Explanatory models and distress in primary caregivers of patients with acute psychotic presentations: A study from South India.

BACKGROUND: Emotional distress among caregivers of people with mental illness is common, changes overtime and requires appropriate coping strategies to prevent long-term disability. Explanatory models, which underpin understanding of disease and illness, are crucial to coping. AIM: To study the association of explanatory models and distress among caregivers of people with acute psychotic illness. METHOD: A total of 60 consecutive patients and their primary caregivers who presented to the Department of Psychiatry, Christian Medical College, Vellore, were recruited for the study. Positive and Negative Syndrome Scale (PANSS), Short Explanatory Model Interview (SEMI) and the General Health Questionnaire-12 (GHQ-12) were used to assess severity of psychosis, explanatory models of illness and emotional distress. Standard bivariate and multivariable statistics were employed. RESULTS: Majority of the caregivers simultaneously held multiple models of illness, which included medical and non-medical perspectives. The GHQ-12 score were significantly lower in people who held multiple explanatory models of illness when compared to the caregivers who believed single explanations. CONCLUSION: Explanatory models affect coping in caregivers of patients with acute psychotic presentations. There is a need to have a broad-based approach to recovery and care.

Risk factors for suicide in rural south India.

BACKGROUND: The relative contributions of psychosocial stress and psychiatric morbidity to suicide are a subject of debate. AIMS: To determine major risk factors for suicide in rural south India. METHOD: We used a matched case-control design and psychological autopsy to assess 100 consecutive suicides and 100 living controls matched for age, gender and neighbourhood. RESULTS: Thirty-seven (37%) of those who died by suicide had a DSM-III-R psychiatric diagnosis. Alcohol dependence (16%) and adjustment disorders (15%) were the most common categories. The prevalence rates for schizophrenia, major depressive episode and dysthymia were 2% each. Ongoing stress and chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship within the past year were also significantly associated with suicide. CONCLUSIONS: Psychosocial stress and social isolation, rather than psychiatric morbidity, are risk factors for suicide in rural south India.

Stigma and explanatory models among people with schizophrenia and their relatives in Vellore, south India.

BACKGROUND: Stigma associated with mental illness affects patients and their families. Diverse beliefs about the cause and treatment of schizophrenia are common among patients and their relatives. AIM: To study the association between stigma and beliefs about illness in patients and their relatives. METHOD: Standard instruments were used to assess beliefs about illness and about stigma among patients with schizophrenia and relatives in Vellore, south India. RESULTS: The majority of the patients and their relatives simultaneously held multiple and contradictory models of illness and its treatment. Stigma among patients with schizophrenia and their relatives is associated with specific beliefs about causes of mental illness. CONCLUSIONS: Beliefs may play a role in mitigating or may aggravate the effects of stigma. The cross-sectional study design precludes definitive conclusions on direction of the causal association.