Abusive head trauma in India: imaging raises the curtain.

The purpose of the study was to identify children at our institute who possibly suffered abusive head trauma (AHT). A retrospective study of CT imaging of children between one month to three years of age between January 2013 and May 2021 was carried out at a dedicated neurocentre in Southern India. We identified 48 cases of possible AHT. The demographics, clinical features at presentation, imaging and fundus findings were analyzed. Imaging revealed subdural hemorrhage (SDH) in 42 and sub dural effusion (SDE) in 5 cases, one case had only hypoxia. The location of SDH was studied as was hypoxia underlying SDH, global hypoxia and ischemia. Cases of subarachnoid hemorrhage (SAH), parenchymal hematoma & intraventricular hemorrhage (IVH) were also noted. Skeletal survey, chest X-ray and CT spine were reviewed. AHT needs to be paid attention to in the Indian scenario. An extensive work up is required to substantiate the claim and to work on prevention & management of these cases subsequently.

Predictors of behavioral and emotional issues in children involved in custody disputes: A cross sectional study in urban Bengaluru.

BACKGROUND: The increasing rates of divorce in urban India has led to the subsequent parental battle for the child's custody. This paper discusses the behavioral and emotional issues of these children in relation to their psychosocial environmental factors and other relevant socio-demographic variables. METHODS: We used samples from parent interviews concerning 52 children aged 7-17-years-old, involved in child custody cases in the Family court of urban Bengaluru. The Strengths and Difficulties Questionnaire was used to measure response variables of behavioral and emotional issues in these children. Predictor models of quantile and multiple linear regression were used to assess the influence of psychosocial environmental factors and socio-demographic variables on the response variables. RESULTS: The predictor models revealed that risk of child suffering emotional and behavioral issues increased with factors such as excessive parental control, change of academic environment, general unrest at school, frequency of child's court visit, child's visitation of non-custodian parent on occasions and vacations, and negatively altered family relationship. The model however intriguingly showed that residing in nuclear household rather than with their grandparents in a non-nuclear household, decreased the risk of mental health issues in these children. CONCLUSIONS: This study is a novel attempt to understand the influence of the psychosocial issues on the child's mental health in the context of custody cases in India. Despite the minimum sample size, the findings imply that family-based intervention is the need of the hour in these cases. The implications for clinical practice and research are discussed.

Family support and well-being programme (FSWP): A specialized family strengthening psychosocial services for parents of children in conflict with law.

Background: A multidimensional family support and well-being programme (FSWP) was initiated to support the families of children in conflict with law (CICL) and strengthen their participation in the integration process. This programme aims to successfully reintegrate children into the family and build parental capacity to manage them. This study presents the overview of the multidimensional FSWP initiated in an observation home, facility for CICLs, Bengaluru, a metropolitan city of India. Methods and Materials: The team of psychiatric social workers systematically delivered the family support programme to promote families' involvement at multiple levels (individual, relationships, community, and societal) for successful reintegration of children in communities. The preliminary data about the participants was collected using strengths and difficulties questionnaire and parent interview schedule. Results: The programme activities consisted of engaging parents and family members in the parenting management training programme, addressing their psychosocial issues, identifying resources for postrelease rehabilitation and promotive interventions with children and their parents. The FSWP activities are developed to increase positive outcomes like favorable behavioral changes in children and emotional regulation, frequent participation and support of parents in the trial and rehabilitation process, and encouraging parental involvement in for successful community reintegration and placements of children. Conclusion: The family characteristics are integrally related to delinquency and practioners need to integrate such factors to improve parenting behaviors and enhance positive relationships between families and children.

Swatantra Clinic: A descriptive study on the specialized child mental health service for children in difficult circumstances at a tertiary care center in India.

In India, children in difficult circumstances, like institutionalized children have higher mental health morbidity and complex psychosocial concerns than the non-institutionalized children. To cater to the complex needs of these children referred by the Juvenile Justice System, a specialized service called 'Swatantra Clinic' was initiated by the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neurosciences, India. This article thereby aims to describe the psychosocial characteristics of these children, along with the array of specialized interventions provided during the first year of its inception in June 2018. It was found that majority of these children were girls and were from lower socio-economic, urban background, primarily referred for externalizing or internalizing concerns. The majority of them reported experiences of physical and verbal abuse along with family stressors and almost half of them had a diagnosable psychiatric condition. The nature of the psychosocial services rendered at the clinic mostly comprised of brief, individual and family counseling along with liaison work with various governmental agencies for rehabilitation services. These form the key components of a comprehensive, collaborative, time-bound and holistic care model to cater to the distinct psychosocial issues of this vulnerable population of children in low - middle resource settings. Policy implications are discussed.

Anxiety and depressive symptoms in pregnancy predict low birth weight differentially in male and female infants-findings from an urban pregnancy cohort in India.

PURPOSE: This study examined the contributions of antenatal anxiety, depression, and partner violence to low birth weight (LBW) in infants and to sex-specific birth weight outcomes among mothers from a cohort in urban India. METHODS: Data from 700 mothers from the PRAMMS cohort (Prospective Assessment of Maternal Mental Health Study) were used. Pregnant women were assessed in each trimester-T1, T2 and T3, for symptoms of anxiety, and depression as well as partner violence. Multivariate analyses were performed for the whole sample and then for male and female infants separately. The final multivariable logistic regression models were each built using a backward selection procedure and controlling for confounders. To accommodate longitudinally measured data, change in scores (T2-T1 and T3-T2) of anxiety and depression were included in the model. RESULTS: Of the 583 women with a singleton live birth, birth weight was available for 514 infants  and LBW was recorded in 80 infants (15.6%). Of these, 23 infants were preterm. Overall, higher T1 Depression scores (OR: 1.11; 95% CI 1.040, 1.187) and an increase in both Depression scores (OR: 1.12; 95% CI 1.047, 1.195) from T1 to T2 and Anxiety scores (OR: 1.32; 95% CI 1.079, 1.603) between T2 and T3 were predictors of LBW. Female infants had a higher chance of LBW with increase in maternal anxiety between T1-T2 (OR: 1.69; 95% CI 1.053, 2.708) and T2-T3 (OR: 1.49; 95% CI 1.058, 2.086); partner violence during pregnancy just failed to reach conventional statistical significance (OR: 2.48; 95% CI 0.810, 7.581) in girls. Male infants had a higher chance of LBW with higher baseline depression scores at T1 (OR: 1.23; 95% CI 1.042, 1.452) and an increase in depression scores (OR: 1.25; 95% CI 1.060, 1.472) from T1 to T2. CONCLUSION: Increasing prenatal anxiety and depressive symptoms in different trimesters of pregnancy were associated with LBW with sex-specific patterns of association in this sample from a Low and Middle Income Country.

Predictors of emotional and behavioral problems among Indian adolescents: A clinic-based study.

BACKGROUND: Emotional and behavioral problems place a heavy burden on the adolescents and their families. Many factors are known to influence adolescent mental health. The current study was designed to determine the predictors of emotional and behavioral problems among Indian adolescents. METHODS: The parents of adolescents in the age group of 10 to 18 (N = 81) were recruited from the National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India. Alabama Parenting Questionnaire (Parent version), Strength and Difficulty Questionnaire (Parent version) and, the Parent Interview Schedule (PIS) were used to assess the parental practices, emotional and behavioral problems and abnormal psychosocial environment of the adolescents. The data were analyzed with stepwise multiple linear and Quantile regression to find out significant predictors of emotional and behavioral problems among adolescents. RESULTS: Adolescent's age, parental involvement, and paternal age are the significant predictors of emotional problems. Parental mental disorder or deviance, gender, and inconsistent discipline are the significant predictors for conduct problems. Poor monitoring and supervision, paternal and maternal age are statistically significant predictors of prosocial skills among the adolescents. Inadequate or distorted intrafamilial communication and parental mental disorder are the significant predictors of total difficulties among the adolescents. CONCLUSION: The study validates the role of abnormal psychosocial environments and negative parenting practices as risk factors for emotional and behavioral problems among the adolescents. A comprehensive analysis which covers all possible variables related to adolescent mental health is mandatory for the health professionals before planning the intervention.

Suicidality in early pregnancy among antepartum mothers in urban India.

This study assessed the prevalence and predictors of suicidality among 462 pregnant women in South India. Women in early pregnancy (<20 weeks) attending an urban public hospital antenatal center were assessed for suicidality using a modified version of the Suicide Behaviors Questionnaire-Revised (SBQR) and a single-item (item 10) from the Edinburgh Postnatal Depression Scale (EPDS). Severity of depressive symptoms, family violence, and perceived social support were also measured. The prevalence of suicidality in pregnancy was 7.6 % (35/462). Eleven women (2.4 %) reported having had suicidal plans, and 8 (1.7 %) had made a suicidal attempt during the current pregnancy. Younger age, belonging to a middle socioeconomic status, poor perceived support, domestic violence, depressive symptoms, and having a past history of suicidality predicted suicidal ideation during the current pregnancy. Multivariate analysis revealed depression severity and a life time history of suicidal ideation as being the strongest predictors. The findings underscore the need for assessment of psychiatric and psychosocial factors that confer risk among women in this vulnerable period. The results of the study however may be specific to low-income urban women from this geographical location limiting the external validity of our findings.