Impaired mother-infant bonding: a community study from India.

PURPOSE: Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking. METHODS: The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant. RESULTS: The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model. CONCLUSION: Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.

Mental health issues among health care workers during the COVID-19 pandemic - A study from India.

Mental health issues among health care workers (HCWs) in treatment settings during COVID-19 remains understudied in India. This study examines its prevalence and correlates among HCWs in Karnataka State, India. HCWs who attended a workshop to improve mental health well-being during COVID-19 completed an anonymous online questionnaire. In addition to socio-demographics, domains assessed include occupational characteristics, COVID-19 related concerns, anxiety/depression, substance use, suicidality, lifestyle and family functioning. Of the 3083 HCWs who completed the survey (response rate-51.4 %), anxiety disorder and depression was highest among those with frontline COVID-19 responsibilities (anxiety disorder-26.6 %, depression-23.8 %). Prevalence was significantly higher among those with clinical responsibilities compared to those with supportive responsibilities (anxiety disorder: 23.9 % vs 15.5 %), (depression: 20.0 % vs 14.2 %). In the backward step-wise logistic regression analysis, HCWs with anxiety disorder were more likely to be doctors/nurses/hospital assistants, older, female, unmarried, without a leisure activity, report increased alcohol use and suicidal thoughts after pandemic onset, and having a history of receiving mental health interventions. Participants with depression additionally had family distress and hardly ever exercised. To conclude, mental health issues are common among HCWs in India. Interventions need to ensure that HCWs are protected from mental health consequences of working in COVID-19 treatment settings.

Behavioural, emotional and rhythm-related disturbances in toddlers: Preliminary findings from a community-based study in Kerala, India.

PURPOSE: The need to enhance mental health in primary care settings for infants and toddlers is increasingly becoming apparent. However, the lack of trained healthcare personnel and culturally appropriate measures makes it a challenge in low- and middle-income countries. A needs-based assessment of the extent of the problems in toddlers will help address the lacunae in providing mental health services. METHODS: A needs-based assessment was carried out of a community sample of 9,287 mothers with toddlers aged between 13 and 25 months in Kerala, India. This assessment was conducted by junior public health nurses using an indigenously developed checklist titled 'Screening checklist for Behavioural, Emotional and Rhythm-related disturbances in Toddlers' (S-BERT). RESULTS: According to the mothers surveyed, 30.4% of toddlers had concerning or distress causing behaviours. Three factors, namely behavioural, rhythm-related and emotional disturbances, were deemed significant when the item response theory was used to examine the factor structure of S-BERT. CONCLUSION: This study suggests that behaviours that cause distress to mothers of toddlers are common, if queried specifically. Given the constraints in health resources as the cultural factors in operation, use of indigenous tools and principles of collaborative stepped care may be the way forward.

Propósito: La necesidad de mejorar la salud mental en lugares de atención primaria para infantes y niños pequeñitos es cada vez más aparente. Sin embargo, la falta de un personal entrenado de cuidado de salud y medidas culturalmente apropiadas la convierte en un reto en países de bajos y medianos recursos económicos. Una evaluación, con base en las necesidades, de la extensión de los problemas en los niños pequeñitos ayudará a llenar el vacío de proveer servicios de salud mental. Métodos: Una evaluación con base en las necesidades se efectuó en un grupo muestra comunitario de 9,287 madres con niños pequeñitos de edad entre los 13 y 25 meses en Kerala, India. Esta evaluación la llevó a cabo por un grupo de nuevas enfermeras de salud pública usando una lista de verificación desarrollada localmente y conocida como "Lista para verificar la examinación de trastornos en el comportamiento, la emoción y relacionados con el ritmo en niños pequeñitos" (S-BERT). Resultados: De acuerdo con las madres de la encuesta, 30.4% de los niños pequeñitos presentaban preocupaciones o angustias que causaban el comportamiento. Tres factores, a saber, del comportamiento, relacionados con el ritmo y trastornos emocionales, fueron considerados significativos cuando se usó la Teoría de Respuesta a los Asuntos para examinar el factor estructura de S-BERT. Conclusión: Este estudio sugiere que los comportamientos que causan la angustia a las madres de niños pequeñitos son comunes, si se consultan específicamente. Dadas las limitaciones en cuanto a los recursos de salud como los factores culturales operativos, el uso de herramientas locales y principios de cuidados escalonadamente colaborativos pudiera ser el camino a seguir.

But: Le besoin d'améliorer la santé mentale dans des contextes de soin primaire pour les bébés et les jeunes enfants devient de plus en plus apparent. Cependant le manque de personnel de soin de santé formé et le manque de mesures culturellement appropriées en font un véritable défi dans les pays à revenu faible ou intermédiaire. Une évaluation de l'étendue des problèmes chez les jeunes enfants, basée sur le besoin, aidera à s'attaquer aux lacunes en offrant des services de santé mentale. Méthodes: Une évaluation basée sur les besoins a été faite chez un échantillon communautaire de 9287 mères avec des petits enfants âgés de 13 à 25 mois à Kerala en Inde. Cette évaluation a été faite par de jeunes infirmières et infirmiers de santé publique utilisant une checklist développée sur place intitulée "Checklist de dépistage de troubles comportementaux, émotionnels et du rythme chez les petits enfants" (S-BERT). Résultats: Selon les mères qui ont été sondées, 30,4 des petits enfants avaient des comportements inquiétants ou des comportements de détresse. Trois facteurs, soit les perturbations comportementales, liées au rythme et émotionnelles, ont été estimées être importants lors que la Théorie Item Response a été utilisée afin d'examiner la structure de facteur de la S-BERT. Conclusion: Cette étude suggère que les comportements qui causent de la détresse aux mères de petits enfants sont communs, s'ils se trouvent spécialement dans les questions. Compte tenu des contraintes des ressources de santé en tant que facteurs culturels de l'opération l'utilisation d'outils développés sur place et les principes de soins élaborés de manière collaborative peuvent s'avérer être la meilleure manière d'aller vers l'avant.

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.

National Mental Health Survey of India, 2016 - Rationale, design and methods.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

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.

Correlation between time lag of arterial-plethysmographic waveforms and systemic vascular resistance: a prospective study.

Blood pressure (BP), a surrogate of cardiac output (CO), is also dependent on systemic vascular resistance (SVR). But SVR is not routinely monitored in daily clinical practice. We hypothesise that the time difference between the peripheral arterial waveform and the finger plethysmographic waveform (time lag index - TLi) could indicate the systemic vascular resistance. In this study, we correlated TLi with the systemic vascular resistance measured by minimally invasive CO monitor (pulse contour analysis). SVR changes in response to administration of mannitol were studied. American Society of Anesthesiologists (ASA) class I and II patients undergoing major intracranial surgeries were recruited. Arterial cannulation and pulse-oximetry recordings were done in the same limb. Arterial and plethysmographic waveforms were recorded before mannitol infusion (baseline) and at every 10 minutes for 60 minutes after the termination of mannitol infusion. Simultaneously, SVR was recorded from the Vigileo FLotrac CO monitor. Using custom-made programme, the time difference between both waveforms was calculated and corrected for heart rate (TLi). The correlation between time lag and the systemic vascular resistance was assessed using a mixed effect model, adjusting for the subject. Data of one hundred subjects were analysed. Following mannitol administration, there was a significant decrease in the SVR and the TLi (p < .001). The patient characteristics influenced both the baseline values of SVR (intercept) and the changes in SVR over time (slope). As both the baseline value and the change over time for SVR were different in each patient, we used mixed effect model analysis to assess the relationship between SVR and TLi for different time periods. The effect of TLi on SVR was significant (ß = 877.16, p = .008). The high beta coefficient suggests that when SVR increases, the TLi also increase and vice versa. A strong correlation between SVR and TLi was demonstrated for a given patient. Further studies are needed to explore the possibility of utilising this parameter to follow up changes in SVR in an individual patient at a particular point in time in different clinical scenarios.

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.