Perceived Impact of the COVID-19 Pandemic on Psychiatric Training Among Final-Year Medical Undergraduates in Sri Lanka: an Online Survey of Students from Eight Universities.

OBJECTIVE: This study aimed to assess the perceived impact of the COVID-19 pandemic on undergraduate psychiatry training in Sri Lanka and to explore several potentially associated factors. METHODS: An online survey was distributed among students from eight medical schools who recently faced their final exam. Their perceptions on the impact of the pandemic on the psychiatry training and exam performance were rated on a 10-point scale. Resilience was assessed using a two-item scale. RESULTS: A total of 644 students responded (69.5% female, mean age=27.5 years). Among them, 164 (25.5%) reported being quarantined; 25 (4%) reported becoming infected with COVID-19; and 170 (28.6%) reported ward closure for over a week during the clerkship. Greater impact was reported for patient availability (mean=7.08), mental status assessments (mean=6.3), developing rapport (mean=6.2), and diagnostic skills (mean=5.9), whereas the impact on peer-learning (mean=5.5) and self-study (mean=3.6) was relatively lower. Impact on clinical components of the final exam (mean=6) was rated higher than on theory components (mean=4.5). The majority (70.3%) reported that COVID-19-related stress affected their exam preparations. Higher resilience predicted lower perceived impact on all aspects of training/exam performance. Female gender and ward closure predicted greater impact on diagnostic skills, overall training, and clinical exam performance, whereas being quarantined predicted greater impact on peer-learning and self-study. CONCLUSION: The pandemic has significantly affected the undergraduate psychiatry training in Sri Lanka, particularly its clinical components. Increasing clinical exposure to patients, managing students' stress, and building their resilience should be key concerns for medical educators during the pandemic.

Psychometric properties of the Sinhala version of the Swanson, Nolan, and Pelham rating scale (SNAP-IV) Parent Form in healthy children and children with ADHD.

OBJECTIVE: The present study aimed to translate and adapt the Parent Form of the MTA Version of the Swanson, Nolan, and Pelham ADHD/ODD rating scale (SNAP-IV) into Sinhala and examine its psychometric properties. METHOD: The MTA version of the SNAP-IV was translated into the Sinhala language by adhering to the WHO translation and adaptational process. The final Sinhala SNAP-IV (S-SNAP-IV) was administered to parents of 412 healthy children and adolescents (age: 6-18 years), and 272 children and adolescents with ADHD (age: 4-19 years). Internal consistency and factor structure of the S-SNAP-IV were determined in each sample. RESULTS: Conforming to that of the original English version, the S-SNAP-IV showed a three-factor structure (inattention, hyperactivity/impulsivity, and oppositional defiant disorder) in each sample, except for three item deviations (10,11, and 13) in the healthy sample. The S-SNAP-IV showed excellent internal consistency in the total sample (Cronbach's alpha = 0.97), healthy sample (Cronbach's alpha = 0.90), and the clinical sample (Cronbach's alpha = 0.94). The S-SNAP-IV also showed good discriminative validity: Only 1.5% of the healthy sample exceeded the cut-off scores in any domain, whereas all newly diagnosed, unmedicated children were S-SNAP-IV positive in at least one domain. CONCLUSIONS: The findings suggest that the three-factor model fits the S-SNAP-IV, and it clearly distinguishes children with ADHD from non-ADHD children. We conclude that the S-SNAP-IV possesses satisfactory psychometric properties-consistent with the MTA English version and its translations into other languages-making it a reliable and valid instrument for screening children with ADHD.

Prevalence and predictors of emotional and behavioral problems among institutionalized children in Kandy District, Sri Lanka.

BACKGROUND: Child care institutions (CCIs) in Sri Lanka (SL) provide residence to over 14,000 children. These children have a high risk of developing psychological problems. However, there has been no prior scientific inquiry into mental health issues of institutionalized children in SL. OBJECTIVE: To investigate the emotional and behavioral problems of children living in CCIs in Kandy District, and to explore associated factors. PARTICIPANTS AND SETTING: Ten CCIs in Kandy District were selected and all children aged 6-18 years were recruited. METHODS: Child Behavior Checklist (6-18) -Sinhala version (CBCL-S) was filled by the caregivers, and pertinent problem scores were derived. Relevant socio-demographic data were also collected. RESULTS: A total of 259 children participated. Of them, 66.8 % were female. The mean age was 13.9 years. The average duration in care was 4.3 years. Clinical levels of behavioral problems were found in 14 % of children, whereas 7% were borderline. Externalizing problems like rule-breaking and aggression were more common (23.3 %) than internalizing problems (6.6 %). Male children exhibited more behavioral problems (p = 0.034). Present age, age on admission, duration in care, history of sexual abuse, institutional transfers and frequency of family contact were not associated with behavioral problems. CONCLUSIONS: Institutionalized children showing high levels of externalizing problems may be a reflection of disturbed psychosocial development. However, internalizing problems may not be readily recognized, partly due to the shortage of trained caregivers in SL. Educating caregivers to detect and refer children with behavioral problems to psychiatric services is recommended.