Perceived social support, loneliness, and depression among elderly living in old-age homes.

Background: Older persons occasionally or permanently relocate from their own houses to institutions or old-age homes as a result of the current socio-demographic changes and circumstances. In this scenario, the current study aimed to assess the perceived social support, loneliness, and depression among the elderly living in old-age homes. Materials and Methods: We have conducted a descriptive cross-sectional study among the elders living in old-age homes in Bengaluru urban, who have been staying in old-age homes for at least 6 months or above, and the age group of 60 years or above. Data were obtained from 40 respondents from four old-age homes using a simple random sampling method. Structured interview schedules have been used which included a socio-demographic profile, geriatric depression scale, multidimensional scale of perceived social support, and emotional and social loneliness scale. Results: The majority of the respondents (82.5%) belonged to the age category of 60-70 years. More than half of the respondents were females (57.5%); 30% of the respondents were widowed. Nearly two-thirds of them belonged to below poverty line families. The analysis showed a negative correlation between perceived social support and loneliness and depression and a positive correlation between loneliness and depression. There is a significant gender difference among study variables such as perceived social support and depression. The results also show significant differences across the categories of socioeconomic status, duration of physical illness, and a number of organizations changed while comparing perceived social support and depression variables. Conclusion: Perceived social support influences older adults' experience of loneliness and depression among inmates of old-age homes. Hence, there is a need to sensitize the staff working in old-age homes on caregiving skills for enabling the elderly to enjoy better-perceived social support and quality of life.

Efficacy of Psychosocial Care Training Programme for the Staff Working in Old Age Homes.

Background: Training the old-age home staff is essential in raising geriatric mental health care standards in India. Inadequate knowledge on ageing and psychosocial interventions is a significant issue in old-age homes. Old-age home staff must know how to provide individualized psychosocial care and support for older adults. Hence this study aimed to test the feasibility of the psychosocial care training program for the staff working in old-age homes. Methods: A quasi-experimental research design (pre-post without a control group) was used. Forty-two staff members participated. Mary Starke Harper Aging Knowledge Exam (MSHAKE) and structured checklist to measure the staff's knowledge on ageing, psychosocial interventions, welfare legislations, schemes, and support services were administered before, immediately after, and two months after the program and the self-efficacy checklist was administered immediately and two months after the program, to examine the efficacy of the program. Results: Significant improvement was found in the ageing knowledge and the knowledge of psychosocial intervention and psychosocial care. These improvements continued for two months (p < .001). Similarly, their self-efficacy in managing such problems was also sustained across two post-measurements (p = .045). Conclusions: Face-to-face training programs would enhance the knowledge of the old age home staff. This Psychosocial Care Training module can be used for training old age home staff to address various psychosocial needs, concerns and other psychosocial problems of the residents.

Relationship of personality, psychological distress, and substance use with social network characteristics of college going young adults.

Background: Causes of substance use are multifactorial. Factors such as personality, psychological distress, and the person's social ties contribute to the understanding of substance use problems of college students. Aim: The current study aimed to investigate the association between personality traits and psychological distress with ego-centric social networks of substance-using and non-using college students. Method: This cross-sectional descriptive study involved 902 undergraduate students from the government (n = 2) and government-aided (n = 9) colleges. The socio-demographic data sheet, Big Five Personality Inventory, Depression Anxiety and Stress Scale, and the semi-structured Ego-centric Social Network Questionnaire were used to collect data. Results: Of 902 participants, 26.9% of participants used substances. The mean score of anxiety (P < 0.002) and depression (P < 0.002) was significantly higher among the substance users compared with non-users. Agreeableness (P < 0.001) and conscientiousness (P < 0.001) scores were significantly higher among non-users. Depression (P < 0.01), anxiety (P < 0.01), and stress (P < 0.01) correlated positively with the total number of substance users in the network. Agreeableness (P < 0.01) and conscientiousness (P < 0.01) were positively correlated with parents and siblings in the network. Stress emerged as a predictor (OR 1.61, CI 1.09-3.04, P < 0.001) for considering substance users to the social network. Conclusion: Personality and psychological distress are associated with an individual's social network and significantly contribute to student substance use problems.

Lived Experiences of Persons with Chronic Schizophrenia Living in the Community.

Background: Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice. Method: We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants. Results: Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives. Conclusion: Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses.

Association of Social Network Characteristics with Substance Use among College-Going Young Adults: A Cross-Sectional Study.

Background: Family members, peers, and significant others are part of a college student's social network. This cross-sectional study aimed to Assess substance use prevalence and patterns among college students,Compare the social network characteristics of substance users (SUs) and non-users (NUs), andExplore the association of social factors with substance use. Methods: The study involved 902 students from 11 Government and aided private degree colleges. Demographic and clinical data sheet, ASSIST, and Social Network Questionnaire were used to collect the data. Results: Prevalence of substance use was 26.9% and higher among males (21.5%). Alcohol (20%) and tobacco (15.5%) were the commonly used substances. SUs' network was composed of unmarried persons (p<0.002), male members (p<0.001), and friends (p<0.001) with substance use. In contrast, the NUs' network comprised parents (p<0.016) and siblings (p<0.001). NUs had a higher number of influential members in the network, whereas SUs had more closeness with members and received higher financial support (p<0.001). Participant's age (OR 1.27), family history of substance use (OR 2.46), parents' occupation (Business: OR 1.79, being employee in the government or industry: OR 1.76),and having three substance-using members in the network (OR .211) were found to be risk factors. Conclusion: Social network has an association with substance use among college students. Social-network-based interventions may benefit them.

Profiles of Victimized Outpatients with Severe Mental Illness in India.

Persons with severe mental illness (PwSMI) are at risk of being victimized due to persistent cognitive, emotional, and behavioral symptoms, which can become potential threats for effective reintegration into the community. A total of 217 PwSMI, receiving outpatient psychiatric treatment from a tertiary hospital, were screened for abuse, and if they were identified as abuse, then information about contextual factors contributing to abuse, sociodemographic, family, and clinical and legal profiles was created. Overall, 150 PwSMI were victimized, of which 56% were females, 50.7% were married, 20.7% were educated up to middle school, and 31.4% were homemaker. The most common form of diagnosis was schizophrenia (43.3%), with a mean duration of illness of 14 years. All the victimized PwSMI were subjected to emotional abuse. PwSMI were more likely to be victimized by multiple family members due to poor knowledge and understanding about illness (24%). The majority of the PwSMI had disclosed abuse (62.7%) to nonformal sources (33.3%) with no documentation in the clinical file (82.7%). PwSMI experience ongoing abuse and are more likely to be re-victimized, which increases the need for regular screening and culturally sensitive and comprehensive community-coordinated care and support.

Marriage in persons with severe mental illness: A narrative review-based framework for a supported relationship.

Background: Studies in the past have shown the effect of mental illness on marriage in persons with severe mental illnesses (SMIs). Primary care and family physicians have a major role in addressing marriage-associated dilemmas in their life. Methods: The literature search was conducted from databases such as PubMed, ProQuest, EBSCO, Scopus, and Google Scholar for understanding the context and the problem in-depth for bringing out the narrative-review based framework for addressing the dilemmas. Results: Marriage rates in persons with SMI are high in Eastern countries. Marriage in persons with SMI enhances social support and prevents the stigma of being unmarried. Disability, unemployment, stigma, and disclosure-related issues are barriers to getting desirable alliances. Evidence based interventions are available to reduce the associated distress to an extent. Conclusion: Published peer-reviewed literature has pointed out that marriage plays a significant role in the life of persons with SMI and their families, especially in Asian countries where marriage is an important social institution. It can have a positive impact or can lead to relapse, marital conflicts, and divorce based on contextual and clinical factors. Hence, there is a need to come up with tailor-made interventions to address marriage-related expectations in persons with SMI.

Patient and Public Involvement for Dementia Research in Low- and Middle-Income Countries: Developing Capacity and Capability in South Asia.

Background: Patient and public involvement (PPI) is an active partnership between the public and researchers in the research process. In dementia research, PPI ensures that the perspectives of the person with "lived experience" of dementia are considered. To date, in many lower- and middle-income countries (LMIC), where dementia research is still developing, PPI is not well-known nor regularly undertaken. Thus, here, we describe PPI activities undertaken in seven research sites across South Asia as exemplars of introducing PPI into dementia research for the first time. Objective: Through a range of PPI exemplar activities, our objectives were to: (1) inform the feasibility of a dementia-related study; and (2) develop capacity and capability for PPI for dementia research in South Asia. Methods: Our approach had two parts. Part 1 involved co-developing new PPI groups at seven clinical research sites in India, Pakistan and Bangladesh to undertake different PPI activities. Mapping onto different "rings" of the Wellcome Trust's "Public Engagement Onion" model. The PPI activities included planning for public engagement events, consultation on the study protocol and conduct, the adaptation of a study screening checklist, development and delivery of dementia training for professionals, and a dementia training programme for public contributors. Part 2 involved an online survey with local researchers to gain insight on their experience of applying PPI in dementia research. Results: Overall, capacity and capability to include PPI in dementia research was significantly enhanced across the sites. Researchers reported that engaging in PPI activities had enhanced their understanding of dementia research and increased the meaningfulness of the work. Moreover, each site reported their own PPI activity-related outcomes, including: (1) changes in attitudes and behavior to dementia and research involvement; (2) best methods to inform participants about the dementia study; (3) increased opportunities to share knowledge and study outcomes; and (4) adaptations to the study protocol through co-production. Conclusions: Introducing PPI for dementia research in LMIC settings, using a range of activity types is important for meaningful and impactful dementia research. To our knowledge, this is the first example of PPI for dementia research in South Asia.

Implications of Mental Healthcare Act 2017 for geriatric mental health care delivery: A critical appraisal.

The prevalence of mental health problems in older adults is increasing globally as well as in India due to population ageing. Mental Healthcare Act (MHCA) 2017 has a rights-based approach and came into force in India in May 2018. Its provisions have significant implications for promoting mental health care and protecting the rights of persons with mental illness (PMI). Older adults with mental health problems such as dementia have a high risk for loss of mental capacity, abuse, violation of their rights, and institutionalization. This act advocates the development of specialized clinical services for the older adults in mental health care institutions. It also recognizes the rights of PMI to access a range of services required, including rehabilitation services. Several provisions of the act, such as those related to mental capacity, advance directive, nominated representative, and responsibilities of other agencies, have specific challenges related to older adults with mental illness. In this article, we present a critical appraisal of the implications of MHCA 2017 in the context of the care of the older adults with mental illness.