The National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and ...(2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS.
Multisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage.
Conducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology.
A total of 34 802 adults (
18 years) were interviewed.
Prevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0.
The weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40-59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD.
Around 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.
Intervention The District Medical Officer, Kozhikode entrusted the team of District Mental Health Programme (DMHP), Kozhikode to address the panic and fear among the hospital staff who had initially ...treated these patients without taking sufficient precautions as they were unaware of Nipah infection during that period. Apart from the telephonic helpline, an outpatient (OP)-based support and counseling clinic was launched in the Department of Psychiatry, Medical College Hospital for catering to the psychological problems among the health care professionals and staff. In risk communication, all the public concerns are considered legitimate, regardless of how unscientific or unfounded they may be – then only effective messages could be provided. ...dealing with anxiety, fear, and sundry other problems was a novel experience.
The National Mental Health Survey was borne out of the felt need for a comprehensive epidemiological survey on mental health to understand the magnitude of psychiatric morbidities in India to aid in ...mental health policymaking, service planning, and delivery. Kerala was one of the 12 surveyed states, representing southern India.
To estimate the prevalence and pattern of various mental illnesses and substance use disorders in a representative sample from Kerala state.
A household survey using a multi-stage, stratified, random cluster sampling technique, with selection based on probability proportionate to size at each stage.
The community-based survey was carried out by trained field staff on individuals from systematically selected households from three randomly selected districts of Kerala. The instruments used in the survey included M.I.N.I adult version 6.0, a modified version of the Fagerström Nicotine Dependence Scale and questionnaires to screen for epilepsy, intellectual disability, and autism spectrum disorders.
A total of 2479 respondents aged >18 years were interviewed. The lifetime and current prevalence of mental morbidity (excluding tobacco use disorders) was 14.14% and 11.36%, respectively. Neurotic/stress-related disorders and depressive disorders were 5.43% and 2.49%, respectively, while severe mental disorders were prevalent in 0.44% of the sample. The prevalence of high risk for suicide was 2.23%.
The survey revealed high rates of common mental illnesses and suicide risk in the state when compared to national estimates.
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
Schizophrenia causes significant cognitive deficits, negative symptoms and functional impairment. These symptoms persist in certain patients in spite of evidence based pharmacological treatment. Many ...of these patients remain confined in welfare homes run by government or non-governmental organisations. Intervention modules to improve the condition of patients in these homes are scarce in India. We designed an activity based group intervention and assessed its effectiveness in patients with chronic schizophrenia in a welfare home. Participants were patients with chronic schizophrenia who were inmates of a welfare home for persons with mental illness. All of the subjects underwent evaluations that assessed clinical symptoms and functional outcomes at baseline and after 6 months. The evaluation was done using PANSS and RTI-E. The intervention was multimodal. The patients showed significant improvement in negative symptoms (effect size r = − 0.39). They showed improvement in activities of daily living (r = 0.88), communication (r = − 0.82) and instrumental activities of daily living (r = − 0.59). The current intervention resulted in reducing negative symptoms and improving functional outcome in patients with schizophrenia. These findings advocate the integration of rehabilitation programs into the standard treatment protocol for schizophrenia in welfare homes.
Chronic psychiatric illnesses cause disability. The language of recovery is now widely used globally in mental health policy, services, and research. This concept of recovery is relatively new to ...Indian mental health settings. The Recovery Facilitation Services initiated at the Institute of Mental Health and Neurosciences (IMHANS), Kozhikode (Calicut), Kerala, South India, follows a framework for service delivery based on sound principles of psychosocial rehabilitation. This paper elaborates on the rationale, the design, financial aspects, challenges encountered, and general observations regarding the effectiveness of the working of this service.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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
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.
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