative epidemiological study of social anxiety disorder from India. Indian J Psychiatry 2023; 65:1261-1268. [PMID: 38298869 PMCID: PMC10826865 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_826_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background Social anxiety disorder (SAD), also termed as social phobia, is a disabling psychiatric condition with limited epidemiological research on it in India. This study, using data from the National Mental Health Survey (NMHS), 2016, is the first to explore its current prevalence and associated factors in India. Materials and Methods The NMHS in India used a comprehensive population-based study with subjects selected through a multistage stratified random cluster sampling technique across 12 states. The study included 34,802 adults interviewed with the Mini-International Psychiatric Interview 6.0.0. Firth penalized logistic regression (FPLR) was used to estimate covariate odds ratios (ORs), and the treatment gap for SAD and disability measured using Sheehan's disability scale was calculated. Results The study found a 0.47% prevalence of SAD, with an average age of 35.68 years (standard deviation (SD) = 15.23) among those affected. Factors, such as male gender, unemployment, and living in urban areas, were associated with higher odds of SAD, while the elderly had lower odds. A significant proportion of individuals with SAD experienced disability in work (63%), social life (77%), and family life (68%). They spent a median of ₹ 2500 per month on treatment and had a high rate of comorbid psychiatric disorders (58%). The treatment gap was substantial at 82%. Conclusions A considerable portion of India's population (approximately >65 lakhs) is affected by SAD. Surprisingly, the NMHS 2016 report indicates a higher risk of SAD among males compared with females, a trend that warrants further investigation. SAD in India is linked to significant disability and a considerable treatment gap, emphasizing the need for innovative approaches to address this large, affected population, especially in light of the scarcity of mental health professionals.
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pavithra Jayasankar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiciton Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Manjunatha N, Dinakaran D, Sarkhel S, Kumar CN. The National Mental Health (?Psychiatric) Survey (2015-2016): A superb acceleration in public mental health scenario of India. Indian J Psychiatry 2023; 65:1205-1207. [PMID: 38298872 PMCID: PMC10826873 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_835_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Damodharan Dinakaran
- Department of Psychosocial Support in Disaster Management, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sujit Sarkhel
- Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India
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Suhas S, Manjunatha N, Kumar CN, Benegal V, Rao GN, Varghese M, Gururaj G. Firth's penalized logistic regression: A superior approach for analysis of data from India's National Mental Health Survey, 2016. Indian J Psychiatry 2023; 65:1208-1213. [PMID: 38298875 PMCID: PMC10826871 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_827_23] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
The National Mental Health Survey of India (NMHS) was a ground-breaking nationwide study that harnessed a uniform, standardized methodology blending quantitative and qualitative approaches. Covering data from 12 states across diverse regions, its mission was to gauge the prevalence of psychiatric disorders, bridge treatment gaps, explore service utilization, and gauge the socioeconomic repercussions of these conditions. This initiative provided pivotal insights into the intricate landscape of mental health in India. One of the analyses planned for NMHS data was to undertake a logistic regression analysis with an aim to unravel how various sociodemographic factors influence the presence or absence of specific psychiatric disorders. Within this pursuit, two substantial challenges loomed. The first pertained to data separation, a complication that could perturb parameter estimation. The second challenge stemmed from the existence of disorders with lower prevalence rates, which resulted in datasets of limited density, potentially undermining the statistical reliability of our analysis. In response to these data-driven hurdles, NMHS recognized the critical necessity for an alternative to conventional logistic regression, one that could adeptly navigate these complexities, ensuring robust and dependable insights from the collected data. Traditional logistic regression, a widely prevalent method for modeling binary outcomes, has its limitations, especially when faced with limited datasets and rare outcomes. Here, the problem of "complete separation" can lead to convergence failure in traditional logistic regression estimations, a conundrum frequently encountered when handling binary variables. Firth's penalized logistic regression emerges as a potent solution to these challenges, effectively mitigating analytical biases rooted in small sample sizes, rare events, and complete separation. This article endeavors to illuminate the superior efficacy of Firth's method in managing small datasets within scientific research and advocates for its more widespread application. We provide a succinct introduction to Firth's method, emphasizing its distinct advantages over alternative analytical approaches and underscoring its application to data from the NMHS 2015-2016, particularly for disorders with lower prevalence.
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Jayasankar P, Satish S, Suchandra HH, Manjunatha N, Rao GN, Gururaj G, Varghese M, Benegal V. Panic disorder: Epidemiology, disability, and treatment gap from nationally representative general population of India. Indian J Psychiatry 2023; 65:1249-1253. [PMID: 38298880 PMCID: PMC10826862 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_825_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Panic disorder (PD) is one of the most common and debilitating anxiety disorder. Individuals with PD seek frequent healthcare and emergency services leading to frequent work absenteeism and economic burden. However, its prevalence patterns in the Indian context are poorly understood. Hence, this article discusses the epidemiology, disability, and treatment gap from India's National Mental Health Survey 2016. Materials and Methods National Mental Health Survey 2016 was a nationally representative epidemiological survey of adult respondents from 12 states of India. Mini International Neuropsychiatric Interview 6.0.0 is used to diagnose psychiatric disorders. Sheehan disability scale was used to assess the disability. The current weighted prevalence of PD was estimated. Association between PD and its sociodemographic correlates was done using Firth penalized logistic regression. The treatment gap and disability in PD were also calculated. Results The lifetime and current weighted prevalence of PD was 0.5% (95% confidence interval 0.49-0.52) and 0.3% (95% confidence interval 0.28-0.41), respectively. The male gender and unemployed have significantly lesser odds with current PD. The elderly, Urban metro, and the married/separated group have significantly higher odds with current PD. The most common comorbid psychiatric disorder is agoraphobia (42.3%) and depression (30.9%) followed by Generalized Anxiety Disorder (10%). Among respondents with current PD in the past 1 month across three domains, around 80% had a disability of any severity and 20%-25% had marked disability. The overall treatment gap of current PD is 71.7%. Conclusion It is the first study reporting prevalence from a nationally representative sample from the general population of India. The survey has shed light on the epidemiology and the challenges faced by those with PD which emphasizes the urgency of bridging the treatment gap. These findings are paramount to the development of more inclusive and effective mental health policies and interventions to tackle the current burden due to PD.
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Affiliation(s)
- Pavithra Jayasankar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suhas Satish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Manjunatha N. Trishul division of mental health: Conveying all sadness or stress of life is NOT a mental illness to people, the public, professionals, and policymakers. Indian J Psychiatry 2023; 65:983-984. [PMID: 37841550 PMCID: PMC10569322 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_286_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/29/2023] [Accepted: 08/23/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India E-mail:
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Kondapura MB, Manjunatha N, Nagaraj AKM, Praharaj SK, Kumar CN, Math SB, Rao GN. Cost of Illness Analysis of Common Mental Disorders: A Study from an Indian Academic Tertiary Care Hospital. Indian J Psychol Med 2023; 45:519-525. [PMID: 37772137 PMCID: PMC10523518 DOI: 10.1177/02537176221108867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Background The cost of illness (COI) for common mental disorders (CMDs) that include depression, anxiety, and somatoform disorder is less studied in India. Hence, we studied the COI and disability of CMDs and their relationship in patients with depression, anxiety, and somatoform disorders. Methods In this cross-sectional study, we recruited 220 patients (110 with depression, 58 with anxiety disorders, and 52 with somatoform disorders) and evaluated disability using the Sheehan Disability Scale (SDS). The schedule for the cost of illness (S-COI) was used for evaluating COI for the last year. Results The annual COI of CMDs from the patient perspective was ₹21,620 (interquartile range [IQR], ₹47,761; ≈US$290). The median annual direct COI was ₹4,907 (IQR ₹7,502), and indirect COI was ₹12,900 (IQR ₹37744). The direct COI was 18%, whereas the indirect COI was 82%. The direct and indirect COI in the three groups were similar. In all three groups with ongoing treatment, the mean scores indicated a mild level of disability. Total and indirect COI, but not the direct COI, correlated positively with the severity of illness and disability. Conclusion All the CMDs with ongoing treatment are associated with a mild level of disability and are a significant financial burden, with higher indirect costs.
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Affiliation(s)
- Manjunatha B. Kondapura
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anil Kumar Mysore Nagaraj
- Dept. of Psychiatry, Kasturba Medical
College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka,
India
| | - Samir Kumar Praharaj
- Dept. of Psychiatry, Kasturba Medical
College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka,
India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Dept. of Epidemiology, Centre for
Public Health, National Institute of Mental Health and Neurosciences, Bengaluru,
Karnataka, India
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Ohri U, Paul J, Vijayalakshmi P, Govindan R, Manjunatha N, Kumar CN, Math SB. The rationale and guiding principles to design a psychiatric curriculum for primary care nurses of India. J Family Med Prim Care 2023; 12:2114-2119. [PMID: 38024873 PMCID: PMC10657090 DOI: 10.4103/jfmpc.jfmpc_775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 12/01/2023] Open
Abstract
Background The National Mental Health Survey reports a huge treatment gap for all mental disorders. There is an acute shortage of mental health professionals in India. Hence, there is a dire need to support task-shift interventions by nurses in providing non-pharmacological interventions for persons suffering from mental health issues. The traditional psychiatric nursing curriculum emphasizes nurses' knowledge and skills rather than their competency in providing mental health care. We designed an innovative, digitally driven, modular-based primary care psychiatry program for nurses (PCPP-N) to incorporate mental health with physical health and emphasize redesigning nursing practice. In this paper, we discuss the rationale and guiding principles behind designing the curriculum of PCPP-N. Discussion The PCPP-N program is based on nine guiding principles to provide skill-based, pragmatic, and feasible modules of a higher collaborative care quotient (CCQ) and translational quotient (TQ) that are essential for upskilling primary care nurses. In this program, nurses are trained through telemedicine-based 'on-consultation training' augmented with collaborative video consultations. A tele-psychiatrist/tele-psychiatric nurse will demonstrate how to screen, identify, and plan treatment for patients with psychiatric disorders from patients coming for general medical care using the manual Clinical Schedules of Primary care psychiatry Nursing (CSP-N). The CSP-N manual includes a screener, simplified diagnosing guidelines relevant for nurses and primary care settings, nursing management, pharmacological management, and related side effects, counseling, and follow-up guidelines. This program helps the nurses in identifying the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPN curriculum contains pragmatic modules with higher CCQ and TQ. This curriculum is dynamic as the learning is interactive. Upskilling primary care nurses in integrating mental health with physical health may reduce the mental health burden. Further, the policymakers and administrators plan to integrate mental health along with physical health in national health programs.
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Affiliation(s)
- Uma Ohri
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - James Paul
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Poreddi Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
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Paul J, Govindan R, Thakur M, Manjunatha N. Development and validation of "Knowledge on screening and identification of mental illness (KSIM) questionnaire" among primary care nurses in India. J Educ Health Promot 2023; 12:216. [PMID: 37546003 PMCID: PMC10402797 DOI: 10.4103/jehp.jehp_184_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND As stated in the World Health Organization's Mental Health Report 2022, 13%, or almost a billion people, had a mental health issue, and 82% of these people resided in low- and middle-income countries with limited access to mental health treatments. Successful integration of mental health services into primary healthcare depends on primary healthcare providers receiving the proper training and information required to provide basic mental health care in the community. Primary care nurses generally lack the confidence and skills to handle mental health issues while being in an excellent position to screen, identify, refer, and follow-up on a person with mental illness (PMI). The study aimed to develop and validate the KSIM questionnaire to assess the knowledge of primary care nurses in screening, identifying, referral, and follow-up persons with mental health issues in the community. MATERIALS AND METHODS The study was conducted based on a sequential exploratory design in two phases: the development and the validation phases. An extensive literature search was done, and the themes derived from the two focus group discussion (FGD) and three direct interviews, and the inputs from the mental health experts were used to design the KSIM questionnaire. A panel of 17 experts validated the KSIM questionnaire through item-level content validity index (I-CVI) and scale-level CVI (S-CVI) for content validation, and the reliability test was done using the intraclass correlation coefficient ICC test-retest method. RESULTS The draft version-1 of the KSIM questionnaire showed high content validity of individual items (I-CVI range: 0.82-1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The KSIM questionnaire consists of 30 multiple choice questions and 10 case vignettes. The KSIM questionnaire has a very good test-retest reliability using the single measure two-way mixed absolute agreement ICC value 0.97 with 95% CI. CONCLUSIONS Using an iterative approach, the development and validation of the KSIM questionnaire demonstrated high I-CVI and S-CVI with good ICC test-retest reliability to assess the knowledge of primary care nurses on screening and identification, referral and follow-up of a PMI in the community. Primary care nurses' knowledge on how to screen for and identify people with mental health issues in the primary care setting can be evaluated with the help of the KSIM questionnaire, and providing need-based training may help to reduce the time taken for people with mental illness to receive professional help.
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Affiliation(s)
- James Paul
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Monika Thakur
- Psychiatry, TORENT Project, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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Paul J, Govindan R, Vijayalakshmi P, Kathyayani BV, Gandhi S, Madegowda RK, Basavarajappa C, Manjunatha N, Kumar CN, Math SB. An audit of initial six years of 5885 telepsychiatric direct video consultations: Findings from "benefits of savings" analysis and the effect of COVID-19 pandemic. Indian J Psychiatry 2023; 65:611-616. [PMID: 37485418 PMCID: PMC10358816 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_131_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 07/25/2023] Open
Abstract
Background Telepsychiatric direct video consultations (DVCs) meant for continuity of care began in 2017 and continued during the coronavirus disease 2019 (COVID-19) pandemic. Telemedicine-based consultation gained its long-due importance during the COVID-19 travel restriction, despite its existence for a long. The authors intend to share the utility and growth of the initial six years of live telepsychiatric DVCs from an academic hospital in India and also plan to understand the effects of the COVID-19 pandemic on its growth and report findings from an innovative "benefits of savings" (BOS) analysis from these clinics. Methods A first six years of medical audit of the files and registers of telepsychiatric DVCs from two kinds of continuity of care clinics during 2017-2022 is performed. An analysis of 4991 (84.8%) live DVCs is successfully conducted for 1570 patients from the 5885 scheduled appointments. Year-on-year (YOY) growth and BOS analysis of successful DVCs from these clinics were performed. Results and Discussion The growth suggests a gradual increase in DVCs yearly. The BOS analysis suggests its increased acceptability, feasibility at both user and provider ends, and possible cost-effectiveness of these video clinics. YOY analysis suggests a natural growth of these clinics than from the effect of the COVID-19 pandemic, except for an initial surge in 2020 and 2021 and observing stabilization effect by 2022. Conclusion In the authors' understanding, this is the largest study of providing DVCs from India, irrespective of any medical/surgical specialty. The video/remote clinics could be an alternative model for regular follow-ups in ensuring the continuity of care among patients with psychiatric disorders. These clinics also saved significant travel time, travel distance, and travel costs for the patients that could have occurred for their in-person consultations.
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Affiliation(s)
- James Paul
- Department of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | | | - Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | | | - Narayana Manjunatha
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - C Naveen Kumar
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Gangadhar B, Kumar CN, Sadh K, Manjunatha N, Math SB, Kalaivanan RC, Rao GN, Parthasarathy R, Chand PK, Chandra PS, Thirthalli J, Murthy P, Varghese M, Mathur A, Bairy BK, Kishore C, Gowda GS, Basvaraju V, Harihara SN, Isaac MK, Chaturvedi S. Mental Health Programme in India: Has the tide really turned? Indian J Med Res 2023; 157:387-394. [PMID: 37955215 PMCID: PMC10443714 DOI: 10.4103/ijmr.ijmr_2217_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/14/2023] Open
Abstract
Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.
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Affiliation(s)
- B.N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Kamaldeep Sadh
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rakesh Chander Kalaivanan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health & Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India
| | - Prabhat K. Chand
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mathur
- General of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Bhavya K. Bairy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Chethana Kishore
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basvaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Mohan K. Isaac
- Department of Psychiatry, University of Western Australia, Perth, Australia
| | - S.K. Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
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Paul J, Govindan R, Manjunatha N, Kumar CN, Math SB. Development and Validation of Clinical Schedule for Primary Care Psychiatric Nursing (CSP-N) for Primary Care Nurses. Indian J Community Med 2023; 48:443-452. [PMID: 37469911 PMCID: PMC10353680 DOI: 10.4103/ijcm.ijcm_721_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/06/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction As per the World Health Organization's mental health report for 2022, nearly a billion people have mental health issues, and 82% of them are in low and middle-income countries where mental health services are largely absent. For the successful integration of mental health into primary health care, proper training and education of primary care professionals are mandatory. Primary care nurses are in an excellent position to screen, identify, dual collaboration for treatment planning/referral, and follow-up of persons with mental illness (PMI), but they often lack the confidence and competence to tackle mental health problems. The study aimed to develop and validate the clinical schedule for primary care psychiatric nursing (CSP-N). Materials and Methods It is conducted in two phases: the development and validation phases. An extensive literature search has been conducted, and the ten themes derived from the two-focused group discussions and three-direct one-to-one interviews and input from mental health experts were used to design the CSP-N. The CSP-N was checked for content validity by a panel of 17 experts using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). Results The draft version 1 of the CSP-N showed high content validity for individual items (I-CVI range: 0.82 to 1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The CSP-N was developed in four modules. The single-measure two-way mixed absolute agreement ICC value was calculated (for 32 subjects) for the reliability test, and the ICC value was 0.97 with a 95% CI (0.94, 0.99). Conclusions Using an iterative approach, the development and validation of the CSP-N demonstrated high I-CVI and S-CVI for screening and identification, dual collaboration for the treatment plan, referral, and follow-up of a person with mental illness by the nurses in the community.
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Affiliation(s)
- James Paul
- Department of Nursing, NIMHANS, Bengaluru, Karnataka, India
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Kondapura MB, Manjunatha N, Nagaraj AKM, Praharaj SK, Kumar CN, Math SB, Rao GN. Work productivity (absenteeism and presenteeism) in persons with common mental disorders: An observational study from South India. Indian J Psychiatry 2023; 65:412-418. [PMID: 37325101 PMCID: PMC10263087 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_730_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/02/2023] [Accepted: 02/17/2023] [Indexed: 06/17/2023] Open
Abstract
Background The greatest contributor to the economic impact of common mental disorders (CMDs) is said to be the loss of work productivity. There is a paucity of studies from India that looks at the impact of CMDs on the productivity of work, which costs both patient and society significantly. Aim To assess and compare work productivity by evaluating both absolute and relative presenteeism and absenteeism, in persons with CMDs. Materials and Methods This was a cross-sectional observational study on 220 subjects (110, 58, and 52 patients with depressive disorder, anxiety disorders, and somatoform disorders, respectively), recruited through purposive sampling. We evaluated work productivity using the World Health Organization Health and Work Performance Questionnaire. Results Absolute absenteeism was significantly different before and after treatment for CMDs as a group but not for individual disorders. Relative absenteeism, absolute presenteeism, and relative presenteeism were all significantly different before and after treatment among both CMDs as a group and also among individual disorders. Both presenteeism and absenteeism (absolute as well as relative) did not differ significantly across the diagnostic groups. Work productivity has been linearly associated with illness severity and disability. Conclusion CMDs are associated with a significant loss of work productivity. Presenteeism is costlier than absenteeism in affecting work productivity. Loss of work productivity appears to be transdiagnostic across all CMDs. Also, the severity of loss of work productivity is associated linearly with the severity of illness and disability.
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Affiliation(s)
| | | | | | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India
| | | | - Suresh B. Math
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Vijayalakshmi P, Kathyayani BV, Sreelatha M, Reddy S, Manjunatha N, Naveen Kumar C, BadaMath S. Resilience as a protective factor on the quality of life (QoL) of Indian nursing students during the COVID-19 pandemic. Arch Psychiatr Nurs 2023; 42:55-59. [PMID: 36842828 PMCID: PMC9769067 DOI: 10.1016/j.apnu.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/21/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic negatively impacted the quality of life of individuals around the world, including health care professionals. There has been little research that examines the role of resilience concerning the impact of COVID-19 on the quality of life of nursing students. This study aimed to determine how resilience influenced the quality of life among nursing students during the COVID-19 pandemic. METHODS A cross-sectional research design was adopted for this study. A total of two hundred sixty-eight nursing students from three universities, South India responded in the web-based survey. Data was collected using self-reported questionnaires in June 2021. RESULTS Our findings revealed that the participants' resilience was normal, which had a moderate impact on the quality of life of nursing students during the COVID-19 pandemic. The COVID-19 impact on QoL significantly differed with year of education (F = 3.087; p < 0.02) and university (F = 6.697, p < 0.001). Bivariate analysis revealed significant inverse relationships between the impact of COVID-19 on quality of life with resilience (r = -0.259; p < 0.001) and perceived knowledge on COVID-19(r = -0.168; p < 0.006). CONCLUSION In our study, we found that resilience had a moderate impact on the quality of life of nursing students during the COVID-19 pandemic. Therefore, it is important to promote students' resilience and improve their quality of life during stressful situations.
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Affiliation(s)
- P Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, India.
| | - B V Kathyayani
- College of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bangalore, India
| | - M Sreelatha
- Sri Venkateswara Institute of Medical Sciences, Tirupathi, AP, India
| | - SaiYathin Reddy
- The Oxford Medical College, Hospital & Research Centre, Bangalore, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Institute of National Importance, Bangalore, India
| | - C Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Institute of National Importance, Bangalore, India
| | - Suresh BadaMath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Institute of National Importance, Bangalore, India
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Gajera GV, Pandey P, Malathesh BC, Nirisha PL, Suchandra KHH, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Suresha BM, Jain S. Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India. J Neurosci Rural Pract 2023; 14:91-97. [PMID: 36891122 PMCID: PMC9945417 DOI: 10.25259/jnrp-2022-4-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh. Materials and Methods We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub. Statistical Analysis The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design). Results Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001). Conclusion The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.
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Affiliation(s)
- Gopi V. Gajera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Barikar C. Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P. Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K. Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ferose Azeez Ibrahim
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Bada Math Suresha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sumi Jain
- Department of Non-Communicable Diseases, National Health Mission, Chhattisgarh, India
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Visalakshi S, Prateek V, Kamaldeep S, Rahul P, Philip S, Vinay B, Manjunatha N, C Naveen K, Math SB. Role of Mental Health Non-Governmental Organizations (MHNGOs) in Realizing the Objectives of the Mental Healthcare Act (MHCA) 2017. Indian J Psychol Med 2023; 45:69-75. [PMID: 36778607 PMCID: PMC9896111 DOI: 10.1177/02537176211067570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Visalakshi S
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prateek V
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kamaldeep S
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Patley Rahul
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vinay B
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - N Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - C Naveen K
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Nirisha PL, Malathesh BC, Kulal N, Harshithaa NR, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Parthasarathy R, Manjappa AA, Thirthalli J, Chand PK, Arora S, Math SB. Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training. Community Ment Health J 2023; 59:175-184. [PMID: 35779139 PMCID: PMC10290774 DOI: 10.1007/s10597-022-00996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.
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Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Barikar C Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | - Nithesh Kulal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nisha R Harshithaa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - N Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Adarsha Alur Manjappa
- DMHP Psychiatrist, Department of Health and Family Welfare, Government of Karnataka Office of the District Health Officer, Ramanagara District, Ramanagara, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Das S, Malathesh BC, Manjunatha N. India's NITI Aayog's Health Index: Where Is the Mental Health? Indian J Psychol Med 2022; 44:604-606. [PMID: 36339690 PMCID: PMC9615450 DOI: 10.1177/02537176211057411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Soumitra Das
- Dept. of Psychiatry, Sunshine Hospital, Emergency Mental Health, Victoria, Australia
| | - Barikar C Malathesh
- Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Philip S, Chander KR, Varshney P, Patley R, Pandey P, Suhas S, Nirisha PL, Suchandra, Vinay B, Manjunatha N, Kumar CN, Math SB. The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India. Indian J Psychol Med 2022; 44:537-543. [PMID: 36339686 PMCID: PMC9615441 DOI: 10.1177/02537176221074253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. PURPOSE To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. METHOD We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. CONCLUSION Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.
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Affiliation(s)
- Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - K Rakesh Chander
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Prateek Varshney
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Rahul Patley
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Praveen Pandey
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Satish Suhas
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - P Lakshmi Nirisha
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Suchandra
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - B Vinay
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Narayana Manjunatha
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - C Naveen Kumar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Manjunatha N, Ram D. Psychoeducation: Need for an Alternative Generic, Destigmatized, and Patient-Friendly Term in Clinical Practice. Indian J Psychol Med 2022; 44:528-529. [PMID: 36157016 PMCID: PMC9460012 DOI: 10.1177/02537176211024133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
| | - Dushad Ram
- Dept. of Medicine (Psychiatry), College of Medicine, Shaqra University, Shaqra, Saudi Arabia
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23
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Ibrahim FA, Malathesh BC, Gajera G, Pandey P, Nirisha P L, Jyrwa S, Kumar CN, Manjunatha N, Jain S, Bairy BK, Bada Math S. Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached. Int J Soc Psychiatry 2022; 68:954-957. [PMID: 33860714 DOI: 10.1177/00207640211011191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings (n = 2150). The objective of this article is to give a brief overview of the initiative. METHODS CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. RESULTS AND CONCLUSION From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.
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Affiliation(s)
- Ferose Azeez Ibrahim
- Dorothy Pattison Hospital, Black Country Healthcare NHS Foundation Trust, CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Barikar C Malathesh
- Telemedicine Centre, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Gopi Gajera
- CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Praveen Pandey
- CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Lakshmi Nirisha P
- Telemedicine Centre, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Sonakshi Jyrwa
- Department of Psychiatry, AIIMS Nagpur and Ex-Senior Resident, CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | | | - Sumi Jain
- NCDs and Mental Health, Government of Chhattisgarh, Raipur, Chhattisgarh, India
| | - Bhavya K Bairy
- NIMHANS Digital Academy, NIMHANS, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Community Psychiatry Services, NIMHANS, Bengaluru, Karnataka, India
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Bryazka D, Reitsma MB, Griswold MG, Abate KH, Abbafati C, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abdoli A, Abdollahi M, Abdullah AYM, Abhilash ES, Abu-Gharbieh E, Acuna JM, Addolorato G, Adebayo OM, Adekanmbi V, Adhikari K, Adhikari S, Adnani QES, Afzal S, Agegnehu WY, Aggarwal M, Ahinkorah BO, Ahmad AR, Ahmad S, Ahmad T, Ahmadi A, Ahmadi S, Ahmed H, Ahmed Rashid T, Akunna CJ, Al Hamad H, Alam MZ, Alem DT, Alene KA, Alimohamadi Y, Alizadeh A, Allel K, Alonso J, Alvand S, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Ancuceanu R, Anderson JA, Andrei CL, Andrei T, Arabloo J, Arshad M, Artamonov AA, Aryan Z, Asaad M, Asemahagn MA, Astell-Burt T, Athari SS, Atnafu DD, Atorkey P, Atreya A, Ausloos F, Ausloos M, Ayano G, Ayanore MAA, Ayinde OO, Ayuso-Mateos JL, Azadnajafabad S, Azanaw MM, Azangou-Khyavy M, Azari Jafari A, Azzam AY, Badiye AD, Bagheri N, Bagherieh S, Bairwa M, Bakkannavar SM, Bakshi RK, Balchut/Bilchut AH, Bärnighausen TW, Barra F, Barrow A, Baskaran P, Belo L, Bennett DA, Benseñor IM, Bhagavathula AS, Bhala N, Bhalla A, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bintoro BS, Blokhina EAE, Bodicha BBA, Boloor A, Bosetti C, Braithwaite D, Brenner H, Briko NI, Brunoni AR, Butt ZA, Cao C, Cao Y, Cárdenas R, Carvalho AF, Carvalho M, Castaldelli-Maia JM, Castelpietra G, Castro-de-Araujo LFS, Cattaruzza MS, Chakraborty PA, Charan J, Chattu VK, Chaurasia A, Cherbuin N, Chu DT, Chudal N, Chung SC, Churko C, Ciobanu LG, Cirillo M, Claro RM, Costanzo S, Cowden RG, Criqui MH, Cruz-Martins N, Culbreth GT, Dachew BA, Dadras O, Dai X, Damiani G, Dandona L, Dandona R, Daniel BD, Danielewicz A, Darega Gela J, Davletov K, de Araujo JAP, de Sá-Junior AR, Debela SA, Dehghan A, Demetriades AK, Derbew Molla M, Desai R, Desta AA, Dias da Silva D, Diaz D, Digesa LE, Diress M, Dodangeh M, Dongarwar D, Dorostkar F, Dsouza HL, Duko B, Duncan BB, Edvardsson K, Ekholuenetale M, Elgar FJ, Elhadi M, Elmonem MA, Endries AY, Eskandarieh S, Etemadimanesh A, Fagbamigbe AF, Fakhradiyev IR, Farahmand F, Farinha CSES, Faro A, Farzadfar F, Fatehizadeh A, Fauk NK, Feigin VL, Feldman R, Feng X, Fentaw Z, Ferrero S, Ferro Desideri L, Filip I, Fischer F, Francis JM, Franklin RC, Gaal PA, Gad MM, Gallus S, Galvano F, Ganesan B, Garg T, Gebrehiwot MGD, Gebremeskel TG, Gebremichael MA, Gemechu TR, Getacher L, Getachew ME, Getachew Obsa A, Getie A, Ghaderi A, Ghafourifard M, Ghajar A, Ghamari SH, Ghandour LA, Ghasemi Nour M, Ghashghaee A, Ghozy S, Glozah FN, Glushkova EV, Godos J, Goel A, Goharinezhad S, Golechha M, Goleij P, Golitaleb M, Greaves F, Grivna M, Grosso G, Gudayu TW, Gupta B, Gupta R, Gupta S, Gupta VB, Gupta VK, Hafezi-Nejad N, Haj-Mirzaian A, Hall BJ, Halwani R, Handiso TB, Hankey GJ, Hariri S, Haro JM, Hasaballah AI, Hassanian-Moghaddam H, Hay SI, Hayat K, Heidari G, Heidari M, Hendrie D, Herteliu C, Heyi DZ, Hezam K, Hlongwa MM, Holla R, Hossain MM, Hossain S, Hosseini SK, hosseinzadeh M, Hostiuc M, Hostiuc S, Hu G, Huang J, Hussain S, Ibitoye SE, Ilic IM, Ilic MD, Immurana M, Irham LM, Islam MM, Islam RM, Islam SMS, Iso H, Itumalla R, Iwagami M, Jabbarinejad R, Jacob L, Jakovljevic M, Jamalpoor Z, Jamshidi E, Jayapal SK, Jayarajah UU, Jayawardena R, Jebai R, Jeddi SA, Jema AT, Jha RP, Jindal HA, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabthymer RH, Kamble BD, Kandel H, Kanno GG, Kapoor N, Karaye IM, Karimi SE, Kassa BG, Kaur RJ, Kayode GA, Keykhaei M, Khajuria H, Khalilov R, Khan IA, Khan MAB, Kim H, Kim J, Kim MS, Kimokoti RW, Kivimäki M, Klymchuk V, Knudsen AKS, Kolahi AA, Korshunov VA, Koyanagi A, Krishan K, Krishnamoorthy Y, Kumar GA, Kumar N, Kumar N, Lacey B, Lallukka T, Lasrado S, Lau J, Lee SW, Lee WC, Lee YH, Lim LL, Lim SS, Lobo SW, Lopukhov PD, Lorkowski S, Lozano R, Lucchetti G, Madadizadeh F, Madureira-Carvalho ÁM, Mahjoub S, Mahmoodpoor A, Mahumud RA, Makki A, Malekpour MR, Manjunatha N, Mansouri B, Mansournia MA, Martinez-Raga J, Martinez-Villa FA, Matzopoulos R, Maulik PK, Mayeli M, McGrath JJ, Meena JK, Mehrabi Nasab E, Menezes RG, Mensink GBM, Mentis AFA, Meretoja A, Merga BT, Mestrovic T, Miao Jonasson J, Miazgowski B, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mini GK, Mirica A, Mirijello A, Mirmoeeni S, Mirrakhimov EM, Misra S, Moazen B, Mobarakabadi M, Moccia M, Mohammad Y, Mohammadi E, Mohammadian-Hafshejani A, Mohammed TA, Moka N, Mokdad AH, Momtazmanesh S, Moradi Y, Mostafavi E, Mubarik S, Mullany EC, Mulugeta BT, Murillo-Zamora E, Murray CJL, Mwita JC, Naghavi M, Naimzada MD, Nangia V, Nayak BP, Negoi I, Negoi RI, Nejadghaderi SA, Nepal S, Neupane SPP, Neupane Kandel S, Nigatu YT, Nowroozi A, Nuruzzaman KM, Nzoputam CI, Obamiro KO, Ogbo FA, Oguntade AS, Okati-Aliabad H, Olakunde BO, Oliveira GMM, Omar Bali A, Omer E, Ortega-Altamirano DV, Otoiu A, Otstavnov SS, Oumer B, P A M, Padron-Monedero A, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pardhan S, Parekh T, Park EK, Parry CDH, Pashazadeh Kan F, Patel J, Pati S, Patton GC, Paudel U, Pawar S, Peden AE, Petcu IR, Phillips MR, Pinheiro M, Plotnikov E, Pradhan PMS, Prashant A, Quan J, Radfar A, Rafiei A, Raghav PR, Rahimi-Movaghar V, Rahman A, Rahman MM, Rahman M, Rahmani AM, Rahmani S, Ranabhat CL, Ranasinghe P, Rao CR, Rasali DP, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Renzaho AMN, Rezaei N, Rezaei S, Rezaeian M, Riahi SM, Romero-Rodríguez E, Roth GA, Rwegerera GM, Saddik B, Sadeghi E, Sadeghian R, Saeed U, Saeedi F, Sagar R, Sahebkar A, Sahoo H, Sahraian MA, Saif-Ur-Rahman KM, Salahi S, Salimzadeh H, Samy AM, Sanmarchi F, Santric-Milicevic MM, Sarikhani Y, Sathian B, Saya GK, Sayyah M, Schmidt MI, Schutte AE, Schwarzinger M, Schwebel DC, Seidu AA, Senthil Kumar N, SeyedAlinaghi S, Seylani A, Sha F, Shahin S, Shahraki-Sanavi F, Shahrokhi S, Shaikh MA, Shaker E, Shakhmardanov MZ, Shams-Beyranvand M, Sheikhbahaei S, Sheikhi RA, Shetty A, Shetty JK, Shiferaw DS, Shigematsu M, Shiri R, Shirkoohi R, Shivakumar KM, Shivarov V, Shobeiri P, Shrestha R, Sidemo NB, Sigfusdottir ID, Silva DAS, Silva NTD, Singh JA, Singh S, Skryabin VY, Skryabina AA, Sleet DA, Solmi M, SOLOMON YONATAN, Song S, Song Y, Sorensen RJD, Soshnikov S, Soyiri IN, Stein DJ, Subba SH, Szócska M, Tabarés-Seisdedos R, Tabuchi T, Taheri M, Tan KK, Tareke M, Tarkang EE, Temesgen G, Temesgen WA, Temsah MH, Thankappan KR, Thapar R, Thomas NK, Tiruneh C, Todorovic J, Torrado M, Touvier M, Tovani-Palone MR, Tran MTN, Trias-Llimós S, Tripathy JP, Vakilian A, Valizadeh R, Varmaghani M, Varthya SB, Vasankari TJ, Vos T, Wagaye B, Waheed Y, Walde MT, Wang C, Wang Y, Wang YP, Westerman R, Wickramasinghe ND, Wubetu AD, Xu S, Yamagishi K, Yang L, Yesera GEE, Yigit A, Yiğit V, Yimaw AEAE, Yon DK, Yonemoto N, Yu C, Zadey S, Zahir M, Zare I, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zhong C, Zmaili M, Zuniga YMH, Gakidou E. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet 2022; 400:185-235. [PMID: 35843246 PMCID: PMC9289789 DOI: 10.1016/s0140-6736(22)00847-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. METHODS For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. FINDINGS The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. INTERPRETATION There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. FUNDING Bill & Melinda Gates Foundation.
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Chander KR, Moirangthem S, Patley R, Philip S, Varshney P, Basavaraju V, Parthasarathy R, Krishna PVM, Manjunatha N, Channaveerachari NK, Math SB. A camp approach of community psychiatry in India: Past, present, and the future. Ind Psychiatry J 2022; 31:191-196. [PMID: 36419705 PMCID: PMC9678157 DOI: 10.4103/ipj.ipj_195_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022] Open
Abstract
Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.
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Affiliation(s)
- K Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Mental Health, Government of Karnataka, Bengaluru, Karnataka, India
| | - P V Mohan Krishna
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Nirisha PL, Bhaskaran AS, Yedavally NA, Suchandra HH, Manjunatha N, Kumar CN, Math SB. First episode psychosis and COVID-19: A case series and mini review. Asian J Psychiatr 2022; 73:103123. [PMID: 35561660 PMCID: PMC9007930 DOI: 10.1016/j.ajp.2022.103123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | | | - Naveen Achyuta Yedavally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India.
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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Philip S, Varshney P, Chander R, Patley R, Dosajh AC, Basavaraju V, Manjunatha N, Kumar CN, Math SB. Telementoring Counseling Skills for Deaddiction Counselors in Punjab During the COVID-19 Pandemic. Indian J Psychol Med 2022; 44:419-421. [PMID: 35949626 PMCID: PMC9301738 DOI: 10.1177/02537176221081777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prateek Varshney
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rakesh Chander
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rahul Patley
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anu Chopra Dosajh
- Dept. of Health and Family Welfare, Mental Health and Deaddiction, Government of Punjab, Chandigarh, Punjab, India
| | - Vinay Basavaraju
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Philip S, Suhas S, Nirisha PL, Pandey P, Manjunatha N, Kumar CN, Math SB. Ethical and legal issues concerning COVID 19 vaccinations in persons with mental illness in India. Ind Psychiatry J 2022; 31:183-190. [PMID: 36419684 PMCID: PMC9678180 DOI: 10.4103/ipj.ipj_228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/22/2022] [Accepted: 05/11/2022] [Indexed: 11/04/2022] Open
Abstract
Mental healthcare in India faces severe challenges amid the ongoing pandemic. India runs the largest vaccination drive globally, including booster doses to rapidly vaccinate its population of over a billion. As persons with mental illness are at greater risk of adverse outcomes from COVID 19, they need prioritized access and administration of these vaccines. This manuscript examines the current legislation and identifies how the legal and ethical frameworks can prioritize COVID 19 vaccinations for persons with mental illness in India through a review of the various legislations of India concerning persons with mental illness and judicial judgments concerning the pandemic and vaccination. Subsequently, we discuss ethical and legal challenges associated with vaccination in this vulnerable population and possible solutions. Based on the current review, the authors recommend the guidelines for capacity assessment for vaccination decisions and discuss existing legal frameworks relevant to the vaccination of persons with mental illness.
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Affiliation(s)
- Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, Karnataka, India
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Ohri U, Nirisha L, Poreddi V, Manjunatha N, Kumar C N, BadaMath S. Dual Clinical Collaborator: A Pragmatic Role of nurses from developing countries. Invest Educ Enferm 2022; 40:e01. [PMID: 36264689 PMCID: PMC9714980 DOI: 10.17533/udea.iee.v40n2e01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Uma Ohri
- National Institute of Mental Health and Neuro Sciences -Institute of National Importance-, Bangalore (India),
| | - Lakshmi Nirisha
- National Institute of Mental Health and Neuro Sciences -Institute of National Importance-, Bangalore (India),
| | - Vijayalakshmi Poreddi
- National Institute of Mental Health and Neuro Sciences -Institute of National Importance-, Bangalore (India),
| | - Narayana Manjunatha
- National Institute of Mental Health and Neuro Sciences -Institute of National Importance-, Bangalore (India),
| | - Naveen Kumar C
- National Institute of Mental Health and Neuro Sciences -Institute of National Importance-, Bangalore (India),
| | - Suresh BadaMath
- National Institute of Mental Health and Neuro Sciences -Institute of National Importance-, Bangalore (India),
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Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, Mehra A, Saha G, Sahoo S, Singh OP, Tripathi A, Gangadhar BN, Math SB. Current telepsychiatry practice in India - An online survey of psychiatrists. Indian J Psychiatry 2022; 64:307-311. [PMID: 35859562 PMCID: PMC9290427 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_331_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 03/14/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines released in 2020 have provided legal backing for telepsychiatry practice. AIMS To understand the current telepsychiatry practices in India. SETTINGS AND DESIGN An online survey was conducted after ethics approval by the IPS Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose email address was available with the society, were sent the survey link by email. METHODS AND MATERIAL Information about existing telepsychiatry consultation practices in India was collected between June and July 2020. STATISTICAL ANALYSIS USED Frequency, percentages, mean, and standard deviation were calculated. RESULTS 340 responses were analyzed. Nearly three-fourths of the responders used smartphones (n = 260, 76.47%) for audio consultations (n = 196, 57.65%). Among those who were using a dedicated software (n = 36), one-third used the Zoom software (n = 12, 33.33%). Nearly three-fourths (n = 218, 73.4%) provided prescriptions with their registration number on a letterhead in the form of an email or text message. Two-thirds of the responders (n = 228, 67.06%) felt that in-person consultation is better. Many preferred a combination of voice, video, and text including emails (n = 134, 42.01%). CONCLUSIONS This online survey showed that the use of technology has caught up with the practicing psychiatrists. Many are practicing telepsychiatry either formally or informally in India and are comfortable and satisfied with the telepractice.
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Affiliation(s)
- Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajit Avasthi
- Department of Psychiatry, Fortis Hospital, Mohali, Punjab, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Barasat, West Bengal, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Singh
- Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Manjunatha N, Jayasankar P, Suhas S, Rao GN, Gopalkrishna G, Varghese M, Benegal V. Prevalence and its correlates of anxiety disorders from India's National Mental Health Survey 2016. Indian J Psychiatry 2022; 64:138-142. [PMID: 35494323 PMCID: PMC9045348 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_964_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Anxiety disorders (ADs) impact the quality of life and productivity at an individual level and result in substantial loss of national income. Representative epidemiological studies estimating the burden of ADs are limited in India. National Mental Health Survey (NMHS) 2016 of India aimed to strengthen mental health services across India assessed the prevalence and pattern of public health priority mental disorders for mental health-care policy and implementation. This article focuses on the current prevalence, sociodemographic correlates, disability, and treatment gap in ADs in the adult population of NMHS 2016. MATERIALS AND METHODS NMHS 2016 was a nationally representative, multicentered study across 12 Indian states during 2014-2016. Diagnosis of ADs (generalized AD, panic disorder, agoraphobia, and social AD) was based on Mini-International Neuropsychiatric Interview 6.0.0. Disability was by Sheehan's Disability Scale. RESULTS The current weighted prevalence of ADs was 2.57% (95% confidence interval: 2.54-2.60). Risk factors identified were female gender, 40-59 age group, and urban metro dwellers. Around 60% suffered from the disability of varying severity. The overall treatment gap for ADs was 82.9%. CONCLUSIONS The burden of AD is similar to Depressive disorders, and this article calls for the immediate attention of policymakers to institute effective management plans in existing public health programs.
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Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pavithra Jayasankar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N Rao
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gururaj Gopalkrishna
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Basavaraju V, Murugesan M, Kumar CN, Gowda GS, Tamaraiselvan SK, Thirthalli J, Nagabhushana SH, Manjunatha N, Bada Math S, Parthasarathy R, Arunachalam V, Kumar Ks C, Am A, H C. Care at door-steps for persons with severe mental disorders: A pilot experience from Karnataka district mental health program. Int J Soc Psychiatry 2022; 68:273-280. [PMID: 33356744 DOI: 10.1177/0020764020983856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public funded outreach services for persons with severe mental disorders (SMDs), a norm in developed nations, is non-existent in India. We share our pilot experience with an indigenous model named 'Care at Doorsteps' (CADs) for persons with SMDs who dropped out from clinical care of District Mental Health Program (DMHP) at three sites of Karnataka, a south Indian state. AIM The objectives of this study were to identify the reasons for drop outs from routine care and to assess the burden of illness and disability after the intervention. METHODOLOGY Six-month prospective observational study on patients aged 18-60 years, diagnosed as Schizophrenia or bipolar disorder was conducted. Three home visits were made by the team and provided medications, also offered brief psychoeducation and counselling. Care-givers were interviewed to identify the reasons for drop outs and their expectations from the treating team. Patients were also assessed using the Clinical Global Impression Scale (CGI), Indian Disability Evaluation and Assessment Scale (IDEAS) and Burden Assessment Schedule (BAS) during each visit. RESULTS Ninety-six patients (50 males and 46 females) were followed up, of which 85 had a diagnosis of schizophrenia and 11 with bipolar illness. Common reasons for drop out were: single caregiver (breadwinner) unable to accompany the patient, loss of faith in medical treatment and financial constraints. Symptomatic improvement and restoration of productive work were the priority expectations. Over the course, the mean CGI-S showed significant reduction (4.81 ± 1.57, 4.46 ± 1.32 and 4.11 ± 1.39 respectively; p = 0.001). Mean score on BAS showed a significant reduction (85.76 ± 12.15, 83.46 ± 11.30, 84.27 ± 11.82; p = 0.04). Mean total IDEAS scores did not show significant change (13.27 ± 4.78, 12.82 ± 4.24, 13.17 ± 4.40; p = 0.16). CONCLUSION Meaningful assertive outreach care is feasible in India and is found to be useful for persons with SMDs by utilising the already existing public sector resources.
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Affiliation(s)
- Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Manisha Murugesan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Vikram Arunachalam
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Chetan Kumar Ks
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Adarsha Am
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Chandrashekar H
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, Mehra A, Saha G, Sahoo S, Singh OP, Tripathi A, Gangadhar BN, Math SB. The prescriptions of psychotropic medications in telepsychiatry: An online survey of psychiatrists in India. Indian J Psychiatry 2022; 64:159-163. [PMID: 35494322 PMCID: PMC9045339 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1438_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Over the years, telepsychiatry services have expanded in many institutes. The Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines (TPOG) released in 2020 have been received by the fraternity with a mixture of apprehension, relief, and dissatisfaction on the list of drugs provided in Lists O, A, B, and C. Many psychiatrists have raised the issues of having a consensus in the formulation of List A. AIMS To draw consensus on the medications that can be listed in Lists O, A, B, and C in TPOG-2020. SETTINGS AND DESIGN This was an online survey with ethics approval by the Indian Psychiatric Society Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose E-mail address was available with the society, were sent the survey link by E-mail. METHODOLOGY Opinions and suggestions on Lists O, A, B, and C of TPOG-2020 and reasons for the suggestions were collected. STATISTICAL ANALYSIS USED Frequency, percentages, mean, and standard deviation were calculated. T-test and Chi-square tests were used to see the influence of demographics on the concurrence of the lists. RESULTS Responses from 340 responders were analyzed. Majority of the responders agreed that List O (277, 85.5%), List B (263, 82.4%), and List C (223, 69%) are apt except for List A (162, 50.3%). CONCLUSIONS This online survey showed that majority of the responders agreed to the lists except for List A. The approach taken to include the medications in List A, which was to include the essential drugs, has various benefits. However, the lists are not final, and the results of this survey may become an impetus to modify the list in the next edition of TPOG.
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Affiliation(s)
- Chethan Basavarajappa
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Channaveerachari Naveen Kumar
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Barasat, Kolkata, West Bengal, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Singh
- Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bangalore N Gangadhar
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Channaveerachari NK, Manjunatha N, Mukesh J, Damodharan D, Dass GP. The Psychiatrist as an Expert Witness. Indian J Psychiatry 2022; 64:S42-S46. [PMID: 35599660 PMCID: PMC9122128 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_721_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 12/04/2022] Open
Abstract
A psychiatrist, in India, unlike in the western developed world often is required to play dual role of being a treating psychiatrist and that of an expert witness for the same patient. In the clinical scenario, the principle of therapeutic alliance comes into play, while in the court of law, he/she needs to play the role of assisting the judicial system to deliver "justice." Psychiatrist role in the court is directed by the court rules and not by the clinical rules. This chapter aims to describe the various roles played by the psychiatrist in the court room and provides a basic outline of the medicolegal expectations from a psychiatrist.
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Affiliation(s)
| | | | | | | | - Garg Parshotam Dass
- Department of Psychiatry, Government Medical College, Amritsar, Punjab, India
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Philip S, Patley R, Chander R, Varshney P, Dosajh AC, Vinay B, Manjunatha N, Kumar CN, BadaMath S. A report on successful introduction of tele mental health training for primary care doctors during the COVID 19 pandemic. Asian J Psychiatr 2022; 68:102967. [PMID: 34953218 PMCID: PMC8694884 DOI: 10.1016/j.ajp.2021.102967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
Treatment gaps of 60-70%, reflecting, amongst many other factors, Human Resources shortfalls means that 150 million India never accessed mental healthcare. In Punjab, mental health training is required in primary health centers. A short-term synchronous training was conceptualized by the National Institute of Mental Health and Neurosciences. A total of 114 primary care doctors participated for the training. Substantial positive changes in knowledge, attitudes and practices were noted. Task sharing and capacity building initiatives can be undertaken during the pandemic to meet the demand for mental healthcare service delivery.
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Affiliation(s)
- Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Anu Chopra Dosajh
- Mental Health and Deaddiction, Department of Health and Family Welfare, Government of Punjab, India.
| | - B Vinay
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - N Manjunatha
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - C Naveen Kumar
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Suresh BadaMath
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
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Dinakaran D, Manjunatha N, Kumar CN, Math SB, Thirthalli J. The rationale and guiding principles to design a psychiatry curriculum for primary care doctors of India. Natl Med J India 2022; 35:32-37. [PMID: 36039625 DOI: 10.25259/nmji_289_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Integrating psychiatric care into the general practice of primary care doctors (PCDs) is necessary to overcome the shortage of human resources to cater to the burgeoning public mental health needs of India. The traditional psychiatry curriculum is often top-down and specialist-based that contributes little in terms of skill quotient. We designed an innovative, digitally driven, distance education-based, part-time, modular-based Primary Care Psychiatry Programme (PCPP, skill-based). It is being implemented across many states of India to equip PCDs with skills to provide first-line psychiatry treatment. We discuss the rationale and guiding principles behind designing the curriculum of PCPP. Discussion There are nine guiding principles behind designing and implementing PCPP to provide pragmatic, acceptable, feasible modules of higher translational quotient (TQ) that are essential to upskill PCDs. There is a shift in training the location of PCDs in their live brief general consultations utilizing innovative telemedicine-based 'on-consultation training' (OCT) augmented with collaborative video consultations. A monolithic treatment protocol-driven, trans-diagnostic approach is used to design a concise, all-inone, point-of-care manual containing a culturally sensitive, rapid, validated screener and taxonomy, called 'Clinical Schedules for Primary Care Psychiatry'. This incorporates the PCDs' style of clinical practice that helps in picking up the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPP curriculum contains pragmatic modules with higher TQ. This curriculum is dynamic as the learning is bi-directional. This can be used by policy-makers, innovators and academia for integration with national health programmes such as those for non-communicable diseases and reproductive and child health.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Ram D, Manjunatha N. Panic disorder in general medical practice- A narrative review. J Family Med Prim Care 2022; 11:861-869. [PMID: 35495823 PMCID: PMC9051703 DOI: 10.4103/jfmpc.jfmpc_888_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
The under-or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common among non-psychiatric physicians. The non-psychiatrist physician’s role is vital in the care of PD as most patients initially approach general medical settings for medical help, including primary care. However, a significant proportion is undiagnosed and undergoes either unnecessary investigation, misdiagnosed, or mismanaged even among post-Coronary Artery Bypass Grafting patients, which profoundly affects the patients functioning and quality of life. This article aims to provide overviews of relevant epidemiological aspects, presenting features across medical specialties with respective diagnostic dilemmas, assessment, and management of the PD in their general medical settings, including emergency visits. Apart from psychiatrists, this will also assist non-psychiatrist physicians across all medical specialties, including general practitioners, to understand, identify, and provide the first line evidence-based pharmacotherapy and address the unmet need of patients with PD in their day-to-day busy clinical practice. This paper also provides a referral guide for non-psychiatrist physicians to refer to psychiatrists for further management after their first-line management.
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Manjunatha N, Chander KR, Kumar C, Math S. Video consultations with “Paper and Pen” health record: A path-breaking solution to troubleshoot acceptability of telemedicine practice in developing countries. Indian J Public Health 2022; 66:527-528. [PMID: 37039190 DOI: 10.4103/ijph.ijph_1463_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Telemedicine is the delivery of health care from a distance. It also includes research and evaluation of such services using health data which are stored in "Electronic Health Record" (EHR) platforms. EHR has proved to be useful in monitoring health care delivery but setting up of such platforms is tedious and resource-consuming in developing countries. With the recent surge of telemedicine utility during the COVID-19 pandemic, telemedicine has emerged to be pivotal in reaching stranded patients needing care without EHR-based practice. The practice of patient health record (PHR)-based teleconsultations in India has demonstrated how a conventional "paper and pen" method can be combined to popularise telemedicine utility. Thus, use of PHR-based system to maintain health records would prove to be a pragmatic solution for physicians in low-resource settings to improve their reach to a larger population in need for the future.
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Jayasankar P, Manjunatha N, Rao GN, Gururaj G, Varghese M, Benegal V. Epidemiology of common mental disorders: Results from "National Mental Health Survey" of India, 2016. Indian J Psychiatry 2022; 64:13-19. [PMID: 35400745 PMCID: PMC8992756 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_865_21] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/06/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite their higher prevalence, the Common Mental Disorders (CMDs) are under-recognized and under-treated resulting in huge disability. India, home to one-fifth of the global population, could offer insights for organizing better services for CMDs. However, the prevalence and resultant disability in the general population is unknown, and consequently, gaps in management or plan for services are enormous, by default overlooked. AIM Estimating the current prevalence, disability, socioeconomic impact, and treatment gap of CMDs in a nationally representative sample from India. We attempt to identify the missed opportunities and list priorities for planning. METHODOLOGY The National Mental Health Survey of India (2016) is a multisite nationwide household survey conducted across India using a uniform methodology. Overall, 39,532 adults were surveyed with a response rate of 88%. Diagnoses are based on the Mini International Neuropsychiatric Interview 6.0.0. CMDs for this analysis include depressive and anxiety disorders (generalized anxiety disorder, social phobia, agoraphobia, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder). RESULTS The weighted prevalence of current CMDs was 5·1% (95% CI: 5.06-5.13). Prevalence was highest in females, among the 40-59 years of age group, and in metros. Nearly 60% of them reported disabilities of varying severity. The treatment gap was 80·4%. On average, patients and their families spent ₹1500/month towards the treatment of CMDs. CONCLUSIONS This survey gives valuable insights regarding the disability and treatment gap due to CMDs and is imperative for reframing mental health policies and planning interventions. This study also suggests an international investigation to understand the difference in the prevalence of CMDs in developing versus developed countries.
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Affiliation(s)
- Pavithra Jayasankar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, WHO Collaborative Centre for Injury Prevention and Safety Promotion, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Mary Kapanee A, Meena K, Nattala P, Manjunatha N, Sudhir P. Design and development of a training video for Accredited Social Health Activists (ASHAs) on brief psychological intervention for depression. J Family Med Prim Care 2022; 11:3862-3867. [PMID: 36387707 PMCID: PMC9648232 DOI: 10.4103/jfmpc.jfmpc_573_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Depression poses a major public health burden and has a large treatment gap in India. The study attempts to address this treatment gap by developing a training video for Accredited Social Health Activists (ASHAs), who are community health workers, on brief psychological intervention for depression. Methods: The systematic steps utilized in the design and development of the training video on depression were: 1) Content development of the video script and training booklet for ASHAs based on the review of research literature and two Focus Group Discussions, 2) Mental Health Professionals’ evaluation of the video script and training booklet for ASHAs, 3) Translation from English to Kannada, 4) ASHAs’ evaluation of the video script and training booklet for ASHAs, 5) Conversion of the video script into a ‘shooting script’, 6) Video production, 7) Evaluation of the training video, 8) Post-production of the training video, and 9) Development of the training guide. Results: The training video titled “Light of Hope: A Training Video on Depression” was developed along with two training booklets, which are complementary resource materials, for ASHAs and the training Facilitators. The brief psychological intervention for depression elucidated in the training video incorporates the evidence-based strategies of Psychoeducation, Activity Scheduling, Problem-Solving Skills Training, and Diaphragmatic/Abdominal Breathing Skills Training. Conclusion: The study demonstrates the systematic approach that can be employed for the design and development of a mental health training video, which has evidence-based content, incorporates stakeholders’ evaluative perspectives, and is culturally contextualized.
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Kumar C, Varshney P, Malathesh B, Nirisha PL, Harshitha N, Kulal N, Gajera G, Suhas S, Rahul P, Harshitha HA, Manjunatha N, Manjappa A, Math S, Thirthalli J. Stake holder perspectives on the role of accredited social health activists (ASHAs) in Indian public mental healthcare space: A qualitative study. J Family Med Prim Care 2022; 11:7308-7315. [PMID: 36993024 PMCID: PMC10041250 DOI: 10.4103/jfmpc.jfmpc_543_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Community health workers such as Accredited Social Health Activists (ASHAs) are existing resources who can facilitate the bridging of the mental health treatment gap. Knowing about the perspectives of ASHAs in delivering mental health care and other professionals with experience working in the area of community mental health is imperative. Method As part of an implementation research project aimed at comparing the effectiveness of two training methods for community health workers (ASHAs), we conducted five focussed group discussions including four with ASHAs (n = 34) and one with other stakeholders (n = 10). Focussed Group Discussion (FGD) was conducted under the following themes: acceptance and feasibility of provision of mental health services from ASHA's point of view and understanding the supply and demand side opportunities and challenges. The discussion began with open-ended questions, allowing for new themes to emerge until saturation was reached. Results ASHAs were willing to incorporate mental health identification (and referral) in their regular activities without additional perceived burden. ASHAs were easily able to identify severe mental disorders (SMDs). For substance use disorders (SUDs), due to factors such as normalization of substance consumption and stigma, there was a felt difficulty in the recognition by ASHAs. ASHAs' difficulty in identifying the CMDs was because of poor awareness in both those with mental illness and ASHAs. Incentivizing the work of ASHAs was thought to yield more returns. Conclusions ASHAs have the potential to be excellent resources for easy screening, identification, and follow-up of those with mental health concerns in the community. Policies to involve them need to evolve.
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Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, Sahoo S, Saha G, Mehra A, Singh OP, Tripathi A, Gangadhar BN, Math SB. Perceived advantages and disadvantages of telepsychiatry - An online survey of psychiatrists in India. Indian J Psychiatry 2022; 64:93-97. [PMID: 35400742 PMCID: PMC8992744 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_332_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/11/2021] [Accepted: 12/23/2021] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Telepsychiatry is being practiced in India for many years but was formalized only in 2020. It has many advantages and disadvantages. AIMS This study aimed to understand the perceived advantages and disadvantages of telepsychiatry practices in India. SETTINGS AND DESIGN An online survey with ethics approval by the Indian Psychiatric Society (IPS) Ethics Review Board. All psychiatrists who are members of the IPS and whose email address was available with the society were sent the survey link by email. METHODOLOGY Information about existing telepsychiatry consultation practices in India and perception of advantages and disadvantages by the practitioners were collected between June and July 2020. STATISTICAL ANALYSIS Frequency, percentages, mean, and standard deviation were calculated. RESULTS Responses by 340 responders were analyzed. Majority of the responders felt that telepsychiatry would provide easy accessibility to mental health services (n = 283, 83.24%) and would lead to less exposure to infections (n = 222, 65.29%). Half of the responders (n = 177, 52.06%) felt that there would be an increased doctor shopping resulting in poor care and nearly three-fourth (n = 245, 72.06%) felt that mental health professionals would fall into a problem while dealing with a suicidal or a homicidal patient. Some expressed that the inability to do physical and central nervous system examinations could lead to missing out comorbidities. About one-third (n = 117, 36.56%) felt that the patient recording the consultation would be a legal issue. CONCLUSIONS This online survey showed that psychiatrists perceive many advantages and some disadvantages in practicing telepsychiatry.
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Affiliation(s)
- Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Barasat, Kolkata, West Bengal, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Singh
- Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Malathesh BC, Bairy BK, Kumar CN, Nirisha PL, Gajera GV, Pandey P, Manjunatha N, Ganesh A, Mehrotra K, Bhaskarapillai B, Gunasekaran DM, Arora S, Sinha NK, Math SB. Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India. Psychiatr Q 2021; 92:1855-1866. [PMID: 34510379 DOI: 10.1007/s11126-021-09945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10 months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0-20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0-10). Total 20,909 patients were cared for in the 12 months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t = - 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.
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Affiliation(s)
| | - Bhavya K Bairy
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - P Lakshmi Nirisha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopi V Gajera
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aurobind Ganesh
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kanika Mehrotra
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjeev Arora
- Distinguished Professor of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Suchandra HH, Bhaskaran AS, Manjunatha N, Kumar CN, Bada Math S, Reddi VSK. Suicide prevention in the context of COVID-19: An Indian perspective. Asian J Psychiatr 2021; 66:102858. [PMID: 34601291 PMCID: PMC8434885 DOI: 10.1016/j.ajp.2021.102858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
The ongoing COVID-19 pandemic has impacted the health and wellbeing of communities worldwide. Measures to limit transmission, have enhanced vulnerability of individuals to well identified risk factors associated with mental illness and suicide. These include a sense of loneliness, anxiety, depression, insomnia, PTSD, harmful alcohol and drug use. Given that the potential for increased rates of suicide persist, the suicide prevention agenda remains urgent and essential. The same is one of the cornerstones of resilience in a society that is facing an array of challenges due to the pandemic. In this article, we recommend few possible strategies for attenuating suicide risk amidst the COVID-19 pandemic with particular relevance to the Indian context.
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Affiliation(s)
- Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Venkata Senthil Kumar Reddi
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
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Chander R, Murugesan M, Ritish D, Damodharan D, Arunachalam V, Parthasarathy R, Raj A, Sharma MK, Manjunatha N, Bada Math S, Kumar CN. Addressing the mental health concerns of migrant workers during the COVID-19 pandemic: An experiential account. Int J Soc Psychiatry 2021; 67:826-829. [PMID: 32594816 DOI: 10.1177/0020764020937736] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID pandemic has affected the world in a drastic manner taking a toll of not only human lives but also the economy and lifestyle. Of all the population suffering, the underprivileged and vulnerable groups have faced the maximum economic burden. Within India, an ample quota of people migrates annually for elementary occupations in service, sales, building and domestic industries. Generally, they are exposed to discrimination, work-rights exploitation and job insecurity. The onset of COVID 19 has accentuated these issues in unprecedented ways. The Apex Court of the country took note of this plight and gave directions to the governments to take care of the immediate needs of the migrant workers. This article attempts to reflect the mental health concerns of the migrant workers who were temporarily sheltered at relief camps across Bengaluru city in the state of Karnataka, during the ongoing COVID pandemic. The article ends with giving recommendations.
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Affiliation(s)
- Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manisha Murugesan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Daniel Ritish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dinakaran Damodharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vikram Arunachalam
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Aravind Raj
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manoj Kumar Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Nirisha PL, Pahuja E, Manjunatha N, Gupta R, Channaveerachari NK, Math SB. Digitally driven primary care psychiatry program is impactful in real-world scenario. Indian J Psychiatry 2021; 63:619-621. [PMID: 35136267 PMCID: PMC8793722 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_630_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, Tele Medicine Centre, Primary Care Psychiatry Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Erika Pahuja
- Department of Psychiatry, Tele Medicine Centre, Primary Care Psychiatry Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, Primary Care Psychiatry Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India E-mail:
| | - Naveen Kumar Channaveerachari
- Department of Psychiatry, Tele Medicine Centre, Primary Care Psychiatry Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele Medicine Centre, Primary Care Psychiatry Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Manjunatha N, Kumar CN, Math SB. Virtual physical examination in video consultations: A valid inspection component of physical examination? Natl Med J India 2021; 34:122. [PMID: 34599133 DOI: 10.4103/0970-258x.326756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Singh NG, Kumar KN, Nagaraja PS, Manjunatha N. In response to describing right ventricular dysfunction: Diagnostic accuracy studies and sources of bias. Ann Card Anaesth 2021; 24:515-516. [PMID: 34747775 PMCID: PMC8617395 DOI: 10.4103/aca.aca_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/08/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Naveen G. Singh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Karthik Narendra Kumar
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - P S Nagaraja
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - N Manjunatha
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
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More P, Kumar V, Usha Rani MR, Philip M, Manjunatha N, Varambally S, Gangadhar BN. Development, validation, and feasibility of a generic yoga-based intervention for Generalized Anxiety Disorder. Complement Ther Med 2021; 63:102776. [PMID: 34571143 DOI: 10.1016/j.ctim.2021.102776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Evidence suggests that yoga effectively manages anxiety, but techniques are derived from different yoga schools. This paper describes the development, validation, and feasibility of a generic yoga-based intervention in patients with Generalized Anxiety Disorder (GAD). METHODS The first part of the study consisted of designing a generic yoga module from the traditional and contemporary yogic literature and inputs from ten experienced yoga practitioners. The content was validated using a case-vignette method from 28 yoga experts. These yoga experts rated the usefulness of the practices on a scale of 1-5 (5-extremely useful). The second part consisted of testing the feasibility of this validated generic yoga intervention in an open-label clinical trial in patients with GAD. Two weeks of ten supervised yoga sessions (SYS) were offered by a trained yoga therapist to the recruited participants and subsequently advised for home practice. A weekly booster SYS was also provided for three months after 10SYS. RESULTS Yoga experts (n = 28) opined that the yoga intervention would be helpful in patients with GAD with minimal modifications. All experts opined that the module was easy to teach, learn and practice. The final yoga module retained 97.7% (42 out of 43) items of the initial module. In the feasibility study, (n = 20) patients were recruited, and fifteen followed-up after one month. All patients were able to learn and practice the final yoga module within ten sessions without any significant adverse effects. The severity of anxiety reduced substantially after the ten days of SYS and this improvement was sustained for the next 4 weeks. CONCLUSION The designed generic yoga intervention was validated by yoga experts and found safe and feasible in patients with GAD. Patients obtained significant symptom reductions which need to be confirmed in randomized controlled trials.
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Affiliation(s)
- Pooja More
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Vinod Kumar
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - M R Usha Rani
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Shivarama Varambally
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
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50
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Rangarajan SK, Sivakumar PT, Manjunatha N, Kumar CN, Math SB. Public Health Perspectives of Geriatric Mental Health Care. Indian J Psychol Med 2021; 43:S1-S7. [PMID: 34732947 PMCID: PMC8543608 DOI: 10.1177/02537176211047963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In older adults (aged 60 years and above), mental health problems are gaining public health importance because of the increasing prevalence, disease burden, disability, morbidity, and mortality. Epidemiological studies on major mental health disorders such as depression and dementia in older adults have contributed to a better understanding of the distribution and determinants of these conditions. Identifying potential risk factors has stimulated interventional research on preventing these conditions under the public health framework towards their management. The increasing burden of geriatric mental health conditions like dementia in developing countries like India can contribute to significant challenges if there is no adequate strengthening of the public health response. This includes scaling up the measures of prevention, public awareness, early diagnosis, and quality health and social care equitably available to all sections of the population. The Decade of Healthy Ageing (2021-2030) provides the opportunity for concerted and coordinated initiatives to improve intrinsic capacity (physical and mental) and offer an age-friendly environment to enhance the functional ability of all older adults. METHODS This article reviews the critical public health issues related to geriatric mental health in India.
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Affiliation(s)
- Subhashini K. Rangarajan
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Dept. of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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