Prison mental health in South-East Asia: A narrative review.

BACKGROUND: South-East Asia is a densely populated region with a considerable, however, under-prioritized mental health burden. Little is known about the mental health burden and services status in the prisons of the region. OBJECTIVES: We aimed to investigate the individual country-wise prison mental health status in South-East Asian region. METHODS: We performed a narrative review based on the evidence available in PubMed, Scopus, PsycINFO, Google, and Google Scholar considering the review objectives. We highlighted country perspectives on total population, prison numbers, prisoner numbers, the prevalence of psychiatric disorders and suicide among prisoners, prison mental health services, current challenges, and ways ahead. RESULTS: We discussed the prison mental health of five countries (Bangladesh, India, Indonesia, Nepal, and Sri Lanka). We found overcrowding (131.4%-215.6%) in the prisons, a high prevalence of psychiatric disorders in the prisons (40%-100%), negligible prison mental health services, and a lack of data on prison suicide with some variations among the five countries. Among the countries, Bangladesh has the highest prevalence (66.4%-100%) of psychiatric morbidity with an absence of a mental health system. CONCLUSIONS: Prison mental health in tSouth-East Asia is a neglected domain and warrants attention regarding ensuring adequate mental health services to the prisoners as there are high unmet mental health needs and an absence of poorly supported mental health needs.

Rate and sociodemographic correlates of depression, anxiety, and stress among domestic and overseas medical students: A cross-sectional observation from a private medical college in Bangladesh.

Background: Depression, anxiety, and stress are the commonly encountered mental health conditions among medical students. Overseas environment may add additional burden to the existing environment. However, comparison of the rate and associated factors of depression, anxiety, stress among domestic and overseas students has not been attempted in Bangladesh. We aimed to assess the rate and associated factors of depression, anxiety, stress among domestic and overseas medical students in the country. Methods: This cross-sectional study was conducted among 360 undergraduate medical students in 2021. Data were collected by self-reporting instruments by a stratified random sampling method by the Depression, Anxiety, and Stress Scale-21 scale. Bivariable and multivariable binary logistic regression analyses were done by computing crude odds ratio and adjusted odds ratio with 95% confidence interval to identify the associated factors. Results: Among the 360 undergraduate medical students, 181 were domestic and 179 overseas ones. 44.8% of domestic students reported depressive symptoms, 45.3% reported anxiety symptoms, and 33.1% reported stress. On the other hand, half of overseas students experienced depression (50.3%) and anxiety (52.5%), and 41.3% experienced stress. Female medical students were found vulnerable for developing depression, anxiety, and stress than males. Conclusions: The study revealed higher rates of depression, anxiety, and stress among overseas undergraduate medical students enrolled in a private medical school of Bangladesh. Private medical college authorities could consider special services for overseas students to ensure adequate psychosocial support.

Mental disorders during pregnancy and postpartum in Bangladesh: A narrative review.

Background and Aims: Bangladesh has made significant progress in declining maternal mortality in recent decades. However, the available evidence on the various maternal mental disorders in the country has not been comprehensively and critically reviewed to date. This narrative review aimed to assess the mental disorders and associated factors during pregnancy and postpartum in Bangladesh. Methods: A thorough search was performed in PubMed, Scopus, Google, Google Scholar, and BanglaJOL with search terms at the end of January 2024 to identify the original articles published on psychiatric morbidities during pregnancy and postpartum. Results: This review included 28 empirical studies published between 2007 and 2023 with a sample size ranging from 100 to 39,434. Two studies were published before 2010, 16 studies were published between 2011 and 2020, and 10 studies were published between 2021 and 2023. No countrywide study was noted, the Bangla Edinburgh Postnatal Depression Scale (EPDS-B) was used in 57% of studies, suicidal behavior was assessed in three studies, postpartum depression (PPD) was featured in 16 studies, and three qualitative studies were noted. The prevalence of PPD ranged from 9% to 51.7%. About 46% of mothers had positive scores for common mental disorders. The prevalence of mental disorders was 14.2%; among them mood disorders were present at 6.1% and psychoses were noted at 4.5%. Conclusions: There are wide variations in the prevalence of maternal mental disorders in Bangladesh from study to study; a lower prevalence was noted when diagnostic tools were used even though no nationwide study with confirmatory diagnostic tools was noted. Studies with nationwide distribution and diagnostic tools are warranted to understand the problem precisely.

Practical challenges for mental health services among Rohingya refugee in Bangladesh.

Rohingya Muslims have been forcefully displaced from their mother land, Rakhaine State, Myanmar to Bangladesh, a country with about 170 million population with a treatment gap of more than 90% for standard mental health care. Due to the experienced trauma and displacement, high prevalence of depression, anxiety and post-traumatic tress disorders has been identified among Rohingya refugees in addition to the enduring mental health burden of Bangladesh. Very little has been known regarding the practical challenges of mental health services among Rohingya refugees in Bangladesh. In this commentary, we aimed to highlight the practical challenges for mental health services in Rohingya camps in Bangladesh along with our speculative ways forward based on available evidence, work experience, and informal communications. We highlighted the available mental health services, several major challenges including awareness, perception and belief towards mental health, language and cultural barriers, dearth of skilled service providers, inadequate services for severe mental illness, dearth of mental health services for children, inadequate provision of supervision and 'Care for Caregivers' program, and privacy and confidentiality of the clients. Although significant improvements have been made in the mental health field in the emergency crisis sector in Cox's Bazar over the past years, concentrated efforts are urgently required to actualize proposed solutions in this paper.

Health-related quality of life (HRQoL) and associated factors in Bangladeshi adolescents during COVID-19.

Background and Aims: The COVID-19 pandemic and its accompanying countermeasures significantly disrupt the health-related quality of life (HRQoL) of adolescents. We aimed to estimate the status and associated factors related to HRQoL of adolescents during the COVID-19 pandemic from the community population of Bangladesh. Methods: This cross-sectional study followed two-stage sampling. From eight administrative divisions of Bangladesh, 2030 adolescents were enrolled. The KIDSCREEN-10 index was used to measure the HRQoL of adolescents. In addition to this, adolescents' data on sociodemographics, mental well-being, parenting style, insomnia, food insecurity, depression, anxiety and stress, resilient coping, screen-based activity, and anthropometry were taken for finding out the factors associated with HRQoL of adolescents. The hierarchical multilinear regression was performed to assess the association. Results: More than 47% of adolescents were found to have moderate and high HRQoL, while 4.7% of adolescents experienced low HRQoL during data collection. Higher age (B: -0.671), having more siblings (B: -0.316), food insecurity (B: ‒2.010), depression (B: ‒0.321), anxiety (B: ‒0.362), and stress (B: ‒0.150) were found to have significantly negative associations with adolescents' HRQoL during the COVID-19 pandemic. Whereas, positive parenting (B: 0.409), inconsistent parenting discipline (B: 0.266), good mental health (B: 5.662), resilient coping (B: 0.306) were found to have significant positive relationships. Conclusions: The findings from this study indicate that over 52% of the adolescents reported a moderate and lower level of HRQoL. In light of these results, it may be beneficial to prioritize interventions targeting psychological factors such as depression, anxiety, and stress.

Suicidal behaviour among the university students in the UK: A systematic review.

Introduction: Identifying risk factors would help consider suicide prevention in any specific population. We aimed to assess suicidal behaviour among university students in the UK. Methods: An extensive keyword search was conducted through PubMed, Cochrane, CINHAL Plus, PubMed Central, Web of Science, Trip database, and Science Direct, following the PRISMA guidelines to identify different publications. The search strategy for the literature review was based on the Population Exposure Outcome framework. Critical appraisal utilised the CASP tool for cohort studies and the AXIS tool for cross-sectional studies, resulting in 14 included studies. A narrative synthesis was performed. Results: Postgraduate and undergraduate students used different suicidal methods such as poisoning, jumping, hanging, drowning, and suffocating, with jumping most preferred by male students. The predisposing factors of suicide among university students included: mental health problems (depression, psychological stress, psychosis, mania, neuroticism, financial anxiety, imperfect parents' connection with students), sexual orientation with risk of suicide among non-heterosexual students due to lowered self-esteem from feeling disregarded, disrespected and insufficient attention from the surrounding. Suicidal behaviour was high among unmarried students, male and unemployed female students, and students with childhood experiences such as physical abuse, family violence, emotional abuse, neglect, and physical punishment-gender, with females seeking more services from general hospitals with more suicide attempts in older females. High risk was also noted in males, with increased risk in white students compared to black students. Conclusion: The review highlighted that students with previous mental health problems, a history of experiencing sexual abuse in childhood, bad relationships with their mother, disrespect and disregard in the community due to sexual identity are the major contributing factors for suicide among university students in the UK.

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis.

OBJECTIVES: Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA. METHODS: We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence. RESULTS: The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%). CONCLUSIONS: Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

Electroconvulsive therapy in South Asia: Past, present, and future.

The practice of electroconvulsive therapy (ECT) varies both between and within countries. We aimed to review historical and current trends in ECT practices, perceptions, and legislations in South Asia, a region with a high burden of mental illness and suicide. We searched MEDLINE (PubMed) and Google Scholar databases for relevant literature on ECT from each country. Additionally, a team of country-specific investigators performed supplemental searches and contacted key country contacts for relevant information. Relevant data were abstracted under the following headings: ECT practices, perceptions, and legislations. Knowledge gaps and research priorities were synthesized. Modified bitemporal ECT, delivered using brief pulse devices, was most commonly offered across institutions. Schizophrenia, not affective illness, was the most common indication. Electroencephalographic monitoring of seizures was rarely practiced. Thiopentone or propofol was preferred for anesthetic induction, while the favored muscle relaxant was succinylcholine. In India and Sri Lanka, perceptions about ECT were largely favorable; not so in Pakistan and Nepal. Only India and Pakistan had laws that governed any aspect of ECT practice; ECT practice guidelines were available only in India. There is a lack of research on efficacy, ECT in special populations, continuation ECT practices, and interventions to improve ECT-related perceptions. Most regional institutions offered modified brief-pulse ECT, and schizophrenia was the most common indication. Knowledge of and attitude towards ECT varied between countries. There is a need to develop a regional ECT consortium to facilitate uniform training, advocacy efforts, and the development of regional practice guidelines.

Marital status and suicidal behavior in South Asia: A systematic review and meta-analysis.

Background and Aims: The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries. Methods: We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta-analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal). Results: Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1-60.5) for suicidal behavior, 52.7% (95% CI: 44.5-60.7) for suicides, and 43.1 (95% CI: 32.9-53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2-66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%-62.9%) and Pakistan (45.1%; 95% CI: 30.9-59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633). Conclusion: This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause-and-effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.

Prevalence, correlates and common methods of non-suicidal self-injury in South Asia: a systematic review.

INTRODUCTION: The dynamics of self-harm vary substantially around the world, yet it is severely under-researched outside of a small number of high-income 'Western' countries. South Asia is disproportionately impacted by suicide, yet we know less about non-suicidal self-injury (NSSI) in the region. OBJECTIVE: To review and summarise evidence on the prevalence, correlates and common methods of NSSI in South Asia. METHODS: We searched Medline, Embase and PsycINFO for the period 1 January 2000 to 31 August 2023, for peer-reviewed observational studies. A total of 11 studies from eight South Asian countries that reported prevalence and/or correlates of NSSI were included in this review. We assessed the quality of the studies using the Study Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies. We used meta-regression to describe the sources of heterogeneity. Abstracted data were summarised using thematic synthesis. RESULTS: For non-clinical populations, the 12-month prevalence of NSSI ranged from 3.2% to 44.8%, and the lifetime prevalence ranged from 21% to 33%. For clinical populations, the 12-month prevalence of NSSI ranged from 5% to 16.4%, while the lifetime prevalence ranged from 2% to 27%. Male sex, unemployment, financial stress, history of suicidal behaviour and depression were associated with a higher risk of NSSI. Better access to counselling services, higher self-esteem and self-knowledge were associated with a lower risk of NSSI. CONCLUSION: The burden of NSSI in South Asia appears to be high in both clinical and non-clinical populations. Further research, especially with general population samples, is needed to build evidence on the epidemiology, context and meaning of NSSI in South Asia to inform the design of context-specific interventions. PROSPERO REGISTRATION NUMBER: CRD42022342536.

The effect of COVID-19 on the mental health of the people in the Indian subcontinent: A scoping review.

Indian subcontinent has high mental heath burden and low resources to cope the mental health challenges. Assessment of impact of COVID-19 pandemic on the mental health would help to prioritize the resource allocations. We aimed to assess the impact of COVID-19 on the mental health of people in the Indian subcontinent. Following the PRISMA 2020 guideline, a scoping review was performed by systematically searching the PubMed, Scopus, and Embase databases to identify original studies that assessed mental health conditions during the COVID-19 pandemic in the Indian subcontinent. In this review, a total of 34 studies conducted between 2020 and 2022 were analyzed. The prevalence of anxiety disorders was found to range widely, from 2.5% in North Indian urban slum to 53% in Bangladesh and 21.7% in Pakistan. Similarly, the prevalence of depression varied widely, with rates ranging from 3.5% in North India to 29.8% in Pakistan. The prevalence of stress-related problems ranged from 18.3% in Pakistan to 59.7% in Bangladesh. Factors such as female gender, married status, healthcare workers, and mental illness were identified as important predictors of anxiety and depressive disorders. The impact of COVID-19 pandemic on mental health in Indian subcontinent varies widely based on study population and methods. Therefore, a cautious interpretation is needed while generalizing the study results.

Psychometric evaluation and validation of Urdu Social Rank Scale for women with infertility in Pakistan.

Background: Infertility negatively affects nearly all aspects of women's life and is a source of demotion in the rank/status of women that they have achieved after marriage. This social rank/status demotion due to infertility may result in depression and several other psychopathologies. No extant instrument is available to measure the phenomenon of social rank in women with infertility in Pakistan. Objective: The aim of the current study was to evaluate the psychometric properties and validate the Social Rank Scale for women experiencing infertility in Pakistan. Methodology: This study was conducted in four phases. The data were collected from women with primary infertility who visited hospitals all over Pakistan from 2016 to 2018. Social Rank Scale for Women with Infertility (SRS-WI) comprising of two scales, the Social Comparison Scale for Women with Infertility (SCS-WI) and the Submissive Behavior Scale for Women with Infertility (SBS-WI), was developed. Results: The factor structure of 37 items of SCS-WI and of 21 items of SBS-WI was determined through exploratory factor analysis (EFA) on a sample of 215 women with primary infertility with an age range of 20-45 years (Mage = 31.03; SD = 6.18). Principal component analysis with varimax rotation method yielded a three-factor solution for SCS-WI, and 32 items were retained for SCS-WI that accounted for 62.38% variance. For SBS-WI, a uni-factor solution was obtained, and 20 items were retained for SBS-WI, which collectively accounted for 42.01% variance. The factor structure for both scales was confirmed via confirmatory factor analysis among a sample of 210 participants with good model fit indices. Conclusion: The study provides acceptable psychometric properties of the SRS-WI in Pakistan. Testing of psychometric properties in different groups of samples would justify the generalized use of the instrument.

Long-Term Changes in the Quality of Media Reporting of Suicide Following a Celebrity Suicide in India.

Online portals of selected English and local language newspapers and television channels were searched to identify suicide news reports published one year after the celebrity suicide (ACS). These reports (n = 1952) were compared with the corresponding period of the previous year, immediately following the celebrity suicide (ICS) (n = 2486), and a three-month period before the celebrity suicide (BCS) (n = 1381) to assess longitudinal changes in quality of media reporting. There was a decline in reporting of several potentially harmful characteristics over time such as mentioning the deceased's age and gender (p < .001 for both), and location of suicide (p < .001). The quality of media reporting of suicide was significantly better at one year compared to the period immediately following celebrity suicide. This change was mainly driven by an improvement in the reporting quality of English news reports while local language reports continued to remain poorly adherent to reporting guidelines.

Filicide in Bangladesh: A case indicating the need for psychosocial support among mothers during peripartum.

We report a case of filicide which is an under-researched entity in Bangladesh. A 28-year-old lady visited with complaints of irregular eating followed by self-induced vomiting, poor anger control, irregular sleep, hopelessness, and suicidal thoughts for the last year. On the third visit, she admitted that she killed her 32-day-old baby by keeping it in a refrigerator. The case raises some forensic psychiatric complexities as the patient confessed it to the psychiatrist while family members know it as an accidental aspiration. It indicates the complex nature and dire need for psychosocial support in Bangladesh.

Dysfunctional schema modes as determinants of psychiatric comorbidities: a study in a cohort of people with epilepsy.

INTRODUCTION AND AIMS: Symptomatology of epilepsy and its' associated alteration in brain processes, stigma of experiencing seizures, and adverse sequelae of anti-epileptics have been demonstrated to impact behaviour and exacerbate psychopathology. This study examines the role of dysfunctional schema modes in People with Epilepsy (PWE) and their association with psychiatric symptoms. METHODS: Semi-structured interviews were conducted with 108 PWE treated with anti-epileptics for at least one year and with no history or mental disorder or psycho-active substance use. Clinical symptoms were measured utilising the Symptom Checklist-90 (SCL-90) with schema modes measured utilising the Schema Mode Inventory (SMI). RESULTS: Maladaptive coping and child schema modes were significantly higher in individuals from lower socio-economic status group (p < 0.01), with several maladaptive schema modes more prevalent in males. Hostility symptoms were increased in individuals from lower socio-economic classes and were more prevalent early in disease course. Several psychological symptoms including somatisation, interpersonal, obsession, depression, paranoia, hostility, phobia, anxiety, and psychoticism, were predicted by various maladaptive schema modes (p < 0.001). CONCLUSION: This study highlights the impact of maladaptive schemas, suggesting that PWE might benefit from the introduction of appropriate psychotherapeutic interventions such as schema-focused therapy, particularly if from lower socio-economic classes or in the early stages of theirdisease course.

Prevalence of suicidal behaviour among students living in Muslim-majority countries: systematic review and meta-analysis.

BACKGROUND: Assessing suicidal behaviours among students would help to understand the burden and enhance suicide prevention. AIMS: We aimed to determine the prevalence of suicidal behaviour among students living in Muslim-majority countries. METHOD: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted in Medline, EMBASE and PsycINFO. Meta-analyses were performed to pool the lifetime, 1-year and point prevalence rates for suicidal ideation, plans and attempts. RESULTS: From 80 studies, 98 separate samples were included in this analysis. The majority (n = 49) were from the Eastern Mediterranean, and 61 samples were of university students. The pooled prevalence of suicidal ideation was 21.9% (95% CI 17.4%-27.1%) for lifetime, 13.4% (95% CI 11.1%-16.1%) for the past year and 6.4% (95% CI 4.5%-9%) for current. The pooled prevalence of suicide plans was 6.4% (95% CI 3.7%-11%) for lifetime, 10.7% (95% CI 9.1%-12.4%) for the past year and 4.1% (95% CI 2.7%-6.2%) for current. The pooled prevalence of suicide attempts was 6.6% (95% CI 5.4%-8%) for lifetime and 4.9% (95% CI 3.6%-6.5%) for the past year. The lifetime prevalence of suicidal ideation was highest (46.2%) in South-East Asia, but the 12-month prevalence was highest (16.8%) in the Eastern Mediterranean. CONCLUSIONS: The study revealed notably high rates of suicidal behaviours among students living in Muslim-majority countries. However, the quality of studies, differences in regional and cultural factors, stages of studentship and methods of measurement should be considered when generalising the study results.

Racism, cricket, and impact on mass psychology.

Racism is not an uncommon phenomenon in sports, with cricket being no exception to it. Cricket is played in many countries, with its dominance in South East Asia, Europe, Australia, and Africa. Racist remarks in cricket hit media headlines and ignite agitations among the cricket fans. This article discusses the psychological impact of racism associated with cricket and possible remedial measures.