Background:
Suicides are among the leading cause of death among adolescents and young adults worldwide, including India. Suicide attempts are about 20 times more common than completed suicides. ...Teenagers and youth who attempt suicide belong to a heterogeneous group. Various biological and psychosocial factors, including family factors, contribute to such behavior. Quality of family functioning and relationships may act as an important contextual factor in deciding suicidal behavior. Hence, this study was done to explore the family factors contributing to suicide attempts.
Methods:
Qualitative exploratory study design and purposive sampling were used. Data were collected from 22 adolescents and young adults using an in-depth interview method. All audio recordings were transcribed in Malayalam, and then translated to English. Codes were developed using the qualitative data analysis software. Thematic analysis was done. Themes and relationships were identified and synthesized to a framework that represents the summary of the data.
Results:
Most of the participants perceived the home environment as hostile. Problems within the family included parental conflicts and separation, conflict with a sibling or other members of the family, and marital disharmony. Most of them perceived low family support. Socioeconomic factors such as financial issues, superstitious beliefs, disturbing neighborhoods, interpersonal issues, and the stigma of having a mental illness, in a family member, were also noted.
Conclusion:
Hostile family environment, faulty interactions between family members, and lack of perceived family support may contribute to suicidal behavior among adolescents and young adults. Hence, it is imperative to consider these factors while treating them or planning any suicide prevention program for them.
The study of changing families and the effect on changes in the health of family members is important for planning health policy and programs. Kerala is in fast epidemiological transition and the ...‘Kerala model of development’ is famous. The state had the matrilineal family system and now has a social milieu maintaining a high burden of non-communicable diseases for which lifestyle modification through family-level interventions is a suggested solution.
The specific objectives were to explore the changes in families, understand the health effects of changing families on family members, and describe stakeholder's perspectives on access and utilization of health services.
92 in-depth interviews and 17 focus group discussions were conducted in three representative districts in Kerala. Participants from different age groups from urban and rural settings were separately studied.
The reported changes were, related to nuclearization, role functions of women, elderly care, food habits, parenting styles, type of marriage, household-level decision making, and health service utilization. The linkages of these changes to the perceived health status were also explored.
The reports of stakeholders threw light on poor social penetration of health programs, explanations for new parenting styles, elderly care, and changing behavior of adolescents. The study revealed intergenerational conflicts and gives recommendations for better health care in the community.
There is a dearth of validated red flags measures for early identification of autism spectrum disorder (ASD) among toddlers. Hence, a new screening measure was developed. Item generation was done ...through literature search. Content validity (CVI) assessment was done. Criterion validity was done using Diagnostic and Statistical Manual 5 (DSM-5) as reference standard, data were collected from the case records of children with ASD diagnosis at 2 y, and evaluated for developmental milestones between 12 and 18 mo in a tertiary care setting. Item reduction of the measure from 18 to 9 was done. The area under the curve in the receiver operating characteristic (ROC) curve for new measure was 0.81 (95% CI = 0.73, 0.87);
z
= 7.874;
p
< 0.001 against DSM-5 score of ≥ 2 in the new measure; achieved sensitivity of 93.42% (95% CI = 85.3, 97.8) and specificity of 60% (95% CI = 45.9, 73.0). Thus, new validated red flag sign card (Concern-9) can be used effectively for early screening and identification of ASD among children aged 12–18 mo.
•The reliability and validity (including cut off) of PHQ-9 vary in different settings and languages. We translated PHQ-9 into Malayalam, a language spoken by 30 million people in Kerala, India and ...studied its psychometric properties when administered by health workers to screen for depression among women in a high prevalent primary care setting.•Health workers are a cadre of public health staff attached to the primary health centres in India. When they administered PHQ-9, the optimum cut off to identify depressive disorder was 9 and it had a single factor structure, which could explain 62% of variance.•This study not only proves the psychometric properties of Malayalam version of PHQ-9, but also justifies the judicious involvement available human resource in community mental health. We consider that screening by health workers would be a sustainable mode of early identification of depression.•The policy implication of the study is that, in future, PHQ-9 can be used by health workers to bring to the health system women with depression, who otherwise would have remained unidentified.
Depression is twice more prevalent among women but remains unidentified in primary care.
We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18–60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women.
The internal consistency reliability (Cronbach’s alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86–0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88–0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4–92.6), specificity of 90.1% (95% CI, 84.5–95.6%), positive predictive value of 73.4% (95% CI, 62.4–84.4%) and negative predictive value of 93.9% (95% CI, 90.2–97.6%). The accuracy was 88.2% (84.0–92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73–0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%.
When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.
OBJECTIVESTo develop a tool to assess pre-writing skills of 2-5 y old children in India. METHODSThe tool development process followed the recommendations by Fitzpatrick et al. and the Consensus based ...Standards for the selection of health Measurement Instruments (COSMIN), and included 4 phases. In Phase I, an initial 35-item draft tool was developed by an expert panel for the tool-development. In Phase II, the 35-item draft tool was prevalidated through peer and expert reviews, pilot-study to assess the tool-comprehensibility, and assessment of test-retest and inter-rater reliability. In Phase III, the 35-item draft tool was administered on the 575 typically developing children aged 2-5 y, recruited from rural, urban, slum, and coastal areas through stratified random sampling. In Phase IV, the normative age-range for development of each item was generated by calculating the age-percentiles (10th, 25th, 50th, 75th, 90th). Factor analysis and item reduction was done for items in 2-3, 3-4, and 4-5 y age-groups. The final tool was converted to graphic format with 10th-90th age-percentile bars. RESULTSThe final tool had 26 items with a three-factor structure. Cronbach's alpha was within acceptable limits for all three age-groups (0.723, 0.778, and 0.823 in 2-3 y, 3-4 y, and 4-5 y respectively). Kappa coefficients of the items ranged from 0.6-1 in interrater reliability and 0.64-1 test-retest reliability analysis reflecting substantial agreement between ratings. CONCLUSIONSA 26-item screening tool "Prewriting skills Assessment Tool" (PAT) to assess writing readiness of 2-5 y old children was developed. Tool reliability and construct validity have been established.
•In primary care, depression remains unidentified and untreated. Models which can be incorporated into exiting public health system would ensure sustainability of interventions in depression. This ...study highlights such a model from Kerala, India.•Community-based depression intervention programme (ComDIP) was implemented by primary care physicians and junior public health nurses (JPHNs). Components of ComDIP included psychosocial intervention and antidepressant treatment (Sertraline), provided from the primary health centre. There was significant reduction in severity of depression in women with moderate to severe depression.•ComDIP implementation involved existing human resource and infrastructure in primary care. Hence it would be a model public health programme for other low and middle income countries, with limited resources for mental health care.•ComDIP is an acceptable, accessible and affordable intervention for depression, a mental health condition which otherwise might remain unaddressed because of stigma. The advantage of this model is that depression management was provided by the same familiar primary care team who provided general preventive and curative care. The policy implication of this study is that such a model would improve the reach and horizontally integrate management of depression in primary health care.
In low and middle income countries where mental health resources are limited, community based depression intervention models, which can be implemented through the existing health system, are extremely relevant.
To test the effectiveness of Community based Depression Intervention Programme (ComDIP), newly developed by us, to reduce severity of depression in women, compared to the treatment as usual (TAU).
An RCT (Trial registration Number: CTRI/2011/08/001978, Clinical Trials Registry -India) was conducted in a primary care setting in Trivandrum, Kerala, South India. Health workers screened 422 women, aged 18–60 years, using PHQ-9. Sixty women with HAM-D (Hamilton Depression Rating scale) score above 19 were randomized to receive either ComDIP or TAU. Primary care physicians and health workers together implemented ComDIP which had psycho-social intervention and drug treatment. Those in TAU arm were referred to available mental health services. Primary outcome was measured at 8 weeks, by HAM-D.
At baseline and 8 weeks, mean (SD) HAM-D scores were 29.2 (5.8) and 12.2 (9.3) respectively among women in ComDIP; and 28.6 (5.1) and 21.7 (12.4) respectively among those in TAU (p = 0.02, effect size = 0.82).
ComDIP, implemented through existing health system is an effective public health programme to manage women with depression in primary care.
•Our study confirms the high prevalence of depression in primary care in India; the prevalence is particularly high in women and in governmental settings.•Our study also identifies a high prevalence ...of history of previous suicide attempt in patients in primary care even though the indication for consultation is non-psychiatric.•Most of the patients with a history of suicide attempt have a current diagnosis of depression, usually severe depression.•Our study provides an important perspective for the evaluation of patients in primary care and development of public health interventions targeting depression and suicide risk in primary care.
It is known that persons who die by suicide commonly visit a primary care physician (PCP) shortly before the fatal act.There is little information on history of suicide attempt in depressed patients who consult PCPs for non-mental health indications.This information is important because past history of suicide attempt is a known predictor of future suicide risk.
To estimate the prevalence of depression among outpatients in primary care and to determine the prevalence and determinants of past suicide attempt among them.
This cross-sectional study was conducted in six primary care settings, both public and private, in Kerala, India. A psychiatrist evaluated adult outpatients (n=827), diagnosed depression using ICD-10 Diagnostic Criteria for Research, and elicited history of suicide attempt.
Overall depression prevalence was 27.2% and was higher in women. Past suicide attempt was identified in 6.9% (95% CI, 5.17–8.63%) of all outpatients; higher in women (9.2%) than men (3.6%). Among the depressed, 21.3% had previously attempted suicide; while this figure was 1.5% in the non-depressed. The prevalence of current depression was 81% (severe depression, 61%) in patients reporting past suicide attempts. In univariate analyses, female gender, perceived financial stress, and being depressed were significantly associated with past suicide attempts. In multivariate analysis, current depression was the largest predictor of past suicide attempt (adjusted odds ratio, 14.3; 95% CI, 6.60–31.07).
Depression and suicide attempt are both common in primary care. Depression is the single most important predictor of suicide attempt.
Highlights • Our study confirms the high prevalence of depression in primary care in India; the prevalence is particularly high in women and in governmental settings. • Our study also identifies a ...high prevalence of history of previous suicide attempt in patients in primary care even though the indication for consultation is non-psychiatric. • Most of the patients with a history of suicide attempt have a current diagnosis of depression, usually severe depression. • Our study provides an important perspective for the evaluation of patients in primary care and development of public health interventions targeting depression and suicide risk in primary care.
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