Abstract
The purpose of this article is to close the gap in frameworks for the use of evidence in the mental health policy agenda-setting in low- and middle-income countries (LMICs). Agenda-setting ...is important because mental health remains a culturally sensitive and neglected issue in LMICs. Moreover, effective evidence-informed agenda-setting can help achieve, and sustain, the status of mental health as a policy priority in these low-resource contexts. A scoping ‘review of reviews’ of evidence-to-policy frameworks was conducted, which followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Nineteen reviews met the inclusion criteria. A meta-framework was developed from analysis and narrative synthesis of these 19 reviews, which integrates the key elements identified across studies. It comprises the concepts of evidence, actors, process, context and approach, which are linked via the cross-cutting dimensions of beliefs, values and interests; capacity; power and politics; and trust and relationships. Five accompanying questions act as a guide for applying the meta-framework with relevance to mental health agenda-setting in LMICs. This is a novel and integrative meta-framework for mental health policy agenda-setting in LMICs and, as such, an important contribution to this under-researched area. Two major recommendations are identified from the development of the framework to enhance its implementation. First, given the paucity of formal evidence on mental health in LMICs, informal evidence based on stakeholder experience could be better utilized in these contexts. Second, the use of evidence in mental health agenda-setting in LMICs would be enhanced by involving a broader range of stakeholders in generating, communicating and promoting relevant information.
Depression among married women in Assam: A qualitative study Bora, Debashree; Deuri, Sonia; Saha, Apurba
Indian journal of social psychiatry : official publication of Indian Association for Social Psychiatry,
01/2023, Letnik:
39, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background: Women are at greater risk for depressive disorders than men. They are also known to be genetically and biologically vulnerable. Indian women mostly express their mental stress as somatic ...complaints and many other psychosocial factors influence as well as maintain the depressive symptoms. The psychosocial needs of women are often projected through the presentation of their depressive symptoms. Aim: The present study aimed to explore the psychosocial problems of married women diagnosed with depressive disorder. Methods: The study used a qualitative approach with exploratory research design. This study was carried out in the outpatient department of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur (Assam). Purposive sampling was used and eight women were selected for the study. In-depth interviews were conducted to explore the psychosocial stressors, experiences, and illness narratives (idioms of distress) of these women. Among eight women who consented to participate in the study, six completed the study. Results: The salient findings of this study are that the women diagnosed with mild to moderate depressive disorders conveyed their mental health issues through various physical and emotional problems. Women expressed their problems primarily through somatic complaints, typically a variety of aches in different body parts, lethargy, excessive thinking, and decreased enthusiasm. Psychosocial factors centered around various social contexts and interpersonal issues, economic difficulties, marital difficulties and housing problems. Conclusion: The women's narratives focuses predominantly on the socioeconomic and interpersonal difficulties as the underlying cause of their distressing symptoms is projective of psychosocial aberrations. Experiences expressed by women are located in their social world.
Background
There is a priority need to make community-based care widely available for people living with schizophrenia (PLwS) in low- and middle-income countries. An innovative approach for ...increasing access could be to integrate clinical services available in tertiary care hospitals with community-based care through a task-sharing approach. We describe such an integrated intervention that was implemented at Tezpur in northeast India in collaboration with the Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH).
Method
The objectives of the study were to illustrate the feasibility of integrating and implementing the intervention and to describe its individual, systemic, and public health impacts. Due to the limited resources available, we conducted a pragmatic single-arm longitudinal evaluation of the intervention cohort over 24 months.
Results
Of the 239 PLwS enrolled in the intervention, 198 (83%) were followed up for 24 months, with nearly three-quarters reporting a >70% reduction in disabilities, most notably between 6 and 18 months. There was a marked reduction in unmet needs across multiple domains, and at 24 months, 62% of the cohort was engaged in individual jobs or other market-linked livelihood opportunities. There was greater uptake and retention with outpatient contacts at the LGBRIMH, and PLwS experienced a marked (82%) reduction in inpatient admissions rates, as compared to before enrolment. Over a period of 24 months, primary caregivers reported that their families experienced significantly fewer social difficulties such as unemployment, interpersonal conflicts, and social isolation. The intervention had a significant public health impact, with an estimated 51.8% effective treatment coverage rate for the integrated intervention.
Conclusion
Our findings provide preliminary evidence of the feasibility of implementing the integrated intervention and its effectiveness. We believe that there is merit in further in-depth refinement and exploration of this implementation-related research and cost analysis while replicating the intervention in other tertiary care institutions.
Plain Language Summary
In low- and middle-income countries such as India, integrating clinical services available at tertiary mental health hospitals with community-based care through a task-sharing approach is an innovative way to make community-based care widely available for people living with schizophrenia (PLwS). The purpose of our study was to investigate the feasibility of implementing such an intervention in a community in Tezpur, northeastern India, in collaboration with a Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), and to describe the individual, systemic, and public health effects of the intervention. Our findings suggest that integrating the intervention is feasible, has significant impacts on individuals and public health, and is an effective way to expand access to community-based care for PLwS through partnerships with existing tertiary care institutions.
Background: Intellectual disability (ID) in children can trigger a range of psychological responses in parents. The present study was an attempt to investigate psychological conditions of mothers of ...children with ID and to determine whether these problems were more prominent in mothers of children with ID than mothers with healthy children. Aim and objectives were to investigate psychological impact (i.e. anxiety, depression, and quality of life QOL) on mothers of children with ID. Materials and methods comprised of two groups of subjects, i.e. mothers of sixty children with ID and mothers of sixty healthy children. The study was conducted at the Outpatient Department of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, Assam. Both groups were assessed with Beck Depression Inventory (BDI-II); State Trait Anxiety Inventory (STAI), and World Health Organization QOL-BREF (WHOQOL-BREF). Data was analysed by descriptive statistics, correlation, and t test. Result: The results of the study conclusively found out that the mothers of children with ID were having higher anxiety and depression than mothers with healthy children. The anxiety and depression had negative correlation with QOL of mothers of children with ID. Conclusion: This study shows that anxiety and depression affected QOL in mothers of children with ID.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background:
Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was ...implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015–2016.
Aim:
To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India.
Methods:
NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees.
Results:
The weighted lifetime prevalence of ‘any mental morbidity’ was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10–F19; 22.44%), mood disorders (F30–F39; 5.61%) and neurotic and stress-related disorders (F40–F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%.
Conclusion:
NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.
Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this ...necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Psychiatric rehabilitation programs have sought to develop strategies to enhance and support the community integration of people with psychiatric disabilities. Assessment of psychosocial determinants ...and need prioritisation is necessary for planning any effective rehabilitation programme. This could enable integration of persons with psychiatric disabilities to be individualized and meaningful. This community based study conducted in the North-East Region of India, at LGB Regional Institute of Mental Health, Tezpur, Assam attempted to assess psycho social determinants and the subjective rehabilitation needs of persons with major psychiatric disorders (Schizophrenia and Bipolar Affective Disorders). Fifty home visits were made in municipality areas of Tezpur. Respondents were interviewed using a semi structured interview schedule to assess the socio demographic profile and psychosocial problems. Rehabilitation Needs Assessment Schedule (Nagaswami et al., 1985) was administered to assess respondents' needs regarding rehabilitation. Results indicate that majority of the patients had "inadequate finances, insufficient welfare support, minimal social support and family care burden". Persons with psychiatric disorders and caregivers expressed multiple needs; thereby emphasizing that psycho social problem impacted the rehabilitation needs. Psychiatric patients need comprehensive after-care packages and support is required for both persons with major psychiatric disorders and their caregivers.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Previous attempts of Mental Health Systems Assessment in India were restricted in scope and scale. Information on all aspects of mental health systems (leadership/governance, legislation, ...financing, service delivery, workforce, access to essential medicines, information systems, intersectoral activities, and monitoring and evaluation) was scarcely available. The National Mental Health Survey-Mental Health Systems Assessment (NMHS-MHSA), a unique endeavor, assessed the performance of mental health systems and services through health systems assessment framework. The present paper discusses the design and methodology adopted under NMHS-MHSA along with emphasizing its implication for India and other LMICs. Methods NMHS-MHSA was undertaken in 12 Indian states by contextually adapting WHO-AIMS instrument. Data was collated from several secondary sources including interviews of key stakeholders. Utilizing the data a set of 15-quantitative, 5-morbidity and 10-qualitative indicators were developed to summarize the functional status of mental health systems in the surveyed states. This information was authenticated through state level stakeholder's consultation and consensus building workshops following which a state mental health systems report card with indicators was developed. Conclusion The process and robust method of data compilation enabled NMHS-MHSA to be a reliable and comprehensive method for assessing mental health systems at the state level. It's envisaged that the assessment provides requisite impetus for strengthening mental health program and mental health systems in India. Being less resource intensive, low -and middle- income countries can adopt NMHS-MHSA tool and methodology to assess their mental health systems with contextual modifications. Keywords: Mental Health systems, Services, Methodology, Performance, Progress, India
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