Disentangling comorbidity in chronic pain: A study in primary health care settings from India.

OBJECTIVES: The study examined the prevalence, sociodemographic, and clinical correlates of chronic pain among primary care patients in the state of Kerala, India. It also examined the patterns and relationships of chronic physical and mental health conditions with chronic pain. METHODS: This study is a cross-sectional survey conducted among 7165 adult patients selected randomly by a multi-stage stratified design from 71 primary health centers. The questionnaires administered included Chronic pain screening questionnaire, self-reported Chronic physical health condition checklist, Patient Health Questionnaire-SADS, The Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, WHO Disability Assessment Schedule and WHOQOL- BREF for Quality/Satisfaction with Life. The prevalence and comorbid patterns of chronic pain were determined. Logistic regression analysis and generalized linear mixed-effects model was employed to examine the relationship of chronic pain to socio-demographic variables and examined physical and mental health conditions. RESULTS: A total of 1831 (27%) patients reported chronic pain. Among those with chronic pain, 28.3% reported no co-occurring chronic mental or physical illness, 35.3% reported one, and 36.3% reported multi-morbidity. In the multivariate analysis, patients with chronic pain when compared to those without had higher odds of being older, female, having lower education, not living with their family, greater disability, and poor satisfaction with life. Chronic pain was independently associated with both medical (hypertension, diabetes mellitus, tuberculosis, arthritis, and other medical illnesses) and mental health conditions (depressive disorders, anxiety disorders, and tobacco dependence). It showed a varying strength of association and additive effect with increasing number of co-occurring physical and mental illnesses. CONCLUSIONS: Chronic pain is a common condition among primary care attendees associated with significant burden of medical and mental health comorbidity. The findings highlight the need to incorporate treatment models that will ensure appropriate management to improve outcomes within the resource constraints.

Toddlers at risk for Autism Spectrum Disorders from Kerala, India - A community based screening.

AIMS: To study the at-risk rate for Autism Spectrum Disorders (ASD) on a parent-report questionnaire in toddlers between the ages of 16-24 months. MATERIALS AND METHODS: 6237 toddlers from Kerala, India selected by cluster random sampling were surveyed by community nurses using the Modified Checklist for Autism in Toddlers - Revised (M-CHAT-R) translated to Malayalam and culturally adapted. RESULTS: 5.5% toddlers were at risk on M-CHAT-R and 2.7% on "Best Seven". CONCLUSIONS: M-CHAT-R and its "Best Seven" could be viable community level screening instruments, albeit with further cultural adaptation for a primarily non-English speaking population in India.

Psychological distress among college students in Kerala, India-Prevalence and correlates.

AIMS: To study the prevalence and correlates of psychological distress among college students in Kerala, India. MATERIAL AND METHODS: 5784 students across 58 colleges were self-administered Kessler's Psychological Distress Scale (K10) and other standardized instruments. RESULTS: The prevalence of psychological distress was 34.8% (Mild-17.3%; Moderate-9.2%; Severe-8.3%) with a female predominance. Students with psychological distress were more likely to report academic failures, substance use, suicidality, sexual abuse and symptoms of attention deficit hyperactivity disorder. Students with severe distress had higher morbidity. CONCLUSIONS: Psychological distress is common among college students and its association with negative correlates suggests the need for early interventions.