Comparative efficacy of cognitive behavior therapy and interpersonal therapy in the treatment of depression: A randomized controlled study.

Background: Depressive disorders are one of the most common psychiatric disorders that occur in people of all ages. Aim: To assess the efficacy of cognitive behavior therapy (CBT) and interpersonal therapy (IPT) in cases of depression. Materials and Methods: The sample for the study comprised 52 diagnosed cases of major depressive disorder (MDD) based on the 10th revision of the International Classification of Diseases (ICD-10) criteria in the age range of 21 to 50 years. They were randomized with the help of the app and assigned to CBT and IPT groups. Two patients had dropped out of the CBT group. Hence, finally, 50 cases were taken for study. A total of 12 therapy sessions were given. All patients were given standard treatment as prescribed. Results: Findings of paired samples t-test to assess the within-group differences in both the groups (CBT and IPT) as well as gains score statistics or difference score statistics (pre-test minus post-test) were applied to compare group differences. Results of paired samples 't' test suggest that there was a statistically significant difference in the scores of both the groups from pre-test to post-test. IPT group had shown significantly better outcomes as quantified by the percentage of patients scoring less on the outcome variable of the Beck Depression Inventory (BDI), Montgomery-Asberg Depression Rating Scale (MADRS), Hopelessness Scale, and General Health Questionnaire (GHQ). Conclusion: Both CBT and IPT are efficacious in the treatment of MDD. IPT yielded better results on MADRS as compared to CBT on parameters of outcome in the present study. The findings indicate that interventions were effective in reducing the symptoms of depression.

Pagophagia: A case series.

Pica, in the form of ingestion of various non-food items like clay, chalks, etc., is commonly reported in Indian settings, but its other variant, pagophagia (ice eating), gets attention rarely. This case series is about three female patients who presented in psychiatry outpatient clinics with various mental health issues and ice eating habits. A diagnosis of iron deficiency anemia was common among all three cases, and they were managed with oral iron supplementation along with appropriate psychiatric treatments. Pagophagia is an important clinical presentation to be looked for in the changing Indian society.

Gender differences in quality of life of vitiligo patients attending a tertiary care center.

Background: Vitiligo is a common depigmenting dermatosis characterized by milky-white macules or patches. Any pathological discoloration of the skin has been linked to an impact on the body image of an individual, and vitiligo has been linked to decreased self-esteem and poor socialization of the affected people. In Indian society, vitiligo is labeled as Shweta-Kushta (i.e., white-colored leprosy) and is compared to leprosy-a more stigmatizing skin condition. Aim: This study aims to study gender-related differences in the quality of life of Indian vitiligo patients. Methodology: In this hospital-based cross-sectional study, a total of 55 vitiligo patients (females 25 and males 30) were enrolled using the purposive sampling technique. The sample was assessed on Dermatology Life Quality Index (DLQI) questionnaire, Rosenberg Self-Esteem Scale (RSS), and General Health Questionnaire-12 (GHQ-12) to assess their quality of life, self-esteem, and psychological well-being, respectively. The gender differences in sociodemographic and clinical details as well as their relationship with the quality of life of the patients were sought with the help of appropriate statistical measures. Results: The patients of both genders were comparable in terms of all sociodemographic and clinical variables except the females being less educated and employed than the males. There was a statistically significant trend of higher mean DLQI total score in females than males (6.6 ± 3.55 vs 4.8 ± 2.71, Mann-Whitney U = 263.5, P =0.058). Significantly, the average DLQI score in female vitiligo patients was negatively related to family income (r s = -.659, P <.001) and it was significantly higher for the patients from a rural background than those from an urban background (8.55 ± 3.30 vs 5.07 ± 3.03, Mann-Whitney U = 33.5, P <.05). The average DLQI score was negatively correlated to RSS score but positively correlated to GHQ-12 score in patients of both genders. Conclusion: The quality of life of female patients with vitiligo is poorer than the same in male patients. The poor financial condition of families and rural living are two factors related to the poorer quality of life of female patients. A poorer quality of life in vitiligo patients of both genders is linked with decreased self-esteem and decreased psychological well-being. Gender-related issues in the quality of life and the overall well-being of such patients are important in their management and policy-making.

Psychiatric Symptoms and Fatigue in COVID-19 Survivors.

INTRODUCTION: Psychiatric symptoms and fatigue are common after the coronavirus disease 2019 (COVID-19) illness. The cause of these symptoms is direct neuronal injury and indirect injury with immune-mediated inflammation. In addition, social factors also affect mental health. OBJECTIVE: We aim to compare psychiatric symptoms and fatigue between COVID-19 survivors and healthy controls. MATERIAL AND METHODS: We prospectively evaluated 100 COVID-19 survivors for anxiety, depression, positive affect, and behavior control using the Mental Health Inventory (MHI). Fatigue is assessed using the Modified Fatigue Impact Scale (MFIS) score. We compared them with 100 healthy controls. RESULTS: There was a significant statistical difference between the MHI score and individual components of MHI. Overall, MHI scores in cases and controls were 79.41 and 93.31, respectively, with a P value of less than 0.0001. Computed scores for anxiety, depression, behavior control, and positive affect of COVID-19 survivors showed statistically significant differences as compared to healthy controls. There was a weak association between hospital stay duration and poor MHI scores. Fatigue was significantly worse in COVID-19 survivors, with a mean score of 6.93 in cases and 5.35 in controls, with a P value of 0.0001. This was a cross-sectional study evaluating psychiatric symptom scores, but not establishing the diagnosis. It is suggested that appropriate treatment and counseling for these symptoms should be done. CONCLUSIONS: Psychiatric symptoms and fatigue were significantly more common in COVID-19 patients after recovery from acute illness. It is a major contributing cause of morbidity other than organic complications of COVID-19 and requires attention in management.

Stress, postpartum depression, and anxiety in mothers of neonates admitted in the NICU: A cross-sectional hospital-based study.

Background: Mothers of neonates admitted to a neonatal intensive care unit (NICU) experience heightened distress, anxiety, depression, and trauma symptoms. Despite their prevalence, these conditions are generally neither recognized nor treated due to the constraints of time and concerns about the social acceptability of screening. Aim: To study stress, postpartum depression, and anxiety in mothers of neonates admitted to the NICU. Materials and Methods: One hundred forty consecutive mothers having preterm and low birth weight neonates in the NICU were taken for the study as cases and an equal number of mothers of full-term neonates matched for age and socioeconomic status (SES), were recruited as controls with their informed consent. Subjects were assessed with the Acute Stress Disorder Scale (ASDS), Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), and Perinatal Anxiety Screening Scale (PASS). Results: Mothers of preterm neonates in NICU had significantly higher scores on the ASDS, PSS, EPDS, and PASS compared to controls. There was a significant association of ASDS and PSS scores with younger age, higher education, middle SES, joint family, urban residence, unplanned pregnancy, and male child. There was a significant association of the EPDS scores with lower SES, low education, unemployment, and male child. There was a significant association of the PASS scores with younger age, lower SES, and cesarean section. Conclusion: Mothers of preterm neonates admitted to the NICU compared to controls have significantly higher levels of stress, anxiety, and depression.

Gender differences in burden of care and coping strategies among caregivers of schizophrenia patients.

Background: Caregivers of patients with schizophrenia have a considerable burden of care and develop different coping strategies to deal with the caregiving burden. Aim: The aim of this article is to assess gender differences in the burden of care and coping strategies used among caregivers of clinically stable patients with schizophrenia. Methods: In this cross-sectional study, a total of 57 caregivers (33 males and 24 females) of the patients with schizophrenia attending a psychiatric outpatient setting were included by purposive sampling. The caregivers were assessed with the Burden Assessment Schedule 20 items (BAS-20) and Brief Approach/Avoidance Coping Questionnaire (BACQ) to assess the burden of care and coping strategies, respectively. Results: Average BAS-20 score was comparable between the male and female caregivers. If the patient was a spouse, the male caregivers had a significantly higher burden of the marital relationship than the female caregivers. On the BACQ, the socio-emotional approach subscale was significantly higher in female caregivers. The avoidance-oriented coping score and socio-emotional avoidance subscale were significantly higher in male caregivers. A significant positive correlation was found between BAS-20 score and avoidance-oriented coping scores in all caregivers except the females where a significant negative correlation was found between BAS score and socio-emotional avoidance type of coping. Conclusion: There are no gender differences in the burden of care in caregivers of clinically stable patients with schizophrenia except the male caregivers have a higher burden in the domain of marital relationship. The socio-emotional approach type of coping is higher in females while the socio-emotional avoidance type of coping is lower in male caregivers.

Internet addiction and its effects on psychological wellbeing: A community-based study.

Background: The internet has become an essential part of life, and it has both beneficial and detrimental effects. There is a plethora of evidence relating to the effect of internet addiction on psychological health. There is also an unmet need to lay the foundation for the differences in usage and the effects on mental health in regard to the use of the internet for rural and urban students. Materials and Methods: The present study was conducted on 200 adolescent subjects belonging to the urban and rural areas around the city of Varanasi to establish the pattern of use of the internet as well as its psychological implications. The participants were evaluated upon the Internet Addiction Test (IAT) and General Health Questionnaire-12 (GHQ-12), and information pertaining to socio-demographics as well as accessory information related to internet usage were captured through semi-structured proforma. Results: The results indicated no significant differences in the pattern of internet usage (mean IAT score) as well as psychological health (mean GHQ-12) between urban and rural youth. There was a significant positive association between the overall severity of internet use with poor psychological health (GHQ-12 score). There was a significant difference in the overall mean age as well as the mean age of onset of internet use between both groups (rural versus urban). This study highlighted an important issue of the digital divide based on gender-wise differences in the pattern in the overall sample. Conclusion: This study highlighted the important differences in the pattern of internet use among the rural and urban populations with its clinical implication being a need to educate the youth regarding the healthy use of technology.

Selecting a thesis topic: A postgraduate's dilemma.

It is said that well begun is half done. Choosing a thesis topic and submitting a research protocol is an essential step in the life cycle of a postgraduate resident. National Medical Commission of India mandates that all postgraduate trainees must submit at least one original research work (dissertation), one oral paper, one poster, and one publication to be eligible for final year examination. It is the duty of the faculty to ensure that trainees take active interest and submit their theses on time. However, their journey is often marred by multiple challenges and hurdles. The literature was searched from year 2000 onwards till 2011 using Pubmed, ResearchGate, MEDLINE, and the Education Resources Information Centre databases with terms related to residency training, selecting thesis topic, challenges or hurdles, and conversion of thesis into journal article. Existing literature on the subject matter is sparse. Current article advocates promotion of ethical and original research during postgraduation and proposes a checklist for residents before submission of their proposals.

Gender and sexual orientation of undergraduate medical students in India: A cross-sectional study.

Background: Although the potential for alternate conceptions of gender roles and sexual orientations are diverse, it is by-and-large not well tolerated. This study explores the self-reported gender-roles and sexual orientations of Indian undergraduate medical students. Aim: To study self-reported gender role and sexual orientation of undergraduate medical students in India. Method: One hundred twenty volunteers were included in the study consisting of 60 males and 60 females. A questionnaire comprising of a sociodemographic proforma, Bem Sex-Role Inventory (BSRI), and Epstein Sexual Orientation Inventory (ESOI) were given to each participant. The scales were scored, tabulated, and statistically analyzed. Results: The BSRI revealed that femininity was predominant in both female and male participants, at 68.33% and 55%, respectively. The ESOI revealed that females had significantly higher opposite-sex attraction than males. Though males had higher same-sex attraction than females, the difference was not statistically significant. Females also had a significantly higher sexual orientation range and a mean sexual orientation. Sexual drive was significantly higher in males. Significantly more females supported homosexuality and bisexuality as compared to males. Conclusion: This study helps establish that gender roles can be non-conforming. It helps ascertain that while heterosexual orientation predominates, alternate sexual orientations also exist. It paves the way for future studies and explorations to alleviate public misconceptions.

Epidemic of Depression and Anxiety in child and adolescent population during COVID-19 pandemic: A systematic review and meta analysis of the prevalence of depression and anxiety.

COVID-19 has caused mayhem in the life of people. It has disrupted the social fabric of life. The children and adolescent population has been particularly affected by its direct and indirect effects. This systematic review aims to find the prevalence of depression and anxiety in children and adolescent age groups. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for finding the prevalence of depression and anxiety. We found the total number of participants to be 71,016. A random effect model was used for conducting meta-analysis. The prevalence of depression was mentioned in 17 studies of 23 and the pooled prevalence was 27% [95% confidence interval: 21%-36%] and heterogeneity (I2 statistics; P <.00001) was 100%. The prevalence of anxiety was found in 20 studies of 23 and the pooled anxiety prevalence was 25% (95% confidence interval: 16%-41%) and heterogeneity (I2 statistics; P < .00001) was found to be 100%. The summary of the findings has been provided. Due to high heterogeneity, moderator analysis was performed separately for depression and anxiety subgroups. The study design consisted of cross-sectional studies and some studies conducted through online surveys. The age range varied considerably from 1 year to 19 years; 5 studies had participants aged more than 19 years, but the mean age of the total sample was less than 18 years. We conclude that indeed there is a mental health epidemic among the child and adolescent population. We recommend early intervention and tailored made strategies should for management. As the pandemic is enduring, rigorous monitoring should be done. This age group is under extra pressure owing to a large uncertainty about their studies as well their future.

Quality of online media reports of suicide and attempted suicide in India.

Background: News media reporting of suicide may influence the masses toward or against suicidal behavior. So, responsible reporting by news media is important to protect vulnerable people from the deleterious effects of media reporting. World Health Organization has issued guidelines for media reporting of suicide in this regard. We planned this research to evaluate the quality of online news media reports of suicide and attempted suicides in India. Material and Methods: We assessed a total of 210 news reports about suicide and attempted suicides (70 English, 70 Malayalam, and 70 Hindi) to evaluate the reporting of harmful and protective characteristics in news according to the World Health Organization guidelines for reporting suicide in media. Results: We found all three language media reported almost all potentially harmful characteristics with gender (100%), location/site of suicide in the headline (97.61%), precipitating life events (95.24%), mentioning term 'Suicide' in the headline (98.10%), monocausal explanation for suicidality (90.95%), suicide method in the headline (90.95%), an accompanying photo (92.38%), and suicide method (93.81%) being reported with highest frequency. Potentially protective characteristics were not included in most news reports with poor focus on awareness information. Vernacular language media were poor as compared to English news media about the quality of reporting suicide. Conclusion: We found poor adherence to reporting guidelines by online news media for reporting of suicide with poor coverage of educative and awareness information for the general public. It underlines the need for improving awareness among media professionals about responsible reporting of suicide.

Biopsychosocial correlates of emotional problems in women during pregnancy and postpartum period.

Background: Transition to motherhood is associated with several emotional problems that can have long-term consequences on the mother and baby. Aim: To examine the association of various biomedical and cultural factors with the new onset of emotional problems during pregnancy and postpartum period. Materials and Methods: This prospective longitudinal study included 300 pregnant women interviewed in the third trimester. Results: The prevalence of emotional problems in the study group was 31.58%. The prevalence of anxiety disorder NOS and mixed anxiety and depressive disorder in the last trimester of pregnancy in our study was 4% and 1.33%, respectively, and 0.67% and 1.33%, respectively, at 4 days postpartum. At 6 weeks postpartum, the prevalence of anxiety disorder NOS was 1.33%, generalized anxiety disorder was 0.67%, and major depression was 1.33. The prevalence of postpartum blues in our study was 25.33%. Conclusion: There was a significant association between psychiatric disorders during and postpartum period and the following factors: higher parity, increased maternal age, low hemoglobin levels, cesarean section, planned pregnancy, and extended family. Postpartum blues was associated with higher parity and low blood pressure.

Translation and psychometrics of the Bengali adaptation of Coronavirus Anxiety Scale.

Background: The Coronavirus Anxiety Scale (CAS) was developed in April 2020 as an instrument to gauge the symptoms of stress and anxiety occurring secondary to the COVID-19 pandemic. It was constructed using the English language due to which its application to a multi-linguistic country like India became a hindrance. Aim: To establish psychometric validity and reliability of the Bengali translation of CAS. Materials and Methods: Experts well-versed in the English and Bengali languages translated CAS from English to Bengali. This was followed by further correction by forward and backward translation processes until a version with high accuracy and low redundancy was procured. The original scale was applied to 91 volunteers, and the translated version was applied to the same group after 14 days. Results: The mean scores of the original version and the translated version showed a significant correlation. The Bengali version of CAS had high internal consistency, significant concurrent validity, and acceptable split-half reliability. It was hence deemed easily understandable and capable of measuring anxiety due to COVID-19 similar to the original scale. Conclusion: The Bengali translation of the CAS can be accurately used to assess symptoms of anxiety and stress with high reliability and validity in those who are able to read the Bengali language.

The effect of the COVID-19 pandemic and lockdown on the psychosocial health of medical students.

Background: The COVID-19 pandemic had many psychological adverse effects due to fear and panic of infection. However social distancing and lockdown restrictions imposed to curb the spread of infection had an impact on the social life of people. The effects of this on the psychosocial health of the population were less explored area. Aim: To study the effect of the COVID-19 pandemic and lockdown on the psychosocial health of medical students. Materials and Methods: A cross-sectional observational study was conducted on medical students with the help of an online Google Form administering a questionnaire consisting of sociodemographic information; Coronavirus Social Distance Attitudes Scale and Attitude toward lockdown measure to assess favorable or opposing attitudes of participants toward social distancing and lockdown; Bergen Social Relationship Scale, Evaluation of Social System scale and Social Support Questionnaire to measure quality of social relations and social support satisfaction; and three item loneliness scale to evaluate feeling of loneliness. Results: The loneliness levels in participants were high (mean = 6.74 ± 0.79). There was a gender difference in the variables measured. Male students showed a favorable attitude toward social distancing (Positive social distance attitude scale P < 0.001, negative social distance attitude scale P < 0.001) and a better quality of social relations (Bergen Social relationship P < 0.001, evaluation of social system P < 0.001, SSQN P < 0.001, SSQS P < 0.001). However, male students scored more for loneliness as compared to females during the lockdown period (P < 0.001). Conclusion: The loneliness levels were high in medical students during the COVID-19 pandemic and lockdown and even higher in males who were considered a non-vulnerable group. So the balanced approach between preventive restriction measures and the social connectedness of the population is advised for making social distancing policies in the future.

Childhood trauma and bipolar affective disorder: Is there a linkage?

Bipolar affective disorder (BPAD) is a major psychiatric illness impairing the quality of life. The etiology of BPAD is influenced by different factors possibly related to gene-environment interactions. Approximately 30% to 50% of individuals with BPAD have experienced some traumatic event in childhood. Serious adverse experiences that children may suffer early in life are often described as childhood trauma (CT). It includes physical, emotional, and sexual abuse and physical and emotional neglect. CT is linked with an elevated risk of developing BPAD. Childhood adversities play a role in modulating the early onset of illness, increased number of depressive episodes, increased suicide attempts, and other clinical severity of BPAD. Hospital-based studies comprising heterogeneous populations had researched the specific role of each trauma subtype as a predisposing factor for BPAD. Identifying and addressing CT through early intervention methods may prevent the future development of chronic disorders like BPAD. This review article is an attempt to explore and highlight the existing literature regarding the association of different subtypes of CT with BPAD.

Attitudes toward the use of facemasks during the COVID-19 pandemic in the Indian community.

Background: The use of face masks by all community members for the prevention of COVID-19 infection is considered one of the most effective strategies. However, the use of masks by community members was influenced by many factors which affected its efficacy as a preventive measure. Aim: To evaluate the attitudes toward the use of masks during the COVID-19 pandemic in the Indian community. Materials and Methods: We did an online survey with the help of a questionnaire which included information about demographic data, awareness and attitudes about COVID-19 infection and its preventive measures, and attitudes towards mask use in particular. Results: Participants had a positive attitude towards mask use. However, there were certain reasons for not using masks some of which were gender specific. Conclusion: People had good awareness and attitude towards mask use. However, some gender differences in perception of masks used in various settings should be addressed for future awareness and education of the community about mask use.