Barriers to seeking treatment for alcohol use disorders among males in a tertiary care center in South India - a cross-sectional study.

BACKGROUND: There are limited studies on barriers to seeking treatment for Alcohol Use Disorders (AUD) among males in tertiary care centers in India and abroad. Identification of these factors can aid in addressing the barriers to seeking treatment for AUD in low-and-middle-income countries. OBJECTIVE: To investigate the barriers to seeking treatment for AUD among males in a tertiary care center in South India. METHODS: The study design was cross-sectional. We employed a semi-structured interview proforma, Barriers Questionnaire (Alcohol), and assessed the age of onset of initiation of alcohol, problem drinking, and AUD. RESULTS: The majority (73.3%) belonged to Low-Barrier group. Individual items such as "Denial of Alcoholism", "avoid others counseling", "don't like to talk in groups", "Worried about what others will think for taking help or made fun of by others", "Self or Family embarrassed of taking treatment", "cannot afford treatment due to various reasons", "Fear of losing job", "Fear of losing friends" and "Fear of seeing people" were significantly higher in High-Barrier group. CONCLUSIONS: Our study has helped to identify some of the important impediments. Psychoeducation and reducing the stereotypes related to the treatment of AUD can increase trust in the treatment process, resulting in greater help-seeking, early intervention, and improved quality of life.

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India.

Context: Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings. Aim: This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)). Settings and Design: The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus). Methods and Material: The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI). Statistical Analysis Used: Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group. Results: Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support. Conclusion: The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Mobile Mental Health in Women's Community-Based Organizations: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Of every 10 women in rural India, 1 suffers from a common mental disorder such as depression, and untreated depression is associated with significant morbidity and mortality. Several factors lead to a large treatment gap, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. There is an urgent need to improve the rates of detection and treatment of depression among women in rural India without overburdening the scarce mental health resources. OBJECTIVE: We propose to develop, test, and deploy a mental health app, MITHRA (Multiuser Interactive Health Response Application), for depression screening and brief intervention, designed for use in women's self-help groups (SHGs) in rural India. METHODS: We will use focus groups with SHG members and community health workers to guide the initial development of the app, followed by iterative modification based on input from a participatory design group consisting of proposed end users of the app (SHG members). The final version of the app will then be deployed for testing in a pilot cluster randomized trial, with 3 SHGs randomized to receive the app and 3 to receive enhanced care as usual. RESULTS: This study was funded in June 2021. As of September 2022, we have completed both focus groups, 1 participatory design group, and app development. CONCLUSIONS: Delivering app-based depression screening and treatment in community settings such as SHGs can address stigma and transportation-related barriers to access to depression care and overcome cultural and contextual barriers to mobile health use. It can also address the mental health workforce shortage. If we find that the MITHRA approach is feasible, we will test the implementation and effectiveness of MITHRA in multiple SHGs across India in a larger randomized controlled trial. This approach of leveraging community-based organizations to improve the reach of depression screening and treatment is applicable in rural and underserved areas across the globe. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42919.

Effective and innovative teaching methods in psychiatry for the medical undergraduates in South India: An exploratory study of teachers' and students' perspectives.

Background: Effective teaching methods are important in psychiatry. Previous studies have focused on the assessment of students about the effective teaching methods but not on a self-assessment by teachers. Aims: Primary objective is to evaluate the teachers' and students' perspectives of effective teaching methods in psychiatry for medical undergraduates. Secondary objectives include assessment of the concordance of each item and exploring innovative teaching methods. Settings and Design: A cross-sectional study design used in teachers and medical students from St. John's Medical College, Bangalore (India). Methods and Material: A modified teachers and medical students perspectives of effective psychiatry teaching methods were used. Statistical Analysis: Differences in continuous variable assessed with independent sample-test and categorical variables with Chi-square test. The Domain scores were divided into tertiles and the highest and lowest tertiles were analyzed. Results: Both students and teachers had high perspectives on most of the teaching methods. Differences were found in items such as "using multimedia slide effectively," "good sense of humor while teaching," "presentation summarizes the key points," and "presentation links ideas effectively." Role play-based and live/simulated patient-based teachings were reported most frequently by both. Significantly, a higher proportion of the 6th term students and a lesser proportion of teachers were associated with the lowest tertiles for Domain 1, 2, and 3. Significantly, increased number of 8th term students were found in the higher tertiles in Domain 3. Conclusions: These findings have practical implications in identifying the gaps in effective teaching methods by the teachers. Teachers can improve their teaching methods by upgrading their presentation skills, employing new and innovative teaching skills.

Stressful life events, social support, and risk for relapse in relapsed harmful alcohol users in South India: a comparative study between psychiatry and gastroenterology patients.

Background: Previous studies have identified risk factors for relapse in patients with alcohol use disorders in deaddiction or community settings. There are limited studies comparing the stressful life events, social support, and risk of relapse in relapsed harmful alcohol users between psychiatry and gastroenterology departments.Objective: To compare the stressful life events, social support, and risk of relapse in relapsed harmful alcohol users between psychiatry and gastroenterology departments.Methods: Comparative, cross-sectional study design was used in males with harmful alcohol use as defined by AUDIT and with at least one relapse. Presumptive Stressful Life Events Scale, Multidimensional Perceived Social Support Scale, and Alcohol Relapse Risk Scale were used.Results: Severity of alcohol harmful use was significantly higher in psychiatry patients than gastroenterology. Increased number of gastroenterology patients reported "change in their sleeping habits" as an important factor for relapse than psychiatry, which was not significant. Only stimulus-induced vulnerability was significantly increased in psychiatry patients compared to gastroenterology. Social support significantly correlated with the alcohol relapse risk scores in the psychiatry group, while in the gastroenterology, the severity of alcohol harmful use scores significantly correlated with total alcohol relapse risk scores.Conclusions: The individual stressors and the risk for relapse were different between the two groups. There was no difference in social support between the two groups. These findings can have implications for using these factors in relapse prevention strategies by focusing on the factors specifically found in each group. However, these findings have to be studied in a larger community sample.

A study of resilience among young adult children of alcoholics in Southern India.

Young Adult Children of Alcoholics (YACOA) are vulnerable to emotional psychopathology. However, some of them remain healthy and lead a productive life despite growing up in adverse circumstances. The present study aims at understanding the relationship between resilience and positive psychological factors among those healthy YACOA. Participants who were identified as YACOA were enrolled from both urban and rural colleges in Karnataka (India). Among them, those who did not report emotional psychopathology were assessed on measures of Resilience, socio-cultural factors (family support, community support, and participation in religious rituals), Self-efficacy and psychological well-being. They were divided into high and low resilience groups based on the median scores. YACOA with high resilience had a significant positive association with cultural factors of resilience whereas YACOA with low resilience had significant positive association with self-efficacy and sub-categories of psychological wellbeing. Binary Logistic Regression analysis found that socio-cultural factors were found to be associated with high resilience among YACOA. This study has recognized the significance of socio-cultural factors and self-acceptance in enhancing resilience among healthy YACOA. These findings offer insights into the interventions for the wellbeing of the YACOA.

Do individuals follow up with mental health services after a suicide attempt? Findings from the assertive management of attempted suicide service, Bengaluru, India.

OBJECTIVE: There is limited information from India on whether individuals follow up with mental health services after a suicide attempt. The objective of this study was to determine follow-up rates after a suicide attempt with mental health services of those individuals treated as part of the assertive management of attempted suicide service in a general hospital in Bengaluru, India. MATERIALS AND METHODS: Records from 284 persons from January 2016 to December 2016 were analyzed to ascertain their follow-up rates with mental health services after a suicide attempt. RESULTS: After discharge, 25% individuals followed up on a single occasion with mental health services. Individuals with a psychiatric diagnosis were significantly more likely to follow up with mental health services as compared to those without a psychiatric diagnosis (P < 0.011, odds ratio: 2.875, confidence interval at 95%: 1.276-6.481). 90.8% were contacted through telephone as part of aftercare. CONCLUSIONS: Most individuals in India, especially those without a psychiatric diagnosis, do not follow up with mental health services after a suicide attempt. Periodic telephonic contacts are a useful aftercare strategy to reach out to this high-risk population. Limitation of this study is that findings are from an urban general hospital setting.

Influence of socio-cultural factors on the emotional problems among college going young-adult children of parents with alcoholism: A study from South India.

Young-adult children of parents with alcoholism are vulnerable to anxiety and depression. We studied the prevalence of emotional psychopathology and examined the mediating role of environmental factors (family support, community support and participation in religious rituals) in relation to psychopathology. College students (N = 1555), aged 18-24 years, from urban and rural domicile were screened on Children of Alcoholics Screening Test (CAST) and those who were positive were assessed for emotional psychopathology on Depression, Anxiety and Stress Scale (DASS-21). Young-adult children of alcoholics with emotional psychopathology were compared with those without emotional psychopathology on demographic characteristics, quality of life, and a questionnaire which measured the role of socio-cultural factors. 33% (N = 512) of 1555 participants screened were found to be Young-adult children of alcoholics. Among them, 35% (N = 181) reported experiencing emotional psychopathology. Participants with high emotional psychopathology reported receiving less support from the family (8.44 ± 1.19 vs 9.57 ± 1.26, p = 0.003), community (6.97 ± 1.08 vs 8.88 ± 1.19, p = 0.001); they participated less in religious rituals (5 ± 0.18 vs 6.56 ± 0.41, p = 0.008) compared to those without psychopathology. Quality of life was significantly lower among Young-adult children of alcoholics with emotional psychopathology. A considerable proportion of Young-adult children of alcoholics reported emotional psychopathology and their quality of life was poor. The modifiable socio-cultural factors such as family, community support and participation in religious rituals were associated with emotional psychopathology. A better utilization of these factors may mitigate the burden of emotional psychopathology and improve quality of life in this vulnerable group.