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Abstract Background Major population movements, social structure, and caste endogamy have influenced the genetic structure of Indian populations. An understanding of these influences is increasingly important as gene mapping and case-control studies are initiated in South Indian populations. Results We report new data on 155 individuals from four Tamil caste populations of South India and perform comparative analyses with caste populations from the neighboring state of Andhra Pradesh. Genetic differentiation among Tamil castes is low (RST = 0.96% for 45 autosomal short tandem repeat (STR) markers), reflecting a largely common origin. Nonetheless, caste- and continent-specific patterns are evident. For 32 lineage-defining Y-chromosome SNPs, Tamil castes show higher affinity to Europeans than to eastern Asians, and genetic distance estimates to the Europeans are ordered by caste rank. For 32 lineage-defining mitochondrial SNPs and hypervariable sequence (HVS) 1, Tamil castes have higher affinity to eastern Asians than to Europeans. For 45 autosomal STRs, upper and middle rank castes show higher affinity to Europeans than do lower rank castes from either Tamil Nadu or Andhra Pradesh. Local between-caste variation (Tamil Nadu RST = 0.96%, Andhra Pradesh RST = 0.77%) exceeds the estimate of variation between these geographically separated groups (RST = 0.12%). Low, but statistically significant, correlations between caste rank distance and genetic distance are demonstrated for Tamil castes using Y-chromosome, mtDNA, and autosomal data. Conclusion Genetic data from Y-chromosome, mtDNA, and autosomal STRs are in accord with historical accounts of northwest to southeast population movements in India. The influence of ancient and historical population movements and caste social structure can be detected and replicated in South Indian caste populations from two different geographic regions.

Background: Intergenerational conflicts with parents or grandparents have been shown to have adverse effects on young people. Inevitably these conflicts influence the mental health and well-being of young people. Aims: The scoping review aimed to identify the extent of existing literature related to intergenerational conflicts in a familial context, including the factors associated with those conflicts and the interventions addressing intergenerational issues. Method: Articles across OVID, PubMed, and ERIC databases on intergenerational conflicts involving youth (10–24), parents, and/or grandparents were identified. The review is reported adhering to PRISMA-ScR guidelines. Results: From 185 database articles, 43 studies met eligibility criteria, and 4 more were added via cross-referencing, totalling 47. They were grouped into pre-COVID, COVID-related studies, and intervention studies. Parent-child conflict significantly impacted youth mental health, particularly internalising and externalising behaviours. Besides examining the associations, the review addresses the intergenerational conflict in the purview of Gender and cultural differences. Also, a focus on Interventions designed to enhance intergenerational relationships and resolve conflicts was discussed. Conclusions: This review illuminates the detrimental impact of intergenerational conflicts within familial dynamics on the mental well-being of young individuals. It also encompasses the distinct landscape of intergenerational conflicts during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairments in individuals with psychotic disorders impact day-to-day activities and social and occupational functioning (Bowie CR, 2006). Most of the cognitive interventions were developed in the west focusing mainly on clinical research and were not available in routine care. Adaptability and accessibility of these techniques in low-resource settings like India had major challenges. Keeping this in mind, Compensatory Cognitive Training (CCT), being an economical and noncomputerized intervention, was adapted to be used for an urban English-speaking population in India. Aim: The study aimed to determine the acceptability and feasibility of delivering CCT to persons with schizophrenia through virtual one-on-one sessions. Materials and Methods: Patients with a diagnosis of schizophrenia were assessed for their subjective and objective cognitive deficits. CCT was delivered for 13 participants as a virtual one – one session. Three participants dropped out midway. Semistructured interview was conducted with all ten participants who completed the intervention to understand their acceptability of Virtual CCT. Feasibility was assessed using a visual analog scale on their attendance, involvement, and comprehending ability. The mean percentile scores on cognitive domains at baseline and end of intervention were analyzed. Results: Significant change was observed in specific domains of cognition. Participant involvement, lesser dropout rates, and their feedback indicated that Virtual CCT is a feasible and acceptable intervention. Conclusion: Virtually delivered CCT appears to be an acceptable and feasible intervention to increase access to cognitive interventions for persons with schizophrenia in LAMI countries. This needs to be tested in larger populations.

Abstract Background Cognitive deficits are the core component in persons with schizophrenia which impacts their socio-occupational functioning. Also, cognitive deficits cause significant impairment with the person’s quality of life [3]. Hence, targeting such a pivotal aspect in persons with schizophrenia through suitable interventions is very important. Developed countries have designed various cognitive remediation programs using computers involving high-end software which cannot be generalized to low-resource settings, like India, due to various factors including sociocultural factors, educational standards, and living standards of the patient population. Compensatory cognitive training (CCT) was developed to be “brief, practical, low-tech” and found to be effective in the west [9]. As there are no structured cognitive intervention modules in India, we have adapted the English CCT manual to be used for an urban population in Chennai, India. CCT was found to be feasible in face-to-face group sessions in our setting [12] and is found to be feasible and acceptable as virtual one–one intervention (unpublished data). Therefore, this study aims to evaluate the effectiveness of V-CCT in enhancing cognition and socio-occupational functioning. Methods The proposed study will be a multicenter assessor-blinded randomized controlled trial at two clinical sites in Chennai, India. The preparatory phase of the study would include translation of the manual to the local language, recruitment and training of research assistants, and pilot testing using the translated manual. The second phase will be the main randomized controlled trial (RCT), during which a total of 160 persons diagnosed with schizophrenia will be recruited from both sites. After obtaining informed consent, baseline assessments will be conducted on cognition, functioning, self-esteem, and quality of life. Participants will be randomly assigned to either the virtual CCT group or the control group using a computer-generated randomization table. End-line assessments will be conducted 6 weeks after the baseline by research assistants who are blinded to the randomization post-intervention. Discussion If V-CCT is found to be effective, it will be available for use in Tamil for persons with schizophrenia, and it will have an effect on their functioning, quality of life, and self-esteem. Trial registration The study is registered under Clinical trial registry-India (CTRI), and the registration number is CTRI/2024/04/065267. Registered on April 2024.

Background Approximately 69%–89% of people with severe mental illnesses, particularly psychosis, experience a treatment gap in low- and middle-income countries (LMICs) due to factors such as low public spending on health and weak healthcare systems. The PIECEs project aims to assess the effectiveness and cost-effectiveness of a solution-focused resource-oriented approach (DIALOG+) for improving the quality of life and mental well-being of people with psychosis in India and Pakistan.Methods The research design of this analysis is an economic evaluation piggybacked on the PIECEs randomised control trial to test the feasibility of DIALOG+ in India and Pakistan. It implies a cost-utility analysis with a health system perspective. The costs include the cost of the intervention, the cost of healthcare providers and the cost to the household. The primary outcome will be quality-adjusted life years. Incremental cost, incremental effectiveness and incremental cost-effectiveness ratios will be calculated using linear regression models with a hierarchical data structure. A probabilistic sensitivity analysis will be carried out to test for the uncertainty surrounding the estimates of cost-effectiveness.Discussion This study will provide evidence of a patient-centred approach to improve the quality of community-based care for people with psychosis in India and Pakistan. The economic evaluation will support efforts to scale up low-cost healthcare interventions such as DIALOG+ to rural and unserved areas, which is otherwise challenging in the resource-constrained health systems in many LMICs.Conclusion The evidence on the cost-effectiveness of DIALOG+ will contribute to efforts to improve community-based care and the quality of life for millions of people suffering from mental health problems in India and Pakistan who experience psychosis.Ethics and dissemination This study is approved by the Queen Mary Ethics of Research Committee (UK), Institutional Ethics Committee of SCARF (India), IRD’s Independent Institutional Review Board (IRD_IRB_2021_01_005) (Pakistan), Karawan-e-Hayat Management Committee (Institutional Approval) (Pakistan), Jinnah Postgraduate Medical Centre Research Committee (NO.F.2-81/2021-GENL/60224/JPMC) (Pakistan), Aga Khan’s Ethics Research Committee (2021-5933-17533) (Pakistan) and National Bio-Ethics Committee, Pakistan (Ref: No.4–87/NBC-774/22/2037 Date: 17 May 2022).The findings of this research will be widely disseminated through research publications and engagement with the communities and the healthcare providers in the public and not-for-profit sectors.Trial registration number ISRCTN13022816.

The objective of this study was to validate and test the efficacy of a 16-week tele-yoga intervention for perceived stress, anxiety, depression, and insomnia in individuals who had had COVID-19 infection in the previous year, and had reported moderately high levels of psychological stress (PSS ≥14). 25 and 50-min versions of the program were developed. They were then validated using Lawshe’s content validity ratio after obtaining feedback from 20 yoga therapy experts. The safety and efficacy of the two programs were subsequently tested in a prospective, multicenter, open-label single-arm study. Eighty-six adults (18 male, 68 female) were recruited from two tertiary mental healthcare institutions, 48 in NIMHANS, Bengaluru; and 38 in SCARF, Chennai. Participants were assessed at weeks zero, 4, and 16 using validated tools. Data were analyzed using a Mixed Model, Intention to Treat approach. After week 16, 31 subjects remained in the trial and continued to practice yoga without any side effects. Subjects who adhered in the trial had significantly higher levels of baseline anxiety and depression as compared to subjects who dropped out. Results at week 4 included significant reductions in levels of perceived stress, anxiety, and insomnia; improvements were maintained at week 16. Correlations between number of yoga sessions and post-intervention PSS scores were negative (r = −0.49), and significant (p

Background: Psychosocial interventions, crucial for recovery in patients with schizophrenia, have often been developed and tested in high income countries. We aimed at developing and validating home-based a booklet based psycho-social intervention with inputs from stakeholders: patients, families, and mental health professionals (MHP) for patients with schizophrenia and related disorders in low resource settings. Methods: We developed a preliminary version of psychosocial intervention booklets based on six themes derived from focus group discussions conducted with patients, families, and MHP. Initially, quantitative assessment of content validity was done by MHP on overall and Content Validity Index of individual items of the specific booklets, followed by in-depth interviews about their views. The booklets were modified based on their inputs. Further, pilot testing of manuals was done on the users - nine pairs of patients and caregivers followed by development of a final version of psycho-social intervention. Results: The percentage content validity of individual modules and overall booklets was ≥78.5% indicating good validity. Most MHP reported that the manuals were relevant and easy to use but were text-heavy, and lengthy. On pilot testing of modified manuals with patients and their family caregivers, majority (77.8%) of them found booklets useful and suggested that there should be separate booklets for both patients and caregivers for providing information and entering separate response for the activities, integrating helpful tips. Language should be simple. Finally, two sets of booklets (“info book” and “workbook”) named ‘Saksham’ (meaning empowered) were created with specific modules (viz., ‘Medicine adherence’, ‘Daily routine’, ‘Eating right’, ‘Physical activity’, ‘Physical health monitoring’, ‘Self-reliance’, and ‘Psychoeducation’) for patients and caregivers each, in two languages (Hindi and English). Conclusion: Booklets with modules for psychosocial interventions for patients with schizophrenia and their caregivers were developed after establishing content validity and pilot testing.

Background: Socio-cultural explanatory factors for mental health problems determine help seeking behaviors. The study aimed to understand the reasons mentally ill patients and their families in India choose to seek help from a religious site. Materials and methods: Persons with mental illness and their families were interviewed at religious sites using a guideline questionnaire. Issues such as significant life events, explanations for perceived abnormal behavior and reasons for choosing a specific religious site for 'treatment' were explored. Discussion: Seeking religious help for mental disorders is often a first step in the management of mental disorders as a result of cultural explanations for the illness. This behavior also has social sanctions. Key words: chronic mental illness, religious sites, qualitative study, ritualistic practices

Geopsychiatry, a newly emerging discipline within psychiatry, examines the influence of geopolitical determinants on mental health and mental illness. Geopolitical determinants include conflict and wars, global austerity, climate change, public health crises (such as the coronavirus disease 2019 (COVID-19)), and migration. This study focuses on the two significant areas of climate change and migration. Climate change can affect mental health directly or indirectly in a variety of ways, including chronic (global warming) and acute (heat waves and environmental disasters) events. Certain groups of migrants, including migrating children, older migrants, refugees, and asylum seekers, are particularly vulnerable to developing psychiatric disorders. The convergence of climate change and migration is significantly complicating the already highly difficult situation for mental health services worldwide, particularly in low- and middle-income countries where access to care is limited. Despite this, the majority of studies examining mental health impacts of these events originate from high-income countries, and there is still a lack of effective preventive and treatment strategies. In 2023, the World Psychiatric Association (WPA) set up a Special Interest Group on Geopsychiatry with a clear and explicit aim to summarize current evidence and propose strategies to tackle geopolitical challenges on mental health. The Special Interest Group aims to support regional and local groups across all psychiatric disciplines and stakeholders dedicated to building local consensus, prioritizing research, crafting policies, and collating and sharing good clinical practices. With such significant effort, we can expand our understanding and collaboration on geopsychiatry and make changes to the care of people with geopolitical and mental health challenges around the globe.

Background: Children in the Juvenile Justice System (JJS) in India include children who may have engaged in criminal acts and children who cannot be cared for by their families of origin for various reasons. Given the nature of the children in such circumstances, they face multiple challenges growing up. Few studies from India have systematically explored interpersonal experiences, including adverse childhood experiences (ACEs) or bullying experiences, and their effects on these children’s mental health. Materials and Methods: A cross-sectional study was conducted using standardized scales to identify the frequencies of and relationships between life experiences and current mental health outcomes (stress, well-being, and psychopathology) faced by children residing in seven child care institutions (CCIs) across two states in India. Results: Of the 278 children who participated in the study, at least one ACE was endorsed by 86.7%, and at least one instance of bullying was experienced by 71.7%. A significant negative correlation was noted between the number of ACEs, bullying experiences, and well-being and a significant positive correlation with stress and psychopathology. Information about the family of origin was significantly associated with lower psychopathology and stress scores. Conclusions: This study highlights the relationship between mental health outcomes, ACEs, and bullying experiences in children in the JJS in India. The study identifies the immediate and ongoing effects of these experiences on children’s mental health and, thus, focuses on the need for appropriate interventions to allay the effects of these experiences.

Background: Persons with schizophrenia (PwS) are vulnerable to developing disordered eating behaviors. However, standardized tools to assess disordered eating patterns are unavailable in the regional language, Tamil. Different versions of the Three-Factor Eating Questionnaire (TFEQ) have been used to measure disordered eating patterns among PwS worldwide. This study aimed to assess the factor structure and reliability of the Tamil version of TFEQ-R18V2 among Tamil-speaking PwS. Methods: Over three months, 135 PwS, aged 18–65 years, who attended the outpatient department of a tertiary mental health service provider in Chennai, completed the Tamil version of TFEQ-R18V2. Thirty PwS completed the tool after two weeks to assess its test–retest reliability. The factor structure of the tool was explored using principal component analysis. Results: The sample included 75 (55.6%) males and 60 (44.4%) females with a mean (±SD) age of 40.1 (±9.8) years and a mean duration of illness of 11.99 (± 8.72) years. Internal consistency and test–retest reliability of the Tamil version were 0.84 and 0.532, respectively. A five-factor structure emerged from the factor analysis, with 65.67% of the variance. Conclusion: The Tamil version of TFEQ-R18V2 emerged as a reliable tool to assess disordered eating patterns among Tamil-speaking PwS.