Self-reported mental health difficulties were of limited use when screening for psychiatric diagnoses in adults born small for gestational age at term

AIM

Being born small for gestational age (SGA) at term increases the risk of adverse health outcomes. We examined whether self-reported mental health differed between adults born SGA and non-SGA at term and could be used to screen for psychiatric diagnoses.

METHODS

We used the Strengths and Difficulties Questionnaire to gather data from 68 participants born SGA and 88 non-SGA controls at a mean age of 26.5 years. Group differences were analysed by linear regression. We calculated the area under the curve and the sensitivity, specificity and predictive values for psychiatric diagnoses.

RESULTS

The mean total difficulties score was 1.9 (95% confidence interval 0.4-3.5) points higher for participants born SGA. They also reported more internalising and emotional problems (p < 0.05). The areas under the curve were 0.82 and 0.68 in the SGA and control groups, respectively. Among participants born SGA, the 90th percentile cut-off had a sensitivity of 0.38, a specificity of 0.93 and positive and negative predictive values of 0.75 and 0.71. The 80th percentile cut-off had higher sensitivity and lower specificity.

CONCLUSION

Adults born SGA reported more mental health difficulties than non-SGA controls. The low sensitivity using the 90th percentile cut-off suggests that a lower cut-off should be considered.

Prevalence of Psychiatric Morbidity and Alcohol use Disorders Among Adolescent Indigenous Tribals from Three Indian States

Background

Among the Indian adolescents, the prevalence of psychiatric morbidity and alcohol use disorders (AUD) are 7.3% and 1.3%. However, no separate data are available for indigenous tribal populations. This study estimated the prevalence of psychiatric morbidity and AUD and associated socio-demographic factors among adolescents in the tribal communities in three widely varying states in India.

Methods

Using validated Indian versions of the MINI 6.0, MINI Kid 6.0, and ICD-10 criteria, we conducted a cross-sectional survey from January to May 2019 in three Indian sites: Valsad, Gujarat (western India); Nilgiris, Tamil Nadu (south India); and East Khasi Hills district of Meghalaya (north-east India) on 623 indigenous tribal adolescents.

Results

Aggregate prevalence of any psychiatric morbidity was 15.9% (95% CI: 13.1-19.0) (males: 13.6%, 95% CI: 10.0-18.1; females: 17.9%, 95% CI: 13.9-22.6), with site-wise statistically significant differences: Gujarat: 23.8% (95% CI: 18.1-30.2), Meghalaya: 17.1% (95% CI: 12.4-22.7), Tamil Nadu: 6.2% (95% CI: 3.2-10.5). The prevalence of diagnostic groups was mood disorders 6.4% (n = 40), neurotic- and stress-related disorders 9.1% (n = 57), phobic anxiety disorder 6.3% (n = 39), AUD 2.7% (n = 17), behavioral and emotional disorders 2.7% (n = 17), and obsessive-compulsive disorder 2.2% (n = 14). These differed across the sites.

Conclusion

The prevalence of psychiatric morbidity in adolescent tribals is approximately twice the national average. The most common psychiatric morbidities reported are mood (affective) disorders, neurotic- and stress-related disorders, phobic anxiety disorder, AUD, behavioral and emotional disorders, andobsessive-compulsive disorder.

Prevalence of psychiatric morbidity and cognitive impairment among non-communicable disease patients in Southern Chennai, Tamil Nadu

Introduction

According to the WHO, non-communicable diseases cause 71% of all deaths globally. Despite many studies showing a significant association between non-communicable diseases (NCDs) and cognitive decline, it is not researched in Tamil Nadu. Hence, this study was conducted to screen for psychiatric morbidity and cognitive impairment (CI) among NCD patients in Southern Chennai.

Aims

The aim of this study was to estimate the prevalence of psychiatric morbidity and CI and their associated factors among NCD patients attending NCD clinics of tertiary care hospitals.

Methods and Material

A cross-sectional study was carried out in NCD patients (n = 343) attending an NCD clinic in a tertiary care hospital. Basic sociodemographic and clinical details were obtained by a semi-structured questionnaire. Cognition function and psychiatric morbidity were assessed using mini-mental state examination, patient health questionnaire 9 and generalised anxiety disorder 7 tools, respectively.

Results

The mean age of the study participants was 58 years. Of 343 participants, 19.2% had severe CI, 26.8% had severe depression, and 29.7% had severe anxiety. Among 180 participants aged 59-86 years, 25.5% participants had osteoarthritis; of these, 41.3% had severe CI (P < 0.0001), 82.6% had severe depression (P < 0.0001) and 63% had severe anxiety (P < 0.027), and their association was statistically significant.

Conclusions

This study concludes that about one-fourth of the NCD patients suffered from CI and psychiatric morbidity, which are of rising concern. Musculoskeletal diseases are neglected to be assessed under NCDs, and in this study, osteoarthritis was found to be significantly associated with depression, anxiety and CI.

Living with and without an intestinal stoma: Factors that promote psychological well-being and self-care: A cross-sectional study

AIMS

This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self-care in stoma patients in the future.

DESIGN

A cross-sectional and comparative study design was employed.

METHODS

Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well-being.

RESULTS

Of 278 participants aged 18-68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one-fifth experienced problems with stoma management. Psychological well-being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly).

Have the psychiatric needs of people seeking gender reassignment changed as their numbers increase? A register study in Finland

BACKGROUND

The number of people seeking gender reassignment (GR) has increased everywhere and these increases particularly concern adolescents and emerging adults with female sex. It is not known whether the psychiatric needs of this population have changed alongside the demographic changes.

METHODS

A register-based follow-up study of individuals who contacted the nationally centralized gender identity services (GIS) in Finland in 1996-2019 (gender dysphoria [GD] group, n = 3665), and 8:1 age and sex-matched population controls (n = 29,292). The year of contacting the GIS was categorized to 5-year intervals (index periods). Psychiatric needs were assessed by specialist-level psychiatric treatment contacts in the Finnish Care Register for Hospital Care in 1994-2019.

RESULTS

The GD group had received many times more specialist-level psychiatric treatment both before and after contacting specialized GIS than had their matched controls. A marked increase over time in psychiatric needs was observed. Among the GD group, relative risk for psychiatric needs after contacting GIS increased from 3.3 among those with the first appointment in GIS during 1996-2000 to 4.6 when the first appointment in GIS was in 2016-2019. When index period and psychiatric treatment before contacting GIS were accounted for, GR patients who had and who had not proceeded to medical GR had an equal risk compared to controls of needing subsequent psychiatric treatment.

CONCLUSION

Contacting specialized GIS is on the increase and occurs at ever younger ages and with more psychiatric needs. Manifold psychiatric needs persist regardless of medical GR.

Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture

Background

To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group.

Materials and Methods

The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group.

Results

Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05).

Conclusions

The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.

Psychiatric comorbidities in patients suffering from systemic lupus erythematosus admitted to a tertiary care hospital in Northern India

BACKGROUND

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multiorgan involvement presenting with a myriad of symptoms, including neuropsychiatric symptoms. Although many studies have evaluated screening questionnaires based psychiatric morbidity, very few studies have used contemporary diagnostic criteria.

OBJECTIVE

This study aimed to evaluate the prevalence of psychiatric disorders in patients with SLE admitted to a tertiary care hospital.

METHODS

A total of 79 patients diagnosed with SLE for at least for 1 year, who were not in delirium were assessed by a qualified psychiatrist for psychiatric morbidity as per the International Classification of Diseases, 10th Revision (ICD-10) criteria. Additionally, these patients were assessed on Patient Health Questionnaire-9 (PHQ-9) item version, Patient Health Questionnaire-15 (PHQ-15) item version, Generalized Anxiety Disorder-7 item scale and Montreal Cognitive Assessment (MoCA).

RESULTS

51% (n = 40) of the participants were diagnosed with a psychiatric diagnosis, with depressive disorders being the most common, seen in 36.7% (n = 29) of the participants. Additionally, 10% (n = 8) participants were diagnosed with adjustment disorder and 2.5% (n = 2) were diagnosed with anxiety (not otherwise specified). Only one patient was diagnosed with organic psychosis. On PHQ-9, 39.8% (n = 33) were diagnosed with depression. 44.3% (n = 35) expressed death wishes and/or suicidal ideations. On PHQ-15, 17.7% (n = 14) of the participants scored for severe somatic distress (score >15). On GAD-7, 55.7% (n = 44) screened positive for anxiety symptoms, but only 7.6% (n = ) had a score of 15 or more to indicate severe anxiety. Nearly half (n = 43; 52%) of the participants also had cognitive impairment as assessed on MoCA, with 13.3% (n = 11) of the participants having scores indicating severe dementia.

CONCLUSIONS

Patients with SLE have a high prevalence of psychiatric comorbidities and should be routinely screened for psychiatric morbidity. They should be appropriately treated, to improve the overall treatment outcomes.

Effect of Postoperative Adjuvant Radiotherapy on Quality of Life, Anxiety, and Depression in Adult Female Breast Cancer Patients

Aim: This study aims to identify anxiety and depression caused by adjuvant radiotherapy in breast cancer cases to determine the deterioration in the quality of life and investigate the effect of early treatment.

Materials and Methods: In this study, the Beck Depression Inventory, Beck Anxiety Inventory, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30) Turkish 3.0 forms were evaluated in 63 breast cancer patients before the start of radiotherapy treatment (T1) and at six weeks after the end of radiotherapy treatment (T2).

Results: A high level of anxiety was detected in 77.8% of patients, and depression was found in 25.4% of patients in T1. When depressive cases were evaluated with EORTC QLQ-C30 scores, the general health status (p = 0.043), role function (p = 0.027), emotional (p < 0.002), cognitive (p < 0.001), and social (p < 0.0001) scales were statistically lower in T1, whereas pain (p = 0.045) and insomnia (p < 0.0001) symptoms were higher in T1. Anxiety and EORTC QLQ-C30 scores in terms of emotional function (p = 0.015), social function (p < 0.003), and symptoms of insomnia (p = 0.027) were found to be statistically higher in T1 anxious cases. However, anxiety was detected in only 3% of T2 cases, and no depression was found in any of the cases. Anxiety and EORTC QLQ-C30 scores and symptom scales were evaluated in terms of role function (p < 0.0001), emotional (p = 0.041) and social scales (p = 0.014), fatigue (p = 0.028), pain (p = 0.033), insomnia (p = 0.011), and constipation (p < 0.0001); these were found to be statistically significant in T2.

Conclusion: This study revealed that early diagnosis and treatment of anxiety before initiating adjuvant radiotherapy reduces the development of long-term anxiety-related depression in the future. Therefore, it is recommended that patients be evaluated for anxiety and depression before starting adjuvant radiotherapy.

Psychiatric Morbidity, Utilization and Quality of Mental Health Care in Long-Term Unemployed People

Research has shown complex interactions between unemployment and mental health. However, the prevalence of specific mental disorders, utilization of mental health care services and influences on help-seeking behavior have been investigated surprisingly little in the past. In this study, we investigated a sample of long-term unemployed people in a cooperation program of the local unemployment agency and a psychiatric university hospital in a larger city in Germany. Mental disorders, treatment history, accordance of treatment to national treatment guidelines and factors influencing previous treatment were assessed. Participants (n = 879; male 56%, female 44%, mean age 43.9 years) showed a high psychiatric morbidity, mostly with diagnoses from the ICD-10 categories F1 (22%), F3 (61%) and F4 (68%). Currently, 18% were in psychiatric treatment, 6% were in psychotherapeutic treatment, and 28% received psychopharmacological treatment. Mostly young men underutilized the psychiatric-psychotherapeutic system, with middle-aged men and women being most frequently in psychopharmacological treatment. Of those treated, only about 10% of the subjects currently received a treatment according to national guidelines. The utilization of psychotherapeutic treatment was strikingly poor. This study identified high psychiatric morbidity and severe treatment gaps in unemployed people. These results can help to target subjects with specific needs for interventions and to modify counseling programs.

A scoping review of psychiatric conditions associated with chronic pain in the homeless and marginally housed population

The present review sought to examine and summarise the unique experience of concurrent pain and psychiatric conditions, that is often neglected, within the population of homeless individuals. Furthermore, the review examined factors that work to aggravate pain and those that have been shown to improve pain management. Electronic databases (MEDLINE, EMBASE, psycINFO, and Web of Science) and the grey literature (Google Scholar) were searched. Two reviewers independently screened and assessed all literature. The PHO MetaQAT was used to appraise quality of all studies included. Fifty-seven studies were included in this scoping review, with most of the research being based in the United States of America. Several interacting factors were found to exacerbate reported pain, as well as severely affect other crucial aspects of life that correlate directly with health, within the homeless population. Notable factors included drug use as a coping mechanism for pain, as well as opioid use preceding pain; financial issues; transportation problems; stigma; and various psychiatric disorders, such as post-traumatic stress disorder, depression, and anxiety. Important pain management strategies included cannabis use, Accelerated Resolution Therapy for treating trauma, and acupuncture. The homeless population experiences multiple barriers which work to further impact their experience with pain and psychiatric conditions. Psychiatric conditions impact pain experience and can work to intensify already adverse health circumstances of homeless individuals.

Psychological legacies of intergenerational trauma under South African apartheid: Prenatal stress predicts greater vulnerability to the psychological impacts of future stress exposure during late adolescence and early adulthood in Soweto, South Africa

BACKGROUND

South Africa's rates of psychiatric morbidity are among the highest in sub-Saharan Africa and are foregrounded by the country's long history of political violence during apartheid. Growing evidence suggests that in utero stress exposure is a potent developmental risk factor for future mental illness risk, yet the extent to which the psychiatric effects of prenatal stress impact the next generation are unknown. We evaluate the intergenerational effects of prenatal stress experienced during apartheid on psychiatric morbidity among children at ages 17-18 and also assess the moderating effects of maternal age, social support, and past household adversity.

METHODS

Participants come from Birth-to-Twenty, a longitudinal birth cohort study in Soweto-Johannesburg, South Africa's largest peri-urban township which was the epicentre of violent repression and resistance during the final years of the apartheid regime. Pregnant women were prospectively enrolled in 1990 and completed questionnaires assessing social experiences, and their children's psychiatric morbidity were assessed at ages 17-18.

RESULTS

Full data were available from 304 mother-child pairs in 2007-8. Maternal prenatal stress in 1990 was not directly associated greater psychiatric morbidity during at ages 17-18. Maternal age and past household adversity moderated the intergenerational mental health effects of prenatal stress such that children born to younger mothers and late adolescent/young adult children experiencing greater household adversity exhibited worse psychiatric morbidity at ages 17-18. Social support did not buffer against the long-term psychiatric impacts of prenatal stress.

CONCLUSIONS

Greater prenatal stress from apartheid predicted adverse psychiatric outcomes among children born to younger mothers and adolescents/young adults who experienced greater concurrent stress. Our findings suggest that prenatal stress may affect adolescent mental health, have stress-sensitising effects, and represent possible intergenerational effects of trauma experienced under apartheid in this sample.

Understandings and experiences of adherence to secondary prevention for patients with cardiovascular disease and comorbid depression or anxiety

Over 20% of cardiovascular disease (CVD) patients have a comorbid mental health disorder, resulting in an increased risk of recurring major adverse cardiac events (MACE) and mortality. Despite the higher risk, patients with comorbid depression or anxiety disorders are twice as likely to be non-adherent to secondary prevention. Therefore, better understanding of the adherence experiences of this subgroup is needed to inform service delivery and enhance adherence for this higher risk group. This study aims to explore the perceptions, understandings, and experiences of adherence to secondary prevention amongst 33 cardiac patients with diagnosed depression and/or anxiety disorder. Participants were recruited as part of the Cardiovascular Health in Anxiety or Mood Problems Study. Semi-structured interviews were conducted and data were analysed via inductive thematic analysis. Patient understandings of adherence to secondary prevention were limited, with medication compliance considered the marker of adherence. Further, participants did not perceive unintentional non-adherence to constitute non-adherence, rather an intent to engage was viewed as defining adherence. Participants also reported that a lack of practitioner understanding and management around their mental health negatively impacted the practitioner-patient relationship and their engagement with secondary prevention. Results highlight that unique barriers, especially around management of comorbid mental health exist for this subgroup. Additionally, adherence to secondary prevention might be limited by patients' narrow understandings of adherence as the intent to engage and as medication compliance.

Associations between adherence to the Taiwan Daily Food Guide and psychiatric morbidity: A population-based study in Taiwan

BACKGROUND

Mental health has become a public health concern worldwide, and the number of affected individuals is rising. Therefore, further research must be conducted to identify potential risk factors to develop optimal prevention strategies to mitigate mental health disorders.

METHODS

Using Taiwanese Nutrition and Health Survey data collected from 2013-2016, we conducted a cross-sectional study to examine whether adherence to the Taiwan Daily Food Guide affects mental health conditions. Study participants were adults aged ≥19 years. The dietary assessment was conducted using a validated food frequency questionnaire. The presence of psychiatric morbidity was defined as a five-item Brief Symptom Rating Scale (BSRS-5) score of ≥10. Logistic regression models were used to determine whether Taiwan Daily Food Guide adherence was related to the presence of psychiatric morbidity.

RESULTS

After adjusting for potential confounders, we observed protective associations between adherence to the Taiwan Daily Food Guide and psychiatric morbidity risk.

CONCLUSION

The Taiwan Daily Food Guide might reduce the risk associated with psychiatric morbidity and could be a reference for developing a national food guide for mental health.

Psychiatric morbidity among human immunodeficiency virus test seekers attending the integrated counseling and testing center facility of a tertiary care hospital in South India

BACKGROUND

Testing for human immunodeficiency virus (HIV) infection has become a mandatory and routine regimen for various reasons. Literature suggests that the level of psychiatric morbidity is high among HIV-infected individuals. However, often psychiatric problems are undetected and untreated among these people and this is possible by the simple measure of screening when these people contact a health-care facility such as an integrated counseling and testing center (ICTC). The paucity of published data in this arena necessitates exploring the facts related to this issue. Hence, this study was aimed to identify the psychiatric morbidity among people undergoing HIV testing by a screening method.

METHODS

A cross-sectional, descriptive study was carried out among 384 individuals, those who were undergoing HIV testing at an ICTC facility of a tertiary care hospital in South India. They were assessed for psychiatric morbidity by a structured clinical diagnostic interview using mini international neuropsychiatric interview. Those people who were identified as having psychiatric problem were referred to psychiatric clinic for further management.

RESULTS

The mean age of the patients was 40 (±13.27) years and the males (n = 254, 66.1%) predominated than the females (n = 130, 33.9%). Psychiatric illness was identified in many patients (n = 91, 24%) including major depressive disorder (n = 64, 16.7%), suicidal ideas (n = 31, 8%), panic disorder (n = 26, 6.8%), and substance abuse (n = 15, 3.9%).

CONCLUSION

The findings imply the need to integrate screening and referral services for the people undergoing HIV testing. Early screening of psychiatric morbidity among individuals utilizing the ICTC facility may help identify and treat the illness at an early stage.

Who will guard the guardians? Cross-sectional study on prevalence of psychiatric morbidity, quality of life, and coping skills in caregivers of children with thalassemia major

Background:

Patients of thalassemia major require frequent hospitalization. Caregivers are more affected than the patient themselves as they better appreciate the magnitude of illness and treatment, resulting in increased risks for psychiatric illness.

Aims and Objectives:

The purpose of the study was to assess the prevalence of psychiatric morbidity in the caregivers of patients with thalassemia major. The study also examined the quality of life of the caregivers, their coping strategies, and its association with sociodemographic variables.

Methodology:

A cross-sectional study with 100 caregivers, recruited by convenience sampling technique, attending the thalassemia daycare center, was carried out over 12 months in a tertiary care hospital. They were administered a semistructured proforma along with General Health Questionnaire 12 (GHQ 12), WHO-Quality of Life-BREF (WHO-QOL-BREF), and Coping Inventory for Stressful Situations 21 scale. The GHQ 12 was used for screening and those scoring three or more underwent a clinical psychiatric interview. Those who were diagnosed with psychopathology were ascribed diagnosis as per ICD-10. Descriptive analysis was done. Associations were studied using Fischer's exact test. Comparison of quality of life with blood transfusion variables was done using Mann–Whitney U test.

Results:

The prevalence of psychiatric morbidity amongst the caregivers was found to be 35% with depressive episode (22%) being the most common. Psychiatric morbidity was found to have a significant association with both, the frequency (P = 0.037) and total number of blood transfusions (P = 0.012). Coping was found to have a strong association with psychiatric morbidity (P = 0.001) and employment (P = 0.009).

Conclusions:

Caregivers of children with thalassemia major face psychological burden like depression or anxiety, for which treatment is not sought. Improved psychological health of the caregivers will ensure better care of the child and guarantee better adherence to the treatment.

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

Psychiatric morbidity in individuals with permanent orthopedic disability

BACKGROUND

Individuals with permanent orthopedic disability present with a number of physical and mental health issues. Psychiatric illnesses have been seen more frequently among people with disabilities as compared to normal population.

AIM

To study psychiatric morbidity among people with permanent orthopedic disability.

MATERIALS AND METHODS

This cross-sectional, observational, hospital-based study was conducted at the department of psychiatry of a tertiary care hospital attached to a medical college during January 01, 2018, to December 31, 2018. The study included subjects over the age of 18 years comprising two groups: Group A (n = 50) including consecutive subjects with orthopedic disability and Group B (n = 50) including normal age- and sex-matched controls. Permission was obtained from the institutional ethics committee before the start of the study. Prior informed consent was obtained from all subjects. Sociodemographic variables were recorded, and psychiatric morbidity was screened on Mini International Neuropsychiatric Interview.

RESULTS

62% (n = 31) of subjects in Group A had psychiatric morbidity as compared to Group B (22%, n = 11). Maximum psychiatric morbidity noted among subjects with disability was generalized anxiety disorder (22%, n = 11), followed by major depressive disorder (20%, n = 10) and alcohol dependence (18%, n = 9). Substance dependence was more in Group A (34%, n = 17) as compared to Group B (18%, n = 9). The most common substance dependence was for alcohol (18%, n = 9), followed by opioids (8%, n = 4) and tobacco (6%, n = 3).

CONCLUSION

Psychiatric morbidity including substance dependence is more common among people with orthopedic disability as compared to normal control subjects.

Sociodemographic, clinical profile, and psychiatric morbidities among patients with attempted suicide in a tertiary care center: A study from Central India

BACKGROUND

Suicide is a major public health concern and is considered one of the leading causes of death globally. Previous suicidal attempts can be considered as a predictor of underlying psychiatric illness. Identifying factors behind suicidal attempt can help mental health professionals for early diagnosis and treatment as well as designing effective suicide prevention strategies.

AIM

The aim of the study is to assess sociodemographic, clinical characteristics, and prevalence of psychiatric morbidities among patients with attempted suicide.

METHODS

A cross-sectional study was conducted in the emergency department of tertiary care hospital; patients of attempted suicide attending emergency from January 1, 2014, to January 1, 2020, constituted the sample for the study. Data were collected using semi-structured questionnaire which contained sociodemographic and clinical variables. All the subjects were administered mini-international neuropsychiatric interview (MINI), MINI Kid was applied for subjects <18 years, and MINI Plus was applied for subjects above 18 years. Patients were diagnosed according to the ICD-10 Classification of Mental and Behavioral Disorders for research.

RESULTS

Suicide attempt was seen more commonly in males, and the most common age group is between 21 and 40 years residing in urban settings. The most common method was consumption of unknown substances (75.35%). Factors leading to suicide are multidimensional in nature. 30.4% of the patients had impulsive traits. 86.5% of people who attempted suicide had a history of psychiatric illness. Detailed assessment of patients for psychiatric illness and psychosocial factors is crucial for planning suicide prevention strategies and policymaking.

CONCLUSIONS

Young population is at high risk for suicide. More than 80% of these have diagnosable psychiatric illness.

Psychiatric morbidity amongst adolescents in a Nigerian juvenile correctional facility

Background

The high occurrence of psychiatric disorders amongst adolescents within the Juvenile Justice System (JJS) has been confirmed. Most of the available data are from developed countries and some of them focus on just a single psychiatric disorder which may not be representative of the situation in low-income countries, hence the need for more studies in developing countries, including Nigeria.

Aim

The study aimed to determine the prevalence of psychiatric disorders amongst adolescent residents of a correctional facility.

Setting

The study was carried out at a Borstal Institution in North-Central Nigeria.

Methods

A descriptive cross-sectional study design was used. One hundred and twenty adolescents were assessed using the socio-demographic pro forma questionnaire designed by the researcher and the Kiddies Schedule for Affective Disorders and Schizophrenia (KSADS-PL). Data were analysed using EPI-INFO 4.06 d version 6.04 software.

Results

A total of 62.5% of the male respondents were older than 15 years. The percentage of respondents with a psychiatric disorder was 82.5%. The rate of psychiatric disorders was high with disruptive behaviour disorders being the most common at 40.8%, others were substance use disorders (15.8%), anxiety disorders (14.2%), psychosis (6.7%) and mood disorders (5%).

Conclusion

This study has established a high prevalence rate of psychiatric disorders amongst incarcerated adolescents. This is in line with the findings of numerous studies worldwide. This study has identified the need to increase awareness and knowledge about the high morbidity of mental disorders in growing juvenile detainee populations. This will allow early identification of adolescents at risk of psychiatric disorders and ensure efficient resource distribution of both JJS service and mental healthcare. Effective and appropriate interventions have shown to improve overall health, quality of life and reduce the rate of recidivism amongst incarcerated juveniles.

Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors

BACKGROUND

The general medical impacts of coronavirus (COVID-19) are increasingly appreciated. However, its impact on neurocognitive, psychiatric health and quality of life (QoL) in survivors after the acute phase is poorly understood. We aimed to evaluate neurocognitive function, psychiatric symptoms and QoL in COVID-19 survivors shortly after hospital discharge.

METHODS

This was a cross-sectional analysis of a prospective study of hospitalized COVID-19 survivors followed up for 2 months after discharge. A battery of standardized instruments evaluating neurocognitive function, psychiatric morbidity and QoL (mental and physical components) was administered by telephone.

RESULTS

Of the 229 screened patients, 179 were included in the final analysis. Amongst survivors, the prevalence of moderately impaired immediate verbal memory and learning was 38%, delayed verbal memory (11.8%), verbal fluency (34.6%) and working memory (executive function) (6.1%), respectively. Moreover, 58.7% of patients had neurocognitive impairment in at least one function. Rates of positive screening for anxiety, depression and post-traumatic stress disorder were 29.6%, 26.8% and 25.1%, respectively. In addition, 39.1% of the patients had psychiatric morbidity. Low QoL for physical and mental components was detected in 44.1% and 39.1% of patients respectively. Delirium and psychiatric morbidity were associated with neurocognitive impairment, and female gender was related with psychiatric morbidity.

CONCLUSION

Hospitalized COVID-19 survivors showed a considerable prevalence of neurocognitive impairment, psychiatric morbidity and poor QoL in the short term. It is uncertain if these impacts persist over the long term.

Obesity Exacerbates Irritable Bowel Syndrome-Related Sleep and Psychiatric Disorders in Women With Polycystic Ovary Syndrome

BACKGROUND/OBJECTIVES

Polycystic ovary syndrome (PCOS) and irritable bowel syndrome (IBS) share similar clinical and psychosocial features. We aimed to investigate the clinical characteristics of IBS in women with PCOS, and its relationship with obesity, metabolic and hormonal profiles, as well as sleep and psychiatric disorders.

SUBJECTS/METHODS

This is a cross-sectional case-control study of 431 untreated women with PCOS and 259 healthy volunteers. All participants were assessed with a comprehensive clinical evaluation and two questionnaires: the Athens Insomnia Scale (AIS) and the Brief Symptom Rating Scale (BSRS-5). IBS was diagnosed using the Rome III criteria. Obesity was defined as a BMI ≥30 kg/m². Anthropometric measurements, metabolic, hormonal profiles, and psychosocial morbidities were compared.

RESULTS

Women with PCOS were more likely to have IBS (10.7% vs 5.8%, p=0.029) and obesity (29% vs 4%, p<0.001) than healthy volunteers. Mixed-type IBS (IBS-M) was the most common subtype (74%) among patients with PCOS and IBS. There was a higher prevalence of psychiatric morbidities (total BSRS-5 score ≥10) in women with PCOS than in healthy women (11.4% vs 3.5%, p<0.001). Women with PCOS and IBS were more likely to have sleep difficulties (67.4% vs 30.9%, p<0.001) and psychiatric morbidities (21.7% vs 10.1%, p=0.019) than those without IBS. Anthropometrics, metabolic and hormonal profiles were similar between PCOS women with and without IBS. Among women with PCOS, those with both IBS and obesity had the highest risk of developing sleep difficulties (odds ratio: 5.91; 95% confidence interval: 1.77-19.77) and psychiatric distress (odds ratio: 4.39; 95% confidence interval: 1.26-15.29) than those without.

CONCLUSION

Women with PCOS have increased IBS, obesity, sleep and psychiatric disturbances. The presence of IBS in PCOS women is associated with sleep and psychiatric disorders. The coexistence of obesity and IBS exacerbates sleep difficulties and psychiatric distress. Screening and management of IBS and obesity might be warranted to improve sleep and psychiatric disturbances in women with PCOS.

A Three-Site Study of Alcohol Consumption among Adolescents from Indigenous Tribes in India

BACKGROUND

Alcohol use disorder is elevated among members of indigenous tribes in India, like native populations in several other countries. Despite constituting 8.6% of the Indian population, tribals are among the most geographically isolated, socioeconomically underdeveloped, and underserved communities in the country. Based on the experience from our centers (in Tamil Nadu, Meghalaya, and Gujarat), we are aware of escalating alcohol use among tribal communities. The aims of this study are (a) to estimate alcohol use and psychiatric morbidity among teenagers from indigenous tribes, and (b) pilot test a psychoeducational efficacy study.

METHODS

The biphasic study is being conducted in three states of India: Tamil Nadu in South, Meghalaya in Northeast, and Gujarat in West. Phase 1 is a cross-sectional study of tribal adolescents at each site. The MINI 6.0/MINI Kid 6.0 questionnaire was used to estimate extent of psychiatric morbidity and substance addiction. Phase 2 is an intervention trial of 40 participants at each site to assess the effectiveness of NIMHANS LSE module in protecting the tribal adolescents from alcohol use.

CONCLUSIONS

The desired primary outcome will be forestalling the onset of alcohol use among this group. This paper focuses on the methodology and strategies to be used to achieve the objectives.

Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a Nigerian state: a cross-sectional analytical study

Introduction

the study assessed the prevalence and factors associated with psychiatric morbidity (an array of psychological disorders), and comorbid anxiety and depression among medical students in Ekiti State, Nigeria.

Methods

a cross-sectional study of medical students in two universities (one public and one private) in Ekiti state was conducted. A semi-structured questionnaire with adapted questions from the General Health Questionnaire and Hospital Anxiety and Depression Scale was used to obtain information on socio-demographic characteristics, psychiatric morbidity and comorbid anxiety and depression. Data was collected from April 2019 to August 2019. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.

Results

a total of 944 medical students participated in the survey. The overall prevalence of psychiatric morbidity and comorbid anxiety and depression among the respondents was 25.0% (CI = 22.1-27.8) and 14.3% (CI = 12.3-16.5) respectively. The factors independently associated with psychiatric morbidity included being a student of a private institution [adjusted odds ratio [AOR] =6.533, [95% confidence interval [C.I] =3.298-12.940], average academic performance [AOR =1.711, [95% C.I =1.173-2.496], below average academic performance [AOR =2.425, [95% C.I =1.313-4.478], and having a father or a mother with highest level of formal education below first degree [AOR =3.147, [95% C.I =1.579-6.272] and [AOR =2.053, [95% C.I =1.074-3.927] respectively. The factors independently associated with comorbid anxiety and depression were being a student receiving less than one dollar equivalent per day as allowance [AOR = 1.953, [95% C.I = 1.135-3.360] and being a student from the Igbo ethnic group [AOR = 0.533, [95% C.I = 0.333-0.853].

Conclusion

the prevalence of psychiatry morbidity and comorbid anxiety and depression was high among medical students in Ekiti State, Nigeria. Periodic medical [mental health] screening for medical students may be appropriate to screen, detect and manage psychiatric comorbidities. This will help to ensure optimal mental health for this group of university students.

Comparison of maternal stress and psychiatric morbidity among mothers of children having psychiatric disorders and those of typically developing children

INTRODUCTION

Motherhood is regarded to be stressful, but when the child has a psychiatric illness, the mother is affected more than the father since she is the primary caregiver. She gets affected not only emotionally but also psychologically. Increasing severity of stress in mothers may lead to negative outcome on a child's care.

AIMS

The aim of this study was to evaluate the stress levels in mothers of children diagnosed with psychiatric disorder and to study the association between children having a psychiatric disorder and the psychiatric morbidity in their mothers.

MATERIALS AND METHODS

This was a case-control study with a total of 150 participants, in which 75 consecutive mothers of children were diagnosed with any psychiatric illness using ICD-10 criteria and compared to 75 mothers of typically developing children. The study was approved by the Institutional Ethics Committee. The Parental Stress Scale and the Mini-International Neuropsychiatric Interview-Plus questionnaire were used for assessments.

RESULTS

The study showed statistically significant stress scores (49.54) in mothers having children diagnosed with psychiatric illnesses as compared to scores (30.98) in mothers of normally developing children. Psychiatric morbidity in cases (n = 58; 77.3%) was statistically significant as compared to controls (n = 23; 30.6%). Depression and anxiety were among the most common psychiatric morbidities evaluated, and the highest was for mothers having children with severe mental retardation.

CONCLUSION

In all children with psychiatric disorders, mothers have to be screened for psychiatric morbidity to prevent, detect, and manage it at the earliest.

Prevalence and Pattern of Psychiatric Morbidity Among Community-Dwelling Elderly Populations in Abeokuta, Nigeria

BACKGROUND

Many elderly persons in Nigeria are having mental health challenges and there is a lack of commensurate increase in services to attend to such.

AIM

To assess the prevalence, pattern and correlates of psychiatric morbidity among community dwelling elderly persons (≥ 60 years) in Abeokuta, Nigeria.

METHODS

532 respondents were selected using a multistage, stratified cluster sampling method from the elderly population in Abeokuta. First, participants were administered the socio-demographic questionnaire, General Health Questionnaire-12 (GHQ-12), and the Mini-Mental State Examination (MMSE). Those with a score of ≥ 3 in GHQ-12 were assessed with the Mini International Neuropsychiatric Interview (MINI PLUS), while those with ≤ 16 in MMSE were assessed with the Diagnostic Statistical Manual (DSM) IV criteria for Dementia and the Petersen's criteria for Mild Cognitive Impairment (MCI).

RESULTS

36.3% of the respondents had a probable psychological disorder, while 25.4% had a probable cognitive impairment. 9.8% had a current definitive psychiatric disorder. The commonest disorders were major depressive disorder and dementia. The female gender, the oldest old (≥ 80 years), having a chronic medical illness and bereavement in the last 1 year were most significantly associated with having mental health problems.

CONCLUSION

A significant number of the elderly population in the studied community suffers from a psychiatric illness. It is hoped that studies as these will inform stakeholders on the need to pay closer attention to the mental health needs of the elderly, as their overall wellbeing plays a role in determining the overall health of the community.

Depression and anxiety in patients of chronic kidney disease undergoing haemodialysis: A study from western Rajasthan

Background and Aims:

Chronic kidney disease (CKD) is a long standing debilitating medical condition. CKD patients who are undergoing hemodialysis commonly experience depressive and anxiety symptoms because of various physical and psychosocial factors. The present study aimed to assess psychiatric morbidities i.e., depression and/or anxiety in patients with CKD undergoing hemodialysis. The objective of study was to evaluate depressive and anxiety disorders and their relation to socio-demographic factors in patients with CKD.

Materials and Methods:

A cross-sectional study was conducted at Nephrology department of a tertiary care institution on 100 CKD patients undergoing hemodialysis; who fulfilled the inclusion criteria. Diagnosis of depression and anxiety disorder was made as per WHO (ICD-10) criteria. Hospital Anxiety and Depression scale (HADS) was applied to study severity of the disorders. Data collected was subjected to suitable statistical analysis (mean, standard deviation and Chi-square test).

Results:

Majority (54 percent) of the CKD patients belonged to age group of 41 to 60 years, were Hindus, married and had low monthly income. The prevalence of depressive disorder and anxiety disorder among CKD patients was around 66% and 61%, respectively. Depression and anxiety were significantly associated with gender, occupation, income and duration of haemodialysis in these patients.

Conclusion:

Depression and anxiety are highly prevalent in CKD patients and have varying relations with different socio-demographic characteristics of patients. Clinicians should focus on these morbidities while managing such patients and provide holistic treatment using multidisciplinary approaches to improve the overall quality of life.

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research-Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs.

The association between intimate partner violence, psychiatric morbidity amongst pregnant women and partner alcohol use in southern Nigeria

BACKGROUND

Intimate partner violence (IPV) against women is common, although prevalence and correlates amongst pregnant women in developing countries are poorly researched.

AIM

To identify the magnitude of IPV, and its relationship with psychiatric morbidity and partner alcohol use.

SETTING

This study was conducted among women receiving routine ante-natal care at a secondary level healthcare facility in southern Nigeria.

METHODS

A cross-sectional descriptive study was conducted by recruiting pregnant women (n = 395) attending the Ante-Natal Clinic of the Central Hospital, Benin-City, Edo State, Nigeria, between August 2015 and February 2016 and undertaking face-to-face interviews utilising a socio-demographic questionnaire, the Composite Abuse Scale and the 20-item Self-reporting Questionnaire.

RESULTS

Past 12-month prevalence of IPV was 24.8%, with emotional abuse being the commonest type (89.8%). Forty-six participants (11.6%) screened positive for probable psychiatric morbidity. Predictors of IPV included partner alcohol use in the past 12 months (adjusted odds ratio [aOR]: 2.67; 95% confidence interval [CI]: 1.16-6.16; p 0.02), having a psychiatric morbidity (aOR: 2.53; 95% CI: 1.27-5.04; p 0.01), being single (aOR: 2.12; 95% CI: 1.25-3.58; p 0.01) and multiparous (aOR: 2.5; 95% CI: 1.43-4.38; p 0.001).

CONCLUSION

Intimate partner violence was common amongst pregnant women in Nigeria. Identified modifiable risk factors can be targets for screening and intervention for women in these settings.

Exploring cyberchondria and its associations in dental students amid COVID-19 infodemic

BACKGROUND

Adverse psychological effect of pandemic includes not only increased levels of stress, anxiety, and depression but also cyberchondria - the problematic online health research behavior. It is thought that the distress and uncertainty of pandemic clubbed with information overload and its ambiguity have paved the way for cyberchondria. Students being the vulnerable population, the present study was an effort at understanding cyberchondria in students.

AIM

The aim of the study is to assess cyberchondria and its association with depression, anxiety, stress, and quality of life (QOL) in dental students during the pandemic.

MATERIALS AND METHODS

An online questionnaire-based survey was carried out on dental students. The survey tool comprised a semi-structured pro forma, General Health Questionnaire-12, Depression Anxiety and Stress Scale 21, Cyberchondria Severity Scale 15, and European Health Interview Survey QOL 8.

RESULTS

The study revealed that 98.7% of the students were affected by one of the constructs of cyberchondria, viz., "excessiveness" (93.7%), followed by "distress" (84.3%) and "reassurance"-seeking behavior (83.7%). Cyberchondria affected girls more than boys and shared robust positive correlation with depression, anxiety, and stress but not QOL. Factors such as stress, anxiety, QOL, and changes in appetite were associated with higher severity of depression. Family financial losses, preexisting psychiatric illness, and media adverse effect shared robust positive associations with severity of depression, anxiety, and stress and an inverse association with QOL. 76.0% of the students expressed excessive worries regarding missing out on clinical exposure, and nearly half of the students were dissatisfied with eLearning. 78.3% of the students experienced changes in sleep; 68.7% had changes in appetite; and 89.0% reported reduction in the level of physical activity.

CONCLUSION

Cyberchondria is affecting the large majority of students. Educational institutions must put efforts to sensitize students about cyberchondria.

Trauma and work factors as predictors of firefighters' psychiatric distress

BACKGROUND

Studies into the mental health of firefighters have primarily focussed on individual factors (e.g. biological and psychological factors). Little is known about how exposure to traumatic events and psychosocial and organizational work factors influence firefighters' mental health despite the evidence that these are important for employee health.

AIMS

To study job demands, job control, social support and operational trauma as predictors of firefighters' psychiatric morbidity, and whether job control and social support moderate these relationships.

METHODS

Participants were drawn from a longitudinal cohort study of firefighters in Brazil. Portuguese-language variants of the Self-Report Questionnaire (SRQ-20) and Traumatic Events List for Emergency Professionals measured psychiatric morbidity and exposure to traumatic events. Job demands, job control and social support were measured by the Job Stress Scale. Hierarchical regressions were run controlling for socio-demographics and previous psychiatric morbidity. Subsequent regression steps first included the proposed predictors followed by their interactions.

RESULTS

Thirteen per cent of the sample (n = 40/312) met the caseness criteria indicating psychiatric morbidity. Operational trauma, job demands, job control and social support predicted psychiatric morbidity. Both job control and social support functioned as moderators and where these moderators were high, the job demands and psychiatric morbidity relationships were weaker.

CONCLUSIONS

These findings show that psychosocial factors and operational trauma predict firefighters' psychiatric morbidity. Crucially, the results that improving social support and job control could mitigate the detrimental influence of job demands highlight the need for more research and practice towards organizational-level interventions.

Time patterns of external and alcohol-related mortality after marital and non-marital separation: the contribution of psychiatric morbidity

BACKGROUND

External and alcohol-related mortality is elevated postseparation, but the role of poor mental health in explaining this excess is unclear. We assess postseparation excess mortality by union type and over time since separation and examine how psychiatric morbidity present already before separation, during the separation process and after separation attenuates this excess.

METHODS

Using individual-level register data from 1995 to 2012, we followed 311 751 Finns in long-term unions. Psychiatric morbidity was identified from dates of prescription medication purchases and hospital admissions, separations from dates of moving out of joint households and mortality from the Death Register. Cox regression was used to analyse postseparation mortality controlling for psychiatric morbidity before, during and after separation.

RESULTS

External and alcohol-related excess mortality is most pronounced immediately after separation, particularly among men, and is much larger following marital than non-marital separation. After sociodemographic factors are adjusted for, further adjustment for psychiatric morbidity attenuates the excess by about 25%. Psychiatric morbidity poorly explains alcohol-related postseparation excess mortality, but for suicide mortality, adjustment for psychiatric morbidity reduces the excess by about 40% among men and 50% among women. Among women, this is largely due to psychiatric morbidity present already before separation, whereas among men the attenuation is also due to psychiatric morbidity during the separation process and after it.

CONCLUSION

Separation may exacerbate the problems of people already in poor mental health, and relationship dynamics should thus be considered during treatment. Particularly among men separation is a risk factor for suicide even without pre-existing mental health problems.

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.

Acne vulgaris and risk of depression and anxiety: A meta-analytic review

BACKGROUND

Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted.

OBJECTIVE

We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety.

METHODS

A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region.

RESULTS

Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region.

LIMITATIONS

Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature.

CONCLUSIONS

Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.

Short-Term Impact of Hematopoietic Stem Cell Transplantation on Psychiatric Morbidity and Quality of Life in Hematological Malignancies in Adults

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) is an established treatment for a number of malignancies. Quality of life (QOL) is an important marker for assessing arduous treatment modalities. Diagnosis of cancer, HSCT, and the physical and psychosocial sequelae of the intensive treatment lead to a deficit in the QOL of the recipient. This study aimed to assess the impact of HSCT on psychiatric morbidity and QOL in patients with hematological malignancies.

METHODS

A longitudinal pre-post study was conducted at a cancer research center. Thirty patients with hematological malignancies were assessed at three different time points for psychiatric symptoms and QOL. Sociodemographic and clinical variables were collected using a semi-structured questionnaire. Comprehensive psychopathological rating scale was used to assess the psychiatric symptoms. WHO QOL Bref and cancer-specific European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) were used to measure the quality of life.

RESULTS

The mean (SD) age of the sample was 42.3 (12.8) years, with 24 males and 6 females. Most patients reported anxiety and depressive symptoms, reaching a peak at 3 week post-HSCT. The maximum deficit in QOL scores was seen at 3 weeks, with further improvement at 3-month post-transplant.

CONCLUSIONS

HSCT leads to an increase in symptoms and a decrease in QOL during the acute phase. In the long run, it leads to improvement in physical and psychological wellbeing, with improvement in QOL. The recent surge in the long-term survivors of the procedure calls for further research in this direction so as to aid in their full recovery.

Psychiatric Morbidity, Fatigue, Stigma and Quality of Life of Patients With Hepatitis B Infection

AIMS

This study aimed to evaluate the prevalence of psychiatric morbidity, fatigue, stigma and quality of life (QOL) of patients with hepatitis B infection. Additional aim of the study was to evaluate the correlates of psychiatric morbidity and QOL in patients with hepatitis B infection.

METHODS

A total of 150 patients with hepatitis B virus (HBV) infection (75 inactive carriers and 75 patients with chronic hepatitis) were evaluated on Mini International Neuropsychiatric Interview-PLUS, World Health Organization-QOL-BREF scale, Chronic Liver Disease Questionnaire, Toronto Chinese HBV Stigma Scale, HBV knowledge scale and Fatigue Severity scale.

RESULTS

About half of the study participants (49.3%) had at least one lifetime psychiatric morbidity and of these more than one-third (37.3%) fulfilled at least one current psychiatric diagnosis. Generalized anxiety disorder was seen in 19.3% of the participants. Major depressive disorder was the second most common psychiatric diagnosis fulfilled at the time of assessment, with nearly equal prevalence of first episode of depression (8%) and recurrent depressive disorder (7.3%). Compared to those with inactive hepatitis, patients in the chronic hepatitis group had poorer QOL and experienced more fatigue. However, both the groups did not differ in terms of knowledge and stigma. Compared to those without current or lifetime psychiatric diagnosis, those with current or lifetime psychiatric diagnosis had poorer QOL, higher level of stigma and higher fatigue scale.

CONCLUSION

About half of the patients with HBV infection have psychiatric morbidity, which has negative impact on QOL of patients. Hence, it is important to recognize psychiatric morbidity among patients with HBV.

COVID-19 pandemic and its aftermath: Knowledge, attitude, behavior, and mental health-care needs of medical undergraduates

BACKGROUND

The undeniable impact of the COVID-19 pandemic on the educational sector has left the students perplexed and uncertain. Infection-related fears, inevitable loneliness, disturbed routine making way for adverse lifestyle habits, stressors such as financial crisis faced by their families, and many more further accentuate their vulnerability to mental health issues.

AIM

The aim was to assess the knowledge, attitude, and behavior of medical undergraduate students about the COVID-19 outbreak, and to assess their stress, anxiety, depression, and quality of life (QOL). The study also explored the correlation between the knowledge, attitude, and behavior of the medical undergraduate students about the pandemic and their mental health issues.

MATERIALS AND METHODS

An online questionnaire-based survey was carried out on medical undergraduate students. The survey tool comprised a semi-structured proforma; General Health Questionnaire-12 items; Depression, Anxiety, and Stress scale-21 items; and European Health Interview Survey-Quality of Life-8 items.

RESULTS

Nearly 61.8% of the students seemed well read and had good knowledge about the medical aspects of the pressing issue of COVID-19, and majority of the students had adaptive attitudes and behaviors toward the pandemic. Almost 23.2% of the students had depression, 20.7% had anxiety, and 13.0% had stress ranging from mild to extremely severe. Nearly 75.1% of the students experienced changes in appetite and 53.6% had changes in appetite. Nearly half of the students expressed excessive worries regarding studies. The mean score of QOL of students was 3.9 ± 0.6. Students with adaptive attitudes and behavior experienced relatively less severe depression, anxiety, and stress compared to their counterparts.

CONCLUSION

A significant portion of the medical undergraduates are experiencing mental health issues and study related concerns due to the adversity brought by the pandemic. The concerned educational bodies and institutes must take up necessary steps to mitigate the adverse effects of the pandemic on students.

Psychiatric morbidity in December 2015 flood-affected population in Tamil Nadu, India

BACKGROUND

Floods are the most common type of natural disaster, which have a negative impact on mental health. Following floods, survivors are vulnerable to develop PTSD (post-traumatic stress disorder), depression, anxiety and other mental health problems.

AIM

The aim is to study the psychiatric morbidity in the persons affected by floods during December 2015.

MATERIALS AND METHODS

This study was carried out in Chennai and Cuddalore. In total, 223 persons who were directly exposed to floods were assessed. PTSD Checklist-Civilian Version, Beck's Depression Inventory, Beck's Anxiety Inventory and World Health Organization-Five Well-Being Scale (WHO-5) were used in the study. Chi-square test was used to compare the means.

RESULTS

Overall, psychiatric morbidity was found to be 45.29%; 60 (26.9%) persons had symptoms of PTSD. Anxiety was found in 48 (27.4%) and depression was found in 101 (45.29%) persons; and 11 (4.9%) persons have reported an increase in substance abuse.

CONCLUSION

Following disaster like floods, there is a need for better preparedness in terms of basic necessities and medical and psychological assistance, particularly emphasizing the needs of older persons in order to prevent the development of psychiatric problems.

A study of psychiatric morbidity among school going adolescents

AIM

This study aims to study the prevalence of psychiatric morbidity among adolescents and compare its distribution in the urban and rural areas.

STUDY DESIGN

This was a cross-sectional study.

MATERIALS AND METHODS

One thousand adolescents aged 11 to 16 years studying in various private and government schools in urban and rural areas in district Patiala, Punjab were studied. Stratified cluster sampling was used considering the type of school as strata and sections of each standard as clusters. The study was conducted in two steps; in the first step, self-designed sociodemographic questionnaire and socioeconomic status scale, Parekh's method of socioeconomic classification for rural area, and Kuppuswamy's revised method of social classification for urban areas. To study the psychiatric morbidity, the strength and difficulties questionnaire (SDQ) self-report version and parent version was used. Students who scored borderline or abnormal on SDQ, were further evaluated in second stage by clinical interview, detailed case history, and mental state examination; psychiatric disorders were diagnosed following International Classification of Diseases-10 (ICD-10) criteria.

STATISTICAL ANALYSIS USED

Chi-square, Student's t-test.

RESULTS

The prevalence ranges from 17.94 in the private school in the urban area and 20.96% in government schools in the urban area to 20.61% in private schools in the rural area and 22.17 in government school of the rural area. The overall prevalence of psychiatric disorders is higher among adolescents in the rural area (21.38%) as compared to the urban area (19.43%). Rural adolescents had significantly higher rates of somatoform disorders (4.45%), conduct disorder (3.78%), dysthymia (1.11%), and other mood disorders (0.89%) whereas higher rates of depression (3.88%), anxiety (3.67%), and hyperkinetic disorders (3.02%) were found in urban counterparts.

CONCLUSION

An alarming number of adolescents suffer from different emotional and behavioral problems, but there is no excess of formal mental illness reaching the psychiatrist. This should help us formulate a rational basis for deploying our resources for the treatment and prevention of mental illness in tomorrow's adults.

A cross-sectional study of psychiatric morbidity and quality of life among participants utilizing the preventive health-care services of a tertiary hospital

BACKGROUND

The burden of mental disorders has been increasingly recognized and 450 million people globally are suffering from mental illness. Mental-physical comorbidity has adverse effects on the overall outcome. Research is scarce with regard to mental health screening in the context of "preventive health care" in India. Thus, the study aimed to identify the prevalence of mental illness and the effect on quality of life (QOL) among participants attending preventive health-care unit (PHCU).

SETTINGS AND DESIGN

This was a cross-sectional study conducted in PHCU of a tertiary hospital in Puducherry.

MATERIALS AND METHODS

All consecutive participants (>18 years) attending PHCU were included in the study. The Standard for Clinicians' Interview in Psychiatry (SCIP) screening module, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure, Mini-Cog, and Quality of Life Enjoyment and Satisfaction Questionnaire were administered. Relevant diagnostic modules of SCIP were applied to participants who screened positive on SCIP. Data analysis was performed using SPSS (version 17.0).

RESULTS

The mean age of participants was 43.38 ± 13.99 years. Of 203 participants enrolled, 28.1% screened positive and 26.1% were confirmed to have psychiatric disorder. About 4% screened positive for cognitive impairment. Most commonly diagnosed disorders were alcohol use disorder and major depressive disorder. The prevalence of depressive disorder was higher in patients with physical disorder. Participants with psychiatric disorder alone or with both psychiatric and physical disorders had significantly poorer QOL (F = 27.13; P < 0.001).

CONCLUSION

One-fourth of the participants attending preventive health-care services were found to have psychiatric disorders. The presence of psychiatric disorder was associated with significantly poorer QOL. This highlights the importance of routine mental health screening in this setting.

Sexual Dysfunction among Men in Rural Tamil Nadu: Nature, Prevalence, Clinical Features, and Explanatory Models

BACKGROUND AND AIM

There is a dearth of community data on nature, prevalence, clinical features, and explanatory models related to sexual dysfunction among men, particularly from rural India. This study attempted to examine different aspects of male sexual dysfunction and misconceptions in the community.

MATERIALS AND METHODS

Villages in Kaniyambadi Block, Vellore district were stratified, and four were randomly selected. Men living in these villages were recruited for the study. The following instruments were administered: (i) International Index of Erectile Function, (ii) Chinese Index of Premature Ejaculation (iii) Short Explanatory Model Interview, and (iv) Revised Clinical Interview Schedule. The data were analyzed using standard bivariate and multivariate statistics.

RESULTS

A total of 211 men were recruited. The majority were middle-aged (mean 40.73 years), literate (84.8%), married, and with children (72%), from nuclear families (99.6%), followed the Hindu religion (87.7%), reported satisfaction with their marriage (51.2%), had a single sexual partner (99.5%), and practised contraception (88.2%). A minority reported erectile dysfunction (29.9%), premature ejaculation (19.4%), and depression/anxiety (30.8%). Erectile dysfunction was associated with single marital status (P < 0.001), premature ejaculation (P < 0.001), worry about nocturnal emission and loss of semen (P < 0.02), and punishment by God as causal beliefs (P < 0.001). Premature ejaculation was associated with diabetes mellitus (P < 0.05), alcohol use (P < 0.05), anxiety and depression (P < 0.01), guilt about masturbation (P < 0.001), and belief that nocturnal emission is causal (P < 0.001) and erectile dysfunction (P < 0.05).

CONCLUSION

Sexual misconception and dysfunction in men are significant problems in rural communities in India. They mandate the need for sex education in schools and the empowerment of physicians in primary and secondary care to manage such problems.

Psychiatric morbidity, cognitive dysfunction and quality of life in drug-naive patients with Parkinson's disease: A comparative study

BACKGROUND

To better understand the psychiatric disorders and cognition in Parkinson's disease (PD) and its impact on quality of life (QoL), patients need to be studied soon after diagnosis, before initiation of dopamine replacement therapy.

AIM

This study aims to compare the nature and frequency of psychiatric morbidity, cognitive dysfunction, and quality of life in drug-naive patients with PD and healthy controls.

MATERIALS AND METHODS

The cross-sectional, comparative study was conducted in tertiary care center. Fifty drug-naive PD patients and fifty healthy controls were included and assessed on Modified Hoehn and Yahr scale, PD Questionnaire 8, Kolkata cognitive screening battery, General Health Questionnaire-12, and Hamilton Anxiety and Depression Rating Scale (HAM-A and HAM-D).

RESULTS

The mean scores of HAM-A and HAM-D of patients with PD were significantly higher than that of the comparison group. The patients with PD had statistically significant impairment in verbal fluency, Mini-Mental State Examination, calculation, memory immediate recall, visuoconstructional ability, and memory (delayed recall and recognition) in comparison to patients without PD. No statistically significant difference was observed with respect to object naming between the two groups.

CONCLUSION

QoL of a PD patient is adversely affected by both the motor and nonmotor symptoms of the disease such as depression, anxiety, apathy, sleep disturbances, and cognitive impairment. The link between nonmotor symptoms and reduced QoL has important implications for the management of PD because the nonmotor symptoms often appear before patients are given anti-parkinsonian therapy. Screening of nonmotor symptoms in early stage of disease will decrease the morbidity and mortality and improve the QoL.

The Pattern of Psychiatric Morbidity in an Outpatient Child Psychiatry Clinic: A Cross-sectional, Descriptive Study from a Tertiary Care Hospital in Kashmir, North India

BACKGROUND

Psychiatric disorders are ubiquitous and affect not only adults but also children and adolescents. The age factor plays an important role in the pattern of these psychiatric disorders. The objective of our study was to find the pattern of psychiatric morbidity in children and adolescents at the child and adolescent outpatient service of a tertiary care hospital.

MATERIALS AND METHODS

A semi-structured questionnaire was used to record the sociodemographic status. The state of mental health and psychiatric morbidity was assessed after a thorough clinical assessment. Intelligence quotient was assessed by a clinical psychologist as and when needed. All the diagnoses were made on the basis of Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Text Revision criteria.

RESULTS

A total of 529 patients were included. Most patients belonged to the age group of 6-16 years (70.5%). Boys (67.9%) outnumbered girls. Most of the patients were from rural background (56.7%) and from nuclear families (53%). Attention-deficit hyperactivity disorder (31%) and mental retardation (29%) were the most frequent diagnoses, followed by pervasive developmental disorders (10%). Comorbidity was present in about 18% of our patients.

CONCLUSION

The child psychiatry is gaining acceptance, and children and adolescents with minor mental health issues are being identified and referred for specialized services.

Impact of balloon mitral valvotomy on quality of life and psychiatric morbidity in patients with severe mitral stenosis

OBJECTIVES

To evaluate the quality of life (QoL), psychiatric comorbidities in patients with rheumatic heart disease-mitral stenosis (RHD-MS), and the impact of balloon mitral valvotomy (BMV) on the QoL and psychiatric morbidity.

MATERIALS AND METHODS

Fifty consecutive patients of RHD-MS were evaluated for QoL and psychiatric morbidity prior to BMV and at 3 months after the procedure.

RESULTS

The mean age of the study sample was 34.9 years (standard deviation, 11.1 years). At baseline assessment, majority (94%) had New York Heart Association Class II/III symptoms and QoL scores below average, that is, 50. About two-fifth (19 out of 50) of the patients had one or more psychiatric comorbidity, that is, depression (32%), anxiety (16%), and somatoform disorder (12%). Those with psychiatric comorbidity had poor QoL scores in social, emotional, and mental subscales (P < 0.05) at the baseline. At 3-month follow-up, there were significant improvement in symptoms and transmitral pressure gradients (P < 0.05), QoL scores (P < 0.05), and psychiatric comorbidities (P < 0.05) after BMV. Improvements in QoL were irrespective of the baseline psychiatric comorbidity.

CONCLUSIONS

High prevalence of psychiatric illness and poor QoL scores were observed in patients with RHD-MS. BMV significantly improves the QoL and psychiatric comorbidities.

Prevalence of psychiatric morbidity among parents of children with intellectual disability

BACKGROUND

Intellectual disability is a permanent disabling condition, and caregivers are more vulnerable to develop mental illness. There is little data in developing countries, such as India, concerning about psychological issues in caregivers of intellectually disabled children.

OBJECTIVE

The objective of this study was to find the prevalence of psychiatric morbidity and correlation between sociodemographic factors and psychiatric morbidity in parents of children with intellectual disability.

MATERIALS AND METHODS

This study was carried out among 60 parents of children with intellectual disability at the outpatient Department of Psychiatry, Tertiary Care Centre, India. Parents, who fulfill the inclusion and exclusion criteria of the study, were interviewed by using semi-structured pro forma, International Disease Classification-10 criteria for mental illness, Beck Depression Inventory and Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, and Alcohol Use Disorder Identification Test.

RESULTS

The prevalence of depressive disorder was 28.33%, anxiety disorder was 18.33%, and other psychiatric disorders was 8.33% (psychotic disorder 3.33%, insomnia 1.66%, and alcohol use disorder 3.33%) and total psychiatric morbidity was about 55% in parents of children with intellectual disability.

CONCLUSION

The study shows high psychiatric morbidity in parents of children with intellectual disability, and psychiatric screening should be considered among parents of children with intellectual disability.

A Study on Psychiatric Disorders, Body Image Disturbances, and Self-Esteem in Patients of Cushing's Disease

BACKGROUND

Cushing's disease (CD) is a rare endocrine disorder associated with increased serum levels of cortisol secreted due to an underlying tumour in pituitary. Psychiatric disturbances like depression, psychosis, mania along with body image disturbances are seen in patients of CD. Hence, we undertook this research to find the prevalence and type of psychiatric disorders, body image disturbances, and self-esteem in patients of CD.

MATERIALS AND METHODS

Thirty-five patients diagnosed as CD as per the standard criteria by the endocrinologist were recruited after informed consent and ethics approval. Proforma with demographic details, Structured Clinical Interview for DSM-IV, Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale, and Body Image Concern Inventory were used for assessment of the aims.

RESULTS

65% patients had psychopathology with 21% patients having major depressive disorder, 62% patients had mild, and 28% had moderate depression on BDI. 50% patients had body image disturbances and 60% had low self-esteem. Depression was found to have a negative correlation with self-esteem and positive correlation with body image disturbances.

CONCLUSION

A high prevalence of psychopathology is seen in patients of CD which may often go undetected. Liaison with the endocrinologist would also work towards improving the issues of body image disturbances and self-esteem for better prognosis for the patient.

Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview)

BACKGROUND

Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53-item version [BSI] and the 18-item version [BSI-18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases-10th Revision psychiatric diagnoses.

METHODS

A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI-18 assessments.

RESULTS

The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI-18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case-rule system (a BSI-18 global severity index [GSI] T-score ≥57), sensitivity marginally improved (45%), whereas a second alternative case-rule system (a GSI T-score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T-score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T-scores according to the International Classification of Diseases-10th Revision diagnosis and sex.

CONCLUSIONS

The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI-18, it is mandatory to use alternative case-rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415-26. © 2018 American Cancer Society.

Self-Harm Thoughts Postpartum as a Marker for Long-Term Morbidity

Introduction

Postpartum depression predisposes to maternal affective and somatic disorders. It is important to identify which women are at an increased risk of subsequent morbidity and would benefit from an intensified follow-up. Self-harm thoughts (SHTs), with or without other depressive symptomatology, might have prognostic value for maternal health beyond the postpartum period.

Aim

This study is to investigate the somatic and psychiatric morbidity of postpartum women with SHTs, with or without other depressive symptoms, over a 7-year follow-up period.

Materials and methods

The subjects for this study are derived from a population-based Swedish cohort of women who gave birth at Uppsala University Hospital (May 2006–June 2007) and who answered the Edinburgh Postnatal Depression Scale (EPDS) at 5 days, 6 weeks, and 6 months postpartum. Three groups were included: women reporting SHTs (SHT group, n = 107) on item 10 of the EPDS; women reporting depressive symptoms, i.e., EPDS ≥ 12 at 6 weeks and/or 6 months postpartum, without SHTs (DEP group, n = 94); and randomly selected controls screening negatively for postpartum depression (CTL group, n = 104). The number of diagnostic codes for somatic and psychiatric morbidity according to the International Statistical Classification of Diseases and Related Health Problems system, and the number of medical interventions were retrieved from medical records over 7 years following childbirth and were used as the outcome measures, together with any prescription of antidepressants and sick leave during the follow-up.

Results

The SHT group had the highest psychiatric morbidity of all groups and more somatic morbidity than controls. Affective disorders were more common in the SHT and the DEP groups compared with controls, as well as antidepressant prescriptions and sick leave. One-fifth of women with SHTs did not screen positive for depressive symptoms; nevertheless, they had more somatic and psychiatric morbidity than the control group.

Conclusion

Women reporting thoughts of self-harm in the postpartum period are at an increased risk of somatic and psychiatric morbidity during a follow-up of 7 years after delivery, and this increased risk may not be fully attributed to depressive symptoms. Results underline the importance of screening for self-harm symptoms postpartum and point to a need for individualized follow-up.

Psychiatric Morbidity in Children with HIV/AIDS at a Tertiary Health Institution in North-central Nigeria

INTRODUCTION

Children with human immunodeficiency virus (HIV) infection are living longer with the infection and are at risk of different complications. We assessed for the prevalence of and associated factors for psychiatric morbidity among HIV-infected children in a tertiary facility in Ilorin, Nigeria.

METHODS

A descriptive cross-sectional, two-staged study involving 196 HIV-positive children (6-17 years). A semi-structured questionnaire and psychological instruments were used for the study.

RESULTS

Thirty-eight (19.4%) children had psychiatric disorders: attention-deficit hyperactivity disorder and enuresis. Single parenthood, HIV clinical stages and complications were associated with psychiatric morbidity. Linear combination of the risk factors was not related to the psychiatric disorder. Bivariate correlation analysis showed the tendency to develop psychiatric disorder among the children was positively correlated with complications in the child and the person the child resides with.

CONCLUSIONS

Complicated HIV infection and adverse life events result in elevated risk of having psychiatric morbidity.

Psychoactive substance use and psychiatric morbidity among pregnant women attending an ante-natal clinic in Benin City, Nigeria

OBJECTIVE

This study sought to determine the prevalence, patterns and feasibility of screening for psychoactive substance use among pregnant women in an antenatal clinic in Nigeria. It also aimed to determine the relationship between psychoactive substance use risk severity and psychiatric morbidity.

METHODS

A cross-sectional study was undertaken among 395 pregnant women previously booked for ante-natal care. A sociodemographic questionnaire, the Alcohol Smoking and Substance Involvement Test (ASSIST) and the 20-item self-reporting questionnaire-20 were interviewer administered. The t-test and ANOVA were used to analyse the relationship between substance use risk severity of probable psychiatric symptoms and lifetime use of psychoactive substance/risk severity, respectively.

RESULTS

Participants reported lifetime (50.4%) and preceding 3 months (17%) use of alcohol. Nicotine and sedatives use was rare (n = 2; 0.5%). About a tenth (11.6%) screened positive for psychiatric morbidity. Those reporting alcohol use were significantly more likely to report a greater severity of probable psychiatric symptoms (1.79 vs. 0.92; t = 3.43, P < 0.002). Significant differences were observed according to severity of risk (moderate risk [2.08] vs. low risk [1.72] vs. never used [0.92], F = 6.043, P = 0.03).

CONCLUSION

ASSIST is feasible screening tool among pregnant women. At least, half of the participants report alcohol use in pregnancy and use was significantly associated with psychiatric morbidity.

Psychiatric morbidity among female commercial sex workers

CONTEXT

Psychological distress is higher in women working in sex industry. The various psycho social issues are associated with female commercial sex workers (FCSWs). The host of psychosocial vulnerabilities including, childhood sexual abuse, exposure to childhood physical abuse, poverty, interpersonal violence in adulthood, sexually transmitted diseases, and substance use, forms a fertile ground for psychiatric morbidity.

AIM

This study aims to assess the psychiatric morbidity among FCSWs in Shillong, India.

MATERIALS AND METHODS

In the present study, 100 FCSWs were selected. For the recruitment of sample, simple random sampling procedure was followed; sociodemographic data sheet and the Mini International Neuropsychiatric Interview were administered.

RESULTS

In the study, it was found that 9% of the respondents reported having major depressive episode (current), 25% of the respondents reported major depressive episode (past), 3% were having major depressive episode with melancholic features (current), 21% of the respondents reported posttraumatic stress disorder (PTSD), 8% of the respondents reported to have alcohol dependence, 3% of the respondents reported to have nonalcohol psychoactive substance use disorder, 8% of the respondents were found to have generalized anxiety disorder, and 9% of the respondents were found to have antisocial personality disorder.

CONCLUSIONS

There is a prevalence of mental health problems in the FCSW. Assessment of the psychiatric morbidity in FCSW is significant in developing health policy and interventions to reduce their impact on their well-being. It is the immediate need that the governmental and nongovernmental agencies, mental health professionals, and workers in this area need to be sensitized to the issue of mental health status of the commercial sex workers.