Psychological impact on caregivers of HIV-infected children in Udupi district, Karnataka.

Caregivers of children living with HIV/AIDS (CLWHA) face unique challenges due to disease-related stigma and discrimination, isolation from society, financial constraints, grief and mortality of loved one. A descriptive cross-sectional study was conducted at Udupi ART centre to assess the caregiver burden, psychological distress and their associated factors among the caregivers of CLWHA in Udupi District. The convenience sampling technique was used to collect the data from 171 caregivers and analysed with the help of SPSS version 15.0. Majority of caregivers were female (64.9%) with mean age of 38.1 ± 9.6 years. About 64.3% caregivers were HIV-positive and 63.2% were biological parents of CLWHA. Mild-to-severe caregiver burden on Zarit Burden Inventory (ZBI) was reported among 84.8% of caregivers, and mild-to-severe psychological distress on General Health Questionnaire (GHQ-12) was reported among 49.7% caregivers. Relationship with child was found to be a significant predictor of caregiver burden as compared to other relatives/foster (P < 0.001). Relationship with child (P 0.004), Alcohol use (P 0.008) and Schooling of children (P 0.049) were reported as significant predictors of psychological distress. Study concludes that caregiver burden and psychological distress were high among caregivers of CLWHA. Psychological problems of caregivers need to be addressed and integrated along with the clinical care of HIV-infected children at ART centres.

Perception of stigma toward mental illness in South India.

BACKGROUND: Stigma associated with mental illnesses is one of the principal causes for mentally ill people not receiving adequate mental health care and treatment. The study was conducted to assess the extent of stigma associated with mental illness and knowledge of mental illness among the community. MATERIALS AND METHODS: Community-based, cross-sectional study was conducted among 445 respondents from Udupi district; the community attitude toward the mentally ill (CAMI) scale was used to assess stigma. The probability proportional to sampling size technique was adopted to select the wards/blocks. Household from blocks/wards were selected using convenience sampling. Self- administered semi-structured questionnaire was used to collect the information. Data was analyzed using the software SPSS version 15. RESULTS: Of the total 445 respondents, the prevalence of stigma toward mentally ill people was 74.61% (95% confidence interval, 0.7057, 0.7866). The prevalence of stigma was high under all the four domains of CAMI scale. High prevalence of stigma was seen among females and people with higher income. CONCLUSIONS: The overall prevalence of stigma toward PWMI was found to be high. The stigma toward PWMI was associated with gender with respect to AU, BE and CMHI. Hence, the study suggests that there is a strong need to eliminate stigma associated with mental illness to improve the mental health status of the region.

Psychosocial Determinants of Health-Related Quality of Life of People Living with HIV/AIDS on Antiretroviral Therapy at Udupi District, Southern India.

BACKGROUND: Life expectancy of people living with HIV/AIDS (PLHA) on antiretroviral therapy has appreciably increased. However, psychosocial challenges pose a great threat to their health-related quality of life (HRQOL). The aim of this study was to determine psychosocial factors influencing health-related quality of life of PLHA on antiretroviral therapy. METHODS: A cross-sectional study was conducted using convenience sampling to select 226 PLHA at District hospital. Demographic information was collected using a semistructured questionnaire. HRQOL was assessed using WHOQOL-HIV Bref. The Hospital Anxiety and Depression Scale, CAGE scale, and Multidimensional Scale of Perceived Social Support were used. One-way ANOVA was applied. RESULTS: There was a significant difference in mean quality of life score with respect to level of anxiety in the physical (P < 0.001), psychological (P < 0.001), level of independence (P < 0.001), social relationships (P = 0.047), environment (P < 0.001), and spirituality domain (P < 0.001). Significant difference in mean quality of life score was observed with respect to level of depression in physical (P = 0.003), psychological (P = 0.036), level of independence (P = 0.017), social relationships (P = 0.019), and spirituality (P = 0.001). Friend support was positively associated with HRQOL in physical (P < 0.001), psychological (P < 0.001), level of independence (P = 0.013), social relationships (P < 0.001), environment (0.001), and spirituality domain (0.026). Family support was positively associated with HRQOL in physical (P = 0.001), psychological (P = 0.001), level of independence (P = 0.040), social relationships (P = 0.008), environment (0.001), and spirituality domain (0.026). A significant difference was observed with respect to affiliation to social organization in social relationships domain (P = 0.044). CONCLUSIONS: Psychosocial challenges including anxiety, depression, and social support impact upon all domains of HRQOL of PLHA.

The acceptability, feasibility, and effectiveness of a population-based intervention to promote youth health: an exploratory study in Goa, India.

PURPOSE: To evaluate the acceptability, feasibility, and effectiveness of a population-based intervention to promote health of youth (age: 16-24 years) in Goa. METHODS: Two pairs of urban and rural communities were selected; one of each was randomly assigned to receive a multi-component intervention and the other wait-listed. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer education, and health information materials. Effectiveness was assessed through before-after population surveys at baseline and at 18 months. Outcomes were measured using a structured interview schedule with all eligible youth. Logistic regression compared each pair, adjusted for baseline differences, on prevalence of outcomes in the domains of reproductive and sexual health (RSH), violence, mental health, substance use, and help seeking for health concerns. RESULTS: In both intervention communities, prevalence of violence perpetrated and probable depression was significantly lower and knowledge and attitudes about RSH significantly higher (p < .05). The rural sample also reported fewer menstrual complaints and higher levels of help-seeking for RSH complaints by women, and knowledge and attitudes about emotional health and substance use; and, the urban sample reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and RSH complaints. Although information materials were acceptable and feasible in both communities, community peer education was feasible only in the rural community. The institution-based interventions were generally acceptable and feasible. CONCLUSIONS: Multicomponent interventions comprising information materials, educational-institution interventions and, in rural contexts, community peer interventions are acceptable and feasible and likely to be effective for youth health promotion.

Violence, psychological distress and the risk of suicidal behaviour in young people in India.

BACKGROUND: Suicide among young people has emerged as a major public health issue in many low- and middle-income (LAMI) countries. Suicidal behaviour including ideation and attempt are the most important predictors of completed suicide and offer critical points for intervention. The aim of this study is to estimate the prevalence and risk factors for suicidal behaviour in young people in India. METHOD AND FINDINGS: Cross-sectional study of 3662 youth (16-24 years) from rural and urban communities in Goa, India. Suicidal behaviour during the recent 3 months and associated factors were assessed using a structured interview. Overall 144; 3.9% [95% confidence interval (CI) 3.3-4.6] youth reported any suicidal behaviour in the previous 3 months. Suicidal behaviour was found to be associated with female gender Odds ratio (OR) 6.5 (95% CI 3.9-10.8), not attending school or college OR 1.6 (95% CI, 1.01-2.6), independent decision making OR 2.5 (95% CI 1.5-4.3), premarital sex OR 3.2 (95% CI 1.6-6.3), physical abuse at home OR 3.3 (95% CI 1.8-6.1), life time experience of sexual abuse OR 3.3 (95% CI 1.8-6.0) and probable common mental disorders (CMD) OR 9.5 (95% CI 6.3-14.5). Gender segregated analysis found independent decision making (P=0.68 for interaction), rural residence (P=0.01 for interaction) and premarital sex (P=0.41 for interaction) retained association with suicidal behaviour only among females (P<0.05). The population attributable fraction estimates were largest for CMD (42.8% for females; 35.9% for males); physical abuse in one's home (12.5% for females; 12.4% for males); sexual abuse (12.1% in females; 22.3% in males); and making independent decisions (22.9% for females). Analyses of the risk factors for the relatively less common outcome of suicide attempts found a similar set of factors as for suicidal behaviour; in addition, alcohol use was also an independent risk factor. CONCLUSION: Violence and psychological distress are independently associated with suicidal behaviour; factors associated with gender disadvantage-in particular for rural women, may increase their vulnerabilities. Prevention programs for youth suicide in India need to address both the structural determinants of gender disadvantage, and the individual experiences of violence and poor mental health.