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Background: In India, mental health rehabilitation centers run income generation programs (IGP) for therapeutic engagement, skills training, and income generation of clients. The centers have evolved IGP models relevant to their settings. There is a paucity of published literature on practices employed by the centers. Methods: This paper compiles data gathered from visits to 13 centers between November 2018 and April 2019. Information was collected through observation and interviews with staff involved in IGP, using a semi-structured pro forma designed for study. Results: Most centers were based in south India (n = 11) and urban areas (n = 12). Each center ran two to seven IGP. Each center involved 20–50 clients in IGP. Clients involved in IGP were aged 20–60 years. The centers ran a range of IGP, including the manufacturing of household consumables, paper products, textile products, handicraft products, food products, and jute products; animal husbandry and horticulture initiatives; and running cafeterias and petty shops. IGP were mostly selected based on market demand and sales value of products (n = 11); ease of doing (n = 5); interests, abilities, exposure, and experience of clients (n = 5); and availability of resources (n = 3). Products were priced primarily to cover input and labor costs (n = 8), and many centers sold products below the market rates (n = 5). Running stalls during public events was a common strategy for the sale of products (n = 9). Personal contacts and "word of mouth" publicity were used for advertisement (n = 6). Four centers involved family members in IGP. Conclusion: The nature of IGP varied in terms of setting, available resources, and profile of clients availing the services. Marketing and sales were a challenge. A supportive framework of policies and schemes is essential to promote IGP at mental health rehabilitation centers. This report may be helpful for professionals and centers planning to set up an IGP. [ABSTRACT FROM AUTHOR]

Background: Every society has persons with illness who do not have any family support. Taking care of such uncared-for patients requires a well-structured system providing medical, psychological, emotional, and rehabilitory support. The first ever rehabilitation ward among government hospitals in Tamil Nadu was created at Rajiv Gandhi Government General Hospital (RGGGH), Chennai with the motto of "Caring for the uncared for." This paper highlights the organizational structure, functionality, profile of patients admitted, challenges faced, and the outcome of patients admitted in the rehabilitation ward. Methods: A retrospective study was done on the "untended" patients, who were admitted in the rehabilitation ward at Rajiv Gandhi Government General Hospital (RGGGH), Chennai, Tamil Nadu, India from December 2020 to June 2022. Sociodemographic and clinical characteristics and outcome of the patients were analyzed. Results: A total of 201 adults with physical disabilities or mixed physical and psychiatric disabilities were admitted for intensive rehabilitation. Common medical illnesses included orthopedic disorders in 80 (39.8%), followed by neurological illness in 43 (21.4%) patients. The median length of stay was 50 (24.5-103.5) days with longest stay of 447 days. Of those patients who recovered, 54 patients (26.9%) reunited with family and returned home and 125 (62.2%) patients were sent to old age homes/asylums. Conclusion: A dedicated ward for untended patients is the first of its kind in the state of Tamil Nadu, India. Such a venture has proved to be of benefit, considering the positive outcome in a significant proportion of the beneficiaries. [ABSTRACT FROM AUTHOR]

Background: India has the second-largest population of elderly in the world. Serious mental illness (SMI) is a subset of the mental disorders that result in significant functional impairment and is usually long term. Persons with SMI face several challenges in their old age that are different from the issues faced by younger people with SMI. Understanding the problems faced by elderly individuals suffering from SMI is fundamental for planning programs to address them. The SENIOR (Support Systems Evaluation of Neuropsychiatric Illness in Old age) project is a study aimed at evaluating the problems faced in obtaining mental health care by elderly persons having SMI in the Kerala state of India. Aim: To describe the scientific methodology of the SENIOR project. Methods: This study employs mixed-methods cross-sectional design among a minimum sample of 768 SMI patients identified through cluster sampling from three districts, and Focus Group Discussion among mental health program officials. Discussion: This paper presents a methodological model to assist researchers in future field epidemiological studies on mental illness. Assessing service needs and barriers to access for the most vulnerable among the mentally ill will help the policymakers make evidence-based decisions to improve their quality of life. [ABSTRACT FROM AUTHOR]

Family interventions have been an integral part of mental healthcare in India for several decades. This paper highlights the need for an emerging change in the nature of family interventions in India—from generic interventions for heterogeneous caregiver groups to interventions addressing particular needs based on family stages and structures. It makes a case for recognizing the experiences and needs of one such group, that is, families affected by parental mental illness with children in their care and summarizes the current status of research on this topic in the Indian and global context. It presents implications for future research in India and discusses preliminary ideas for professionals working in adult mental health settings to address the needs of children and families affected by parental mental illness. [ABSTRACT FROM AUTHOR]

Background: Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India. Methods: We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses. Results: Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37–2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07–2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26–0.60, for participants aged 64–75 years vs 30–44 years), reporting more social support (OR = 0.65, 95% CI 0.49–0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61–0.89) were associated with lower odds of missing medication. Conclusions: Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India. [ABSTRACT FROM AUTHOR]

Background: Systematic data on mental health issues among adults with cataracts are not available from India. This study explored the impact of cataract surgery on depressive and generalized anxiety (GA) symptoms in an adult Indian sample. Methods: A multicenter, prospective, longitudinal cohort study was conducted. Subjects were recruited from four tertiary eye hospitals to assess depression, GA, and associated risk factors. A follow-up survey was carried out at 6 (n = 273, group 1), 12 (n = 198, group 2), or 18 months (n = 105, group 3) post-cataract surgery. Variations in the intensity of depression and GA were assessed using multiple classification analysis (MCA). Results: A total of 576 patients completed both baseline and follow-up assessments. The mean (SD) depression score was 25.6 (8.5) before surgery and 8.6 (7.7), 9.9 (7), and 9.8 (6.8), respectively, post-surgery for the three groups on the Center for Epidemiologic Studies Depression scale (CES-D). The mean GA score was 6.7 (4.2) at baseline and 1.1 (2.3), 1 (1.8), and 0.6 (1.3) after surgery on the Generalized Anxiety Disorder scale (GAD-7). MCA showed that factors with the highest impact on the mean change scores for both depressive and GA symptoms were restoration of vision post-surgery (β = 0.381 and 0.185) in group 1, regaining functional independence and female sex in group 2 (β = 0.192 and 0.23), and the presence of ocular comorbidities in the fellow eye (β = 0.36 and 0.315) in group 3. Conclusion: Mental health symptoms improved significantly post-cataract surgery across the three groups. The urgent need to invest in strategies that enable early cataract case detection and treat ocular anomalies in the fellow eye is highlighted. [ABSTRACT FROM AUTHOR]

Objectives: This review aimed to evaluate all the published studies from India conducted in the consultation-liaison (CL) psychiatry setting to identify the diagnostic patterns and referral rates in this setting. Understanding the same can help in organizing the services and knowing the training needs. Materials and Methods: A thorough literature search was done in August 2020 using different search engines (PubMed, Medknow, and Google Scholar). This was followed by an individual search of various Indian Psychiatry journals and a hand search of references in the available articles. Only those studies that described patients referred to psychiatry services from various specialties were included. Results: A total of 33 studies were selected for the review. More than half of them were published in the last 5 years. Studies have primarily reported psychiatric profile medically ill inpatients referred to CL psychiatry services, with the majority of the studies reporting the number of patients seen for the duration of at least 1 year. The referral rates for inpatients across different institutes have varied from 0.01% to 3.6%. The referral rates from emergency set-ups have varied from 1.42% to 5.4%, and in outpatients, from 0.06% to 7.17%. The most commonly diagnosed psychiatric disorders across different studies include depression; organic disorders, including delirium; substance use; intentional self-harm; and anxiety disorders. Conclusions: A limited number of studies have reported the profile of patients seen in CL psychiatry setups. Available data from these studies suggest that referral rates to psychiatry services from other specialists are dismal. There is an urgent need to change the focus of psychiatry training at both undergraduate and the postgraduate levels to enhance the psychiatric knowledge of physicians to improve psychiatry referrals. [ABSTRACT FROM AUTHOR]

Background: Severe mental illnesses lead to deterioration in the life skills of the patient, resulting in socio-occupational dysfunction and low rates of employment. The purpose of this study was to explore attitudes, knowledge, and barriers to employment as experienced by patients and their caregivers in India. Method: Patients with schizophrenia or bipolar affective disorder, aged between 18 and 60 and undergoing inpatient treatment and their caregivers, were approached for written informed consent and recruited for focus group discussions. A total of eight focus groups were conducted until saturation of themes was seen to have been achieved. The data were transcribed, coded, synthesized, and organized into major findings and implications for practice. Results: Role expectations based on gender were seen to influence the decision to work. The possible recurrence of illness due to excess stress and unsupportive working environments was cited as the most common problem that could arise related to employment. Stigma and faulty attributions related to the illness were the most cited barriers to employment. Most participants felt that psychosocial rehabilitation and family and community support were essential for facilitating work. Most participants did not consider mental illness as a disability and were unaware of government schemes for the mentally ill. Conclusion: Considering gender-based role expectations, avenues for self/family employment and improving the awareness of benefits for mental illness both among consumers and health care professionals are essential to enhance economic productivity in people with severe mental illness. [ABSTRACT FROM AUTHOR]

Background: Poor mental health of the mother affects her physical health and the neonate's health and development. Studies from Southern India place different estimates of perinatal mental ill-health. Cultural variables affect health-seeking behaviour and are thus important to study in perinatal women with psychiatric morbidity. Methods: A total of 281 perinatal women were screened on Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Mini International Neuropsychiatric Interview version 6.0 (MINI), assisted with a clinical interview to identify psychiatric illnesses. The cultural formulation interview (CFI) of DSM-5 was applied on perinatal women having psychiatric illnesses and their caregivers. Results: A psychiatric diagnosis was present in 10.3% of perinatal women. Depression and anxiety disorders were seen in 7.12% and 1.41%, respectively. Marital discord (P < 0.0001), psychosocial stressors (P < 0.0001), and past history of psychiatric disorder (P < 0.001) were significantly higher in perinatal women with a current psychiatric diagnosis. On CFI work-related stress, the gender of the infant, low education and conflict across generations were identified as the negative aspects of the culture associated with psychiatric illness during and after pregnancy. Religion and social support were the major coping strategies, while stigma and financial problems were the major barriers to help-seeking. Conclusion: The high prevalence of psychiatric disorders and the strikingly low help-seeking are noteworthy. These findings can help in planning treatment and prevention programs for timely detection and intervention for perinatal psychiatric disorders. [ABSTRACT FROM AUTHOR]

The purpose of this practice note is to explore issues that arise in Manavi’s work with South Asian women who use nonfatal force in heterosexual intimate relationships. It provides a nuanced understanding of the contexts within which a South Asian woman uses physical force. It addresses the many barriers a South Asian woman faces in an abusive relationship that ultimately may lead her to use of force. The goal of the practice note is to act as a tool to strengthen advocacy and service provision made available to South Asian female survivors of violence and abuse. [ABSTRACT FROM PUBLISHER]

New insights on Delusional Procreation Syndrome (DPS), a sequence of delusions in the cycle of human procreation are emerging in recent times. Till date, most of the data on DPS are reported from the clinical samples. Authors report case series of having delusions related to DPS from a rural community sample of schizophrenia patients. Delusion of having spouse, delusion of delivery, and delusion of being a parent are reported in this case-series. This evidence is a forward step towards the validity of DPS as a syndrome. [ABSTRACT FROM AUTHOR]

Not much is known about disease prevalence, treatment outcomes, trained manpower, programs, and patients' awareness of diseases from South Asia, compared with the Western world. While other aspects are improving, the quantitative evaluation of awareness of diseases is lagging. Compared with other diseases, the situation for mental health disorders and addiction is worse. While no single study can fully quantify all aspects of awareness, a good starting point is to understand if increasing the number of mental health facilities is beneficial by understanding people's perception toward the likelihood of contracting various diseases, their preferred approach to treatment, and their perception of whether there are enough current facilities. We surveyed over 8000 families across several states of India and asked if they would treat a particular problem at home, visit a local healer, seek religious council, or go to a modern hospital for treatment. Our questions also included non-medical options to assess how likely people are to avoid trained medical help. We also asked people about their perceived likelihood of a family member ever suffering from (1) diarrhea, (2) high fever, (3) alcoholism, and (4) schizophrenia and other mental health problems. We reversed the order of diseases in our questions for a fraction of the population to evaluate the effect of order of questioning. Finally, we asked, if people feel they have enough local healers, religious places, general hospitals, de-addiction centers, and mental health facilities. Despite the taboo around mental health, many people claimed that their family members were unlikely to contract mental health or addiction problems, people recognized the severe paucity of mental health facilities and de-addiction centers. This raises hope for improving the mental health situation in India. We also found a significant relation between education levels and choices people make, underscoring the positive role education has in improving mental health. [ABSTRACT FROM AUTHOR]