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A study of factors affecting the health seeking behaviour of people with pre-existing mental illness during the COVID-10 pandemic 对COVID-10大流行期间影响已有精神疾病患者求医行为的因素的研究
Pub Date : 2021-01-01 DOI: 10.32746/ijmhns.2021.v4.i1.41
S. R., S. S., R. T., K. P.
Health or care seeking behavior has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy. A little understanding exists concerning socio-ecological barriers experience when seeking mental health care. we aimed at determining the factors that affect health seeking behavior of people with preexisting mental illness during COVID19 pandemic. METHODOLOGY: A Cross sectional study done for three months duration at Department of psychiatry, Chengalpattu Medical College and Hospital with sample size of 105. Ethical committee clearance was obtained.105 patients (age >18 years) consecutive patients having an International Classification of Disease 10 (ICD-10) psychiatric diagnosis, were included. Informed consent was obtained. Data regarding Socio demographic and clinical profile was obtained. RESULTS: In our study,39% of the patients belonged to 30-45 and 46-60 years of age, 6.7% of patients were between the age of above 60. 60% of study participants were male and the rest were female.69.5 % of patients had financial crisis ,70.5% of patients had decrease in the monthly income of the family by 30%or more.60% of patients had difficulty in travel to the hospital due to lack of transport facility during COVID pandemic. DISCUSSION AND CONCLUSION; Factors determining health-seeking behavior can help address problems and delay in early identification and optimal management of mental disorders during pandemic. Implementing community-based strategies to support resilience and psychologically vulnerable individuals during the COVID-19 crisis is fundamental for any community.
保健或求医行为被定义为个人认为自己有健康问题或生病,为寻求适当补救而采取的任何行动。人们对寻求精神卫生保健时遇到的社会生态障碍了解甚少。我们的目的是确定影响covid - 19大流行期间已有精神疾病患者寻求健康行为的因素。方法:在成都医学院精神科进行为期三个月的横断面研究,样本量为105人。获得了伦理委员会的许可。纳入105例连续符合国际疾病分类10 (ICD-10)精神病诊断的患者(年龄0 ~ 18岁)。获得知情同意。获得了有关社会人口统计学和临床概况的数据。结果:本研究中39%的患者年龄在30-45岁和46-60岁之间,6.7%的患者年龄在60岁以上。69.5%的患者有经济危机,70.5%的患者家庭月收入减少30%或以上。在COVID大流行期间,由于缺乏交通设施,60%的患者难以前往医院。讨论与结论;在大流行期间,决定求医行为的因素有助于解决问题,延迟及早发现和最佳管理精神障碍。在2019冠状病毒病危机期间,实施以社区为基础的战略,支持韧性和心理脆弱的个人,对任何社区都至关重要。
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引用次数: 0
Specific Learning Disorder: Challenges and Intricacies for a Practicing Psychiatrist 特殊学习障碍:对执业精神病学家的挑战和复杂性
Pub Date : 2021-01-01 DOI: 10.32746/10.32746/ijmhns.2021.v4.i1.68
Vimal Doshi Veerappan
Specific Learning Disorder (SLD) is one of the common diagnoses often encountered in psychiatry(1). As with many neurodevelopmental disorders early identification, specific intense remediation, appropriate management of comorbid conditions, coordination with teachers and parents and engaging the child long-term are the mainstay of management of SLD. Each of these steps pose unique challenges due to the inherent complexity of SLD, lack of uniform, standardised curriculum and testing methods, wide regional variations in definition, assessment and certification in SLD, strained relationship between professionals of various disciplines and lack of custommade tools for screening, assessment and follow-up in native (Indian) languages(2).
特殊学习障碍(SLD)是精神病学中常见的诊断之一(1)。与许多神经发育障碍的早期识别一样,特殊的强化治疗、合并症的适当管理、与教师和家长的协调以及儿童的长期参与是SLD管理的主要内容。由于SLD固有的复杂性,缺乏统一的标准化课程和测试方法,SLD在定义、评估和认证方面存在广泛的地区差异,不同学科专业人员之间的关系紧张,以及缺乏定制的工具来筛选、评估和跟踪本地(印度)语言(2),这些步骤都带来了独特的挑战。
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引用次数: 0
Predictors of Access to Mental Health Care Services Among Persons with Severe Mental Disorders: A Community-Based Study from Rural South India 严重精神障碍患者获得精神卫生保健服务的预测因素:一项来自印度南部农村的社区研究
Pub Date : 2021-01-01 DOI: 10.32746/10.32746/ijmhns.2021.v4.i1.47
V. Raghavan, Aishwarya Gonzalez Cherubal, S. John, K. Rao, R. Padmavati, R. Thara, Thara R. Predictors
Background: Various factors are associated with access to care among patients with severe mental disorders (SMD). The aim of this study was to identify the predictors of access to care among patients with SMD in rural south India. Methods: The study was conducted in Pudukkottai district of Tamil Nadu, India. After screening and confirmation of SMD by community level workers and trained mental health workers, participants were classified as those who have at some time sought treatment and those who have never accessed mental health care services. Results: Among 422 participants with SMD, 74% had at some point in time accessed mental health care services. Logistic regression showed education asthe predictor of access to mental health care services among patients with severe mental disorders. Conclusion: Improving education and awareness on the mental illness and its treatment options will help the patients with mental illness to seek care early leading to favorable outcomes.
背景:各种因素与严重精神障碍(SMD)患者获得护理有关。本研究的目的是确定印度南部农村SMD患者获得护理的预测因素。方法:本研究在印度泰米尔纳德邦普杜克科泰地区进行。在社区工作人员和训练有素的精神卫生工作者对SMD进行筛查和确认后,参与者被分为曾在一段时间内寻求治疗的人和从未接受过精神卫生保健服务的人。结果:在422名患有SMD的参与者中,74%的人曾在某个时间点接受过精神卫生保健服务。Logistic回归显示,教育程度是严重精神障碍患者获得精神卫生保健服务的预测因子。结论:加强对精神疾病及其治疗方案的教育和认识,有助于精神疾病患者及早就医,获得良好的治疗效果。
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引用次数: 0
Phenomenology and Severity of Symptoms in OCD Patients After COVID 19: A Cohort Study COVID - 19后强迫症患者症状现象学和严重程度:一项队列研究
Pub Date : 2021-01-01 DOI: 10.32746/ijmhns.2021.v4.i1.49
U. Nandhini, S. Vaishali, Ahalya Vedachalam, S. Sudhakar, P. Kannan
Background: COVID 19 pandemic and the associated restrictions can have significant impact on patients with pre-existing mental disorders. Fear of getting infected and excessive focus on contamination can worsen in patients with OCD. Methodology: Thirty patients with OCD attending Chengalpattu Medical College Hospital were evaluated for OCD symptom severity using Y-BOCS severity scores in June and July 2020 and that was compared with their scores five months prior (pre covid) Results: Majority of the study population (53%) had no changes in symptom severity after the onset of COVID19 pandemic. Twenty seven percent (27%) had a decrease in symptom severity while only 20% had increase in severity. Conclusion: Our study results indicate that there were no significant changes in OCD symptom severity after the onset of COVID 19 pandemic.
背景:COVID - 19大流行及相关限制措施可能对已存在精神障碍的患者产生重大影响。对感染的恐惧和对污染的过度关注会加重强迫症患者的病情。方法:于2020年6月和7月使用Y-BOCS严重程度评分评估30例在成都医学院附属医院就诊的强迫症患者的强迫症症状严重程度,并将其与5个月前(covid前)的评分进行比较。结果:大多数研究人群(53%)在covid大流行发病后症状严重程度没有变化。27%的人症状严重程度减轻,而只有20%的人症状严重程度加重。结论:我们的研究结果表明,COVID - 19大流行发生后,强迫症症状严重程度没有明显变化。
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引用次数: 0
Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India 长期精神病住院患者身体合并症的患病率:来自南印度的单中心研究
Pub Date : 2021-01-01 DOI: 10.32746/10.32746/ijmhns.2021.v4.i1.34
V. Narmadha, A. Akshaya, V. Raghavan, P. Poornachandrika
Background: Physical comorbidities are the most common causes of early mortality among patients with mental disorders. Prevention and early treatment of physical comorbidities would lead to better outcomes. Hence, the aim to the study was to estimate the prevalence of physical health disorders present as comorbidities among long-term stay psychiatric inpatients and to compare the difference in the physical comorbidities among male and female patients. Materials and Methods: The study was conducted at Institute of Mental Health, Madras Medical College, Chennai. It was a descriptive study combining data from clinical files and nursing records related to the physical health of the long-term inpatients. The clinical records of long-term inpatients, defined as the duration of stay in the care facility for more than 5 continuous years between 1stJanuary and 30thJune, 2019 were assessed. Results: The estimated prevalence was74.2% (95% CI: 69.5-78.6) for at least one physical disorder comorbidity and 38.8% (95% CI: 33.8-43.9) had more than one physical comorbidities. Female in-patients have 2.7 times higher risk than males to have diabetes mellitus, hypertension and thyroid disorders. They also have 0.92 times higher risk than males to have anaemia. Conclusion: There is a high prevalence of physical comorbidities among long term psychiatric inpatients. Systems for the early detection and better clinical management of these physical comorbidities are essential in any long-term psychiatric facility.
背景:躯体合并症是精神障碍患者早期死亡的最常见原因。身体合并症的预防和早期治疗将带来更好的结果。因此,本研究的目的是估计长期住院精神病患者中作为合并症存在的身体健康障碍的患病率,并比较男性和女性患者身体合并症的差异。材料和方法:本研究在金奈马德拉斯医学院精神卫生研究所进行。本研究为描述性研究,结合长期住院病人的临床档案及护理记录资料。评估2019年1月1日至6月30日期间长期住院患者(连续5年以上)的临床记录。结果:估计患病率为74.2% (95% CI: 69.5-78.6)至少有一种身体疾病合并症,38.8% (95% CI: 33.8-43.9)有一种以上的身体疾病合并症。女性住院患者患糖尿病、高血压和甲状腺疾病的风险是男性的2.7倍。她们患贫血的风险也是男性的0.92倍。结论:长期精神科住院患者躯体合并症发生率较高。早期发现和更好的临床管理这些身体合并症的系统在任何长期精神病院都是必不可少的。
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引用次数: 0
Coping strategies among medical professionals during COVID-19 outbreak 新冠肺炎疫情期间医护人员的应对策略
Pub Date : 2021-01-01 DOI: 10.32746/ijmhns.2021.v4.i1.43
Vaishali Shanmugam
BACKGROUND: COVID -19 pandemic is a very stressful situation for doctors, who face the risk of infection in daily life. Coping is the process by which a person deals with stressful situations or demands. Identifying the coping strategies of our medical professionals will help us to understand their coping styles and to deliver effective interventions to enhance their mental well-being. METHODS: An online survey form with socio-demographic profile and BRIEF COPE tool for assessing different coping strategies was sent to interns, residents, and teaching faculty. The coping strategies were divided into emotion-based, problem-based, and dysfunctional coping, and spearman's correlation was done to determine any correlation between sociodemographic variables and the coping strategies. RESULTS: A total of 84 valid and complete responses were included in the study. There is a variable distribution of mean scores for problem-focused, emotion-focused, and dysfunctional strategies. Age and marital status had a positive correlation with problem-focused and emotion-focused strategies meaning that older adults and married people used these strategies predominantly. Higher designation used problem-focused coping predominantly. Dysfunctional coping strategies had no correlation with any of the sociodemographic variables. CONCLUSION: Sociodemographic factors affecting the coping mechanisms in medical professionals differ from those of the general population seen in previous studies. Within the group of medical professionals, those with higher age, higher designation and married had predominantly adaptive strategies. Interventions targetting maladaptive components of emotion-focused strategies and dysfunctional strategies should be aimed at a younger age group, unmarried people, interns, and residents among the medical professionals to better cope with this COVID scenario.
背景:COVID -19大流行对医生来说是一个非常紧张的局面,他们在日常生活中面临感染风险。应对是一个人处理压力情况或需求的过程。确定我们的医疗专业人员的应对策略将有助于我们了解他们的应对方式,并提供有效的干预措施,以提高他们的心理健康。方法:向实习生、住院医师和教师发放一份带有社会人口统计资料的在线调查表格,并使用BRIEF COPE工具评估不同的应对策略。将应对策略分为情绪型、问题型和功能失调型应对,并采用spearman相关来确定社会人口学变量与应对策略之间的相关性。结果:84份有效且完整的问卷被纳入研究。以问题为中心、以情绪为中心和功能失调策略的平均得分分布是可变的。年龄和婚姻状况与以问题为中心和以情绪为中心的策略呈正相关,这意味着老年人和已婚人士主要使用这些策略。高级职称主要采用以问题为中心的应对方式。功能失调的应对策略与任何社会人口学变量均无相关性。结论:影响医疗专业人员应对机制的社会人口因素与以往研究中发现的普通人群有所不同。在医疗专业人员群体中,年龄较大、职称较高和已婚的人主要采用适应策略。针对以情绪为中心的策略和功能失调策略的适应不良成分的干预措施应针对更年轻的年龄组、未婚人士、实习生和医疗专业人员中的住院医师,以更好地应对这种情况。
{"title":"Coping strategies among medical professionals during COVID-19 outbreak","authors":"Vaishali Shanmugam","doi":"10.32746/ijmhns.2021.v4.i1.43","DOIUrl":"https://doi.org/10.32746/ijmhns.2021.v4.i1.43","url":null,"abstract":"BACKGROUND: COVID -19 pandemic is a very stressful situation for doctors, who face the risk of infection in daily life. Coping is the process by which a person deals with stressful situations or demands. Identifying the coping strategies of our medical professionals will help us to understand their coping styles and to deliver effective interventions to enhance their mental well-being. METHODS: An online survey form with socio-demographic profile and BRIEF COPE tool for assessing different coping strategies was sent to interns, residents, and teaching faculty. The coping strategies were divided into emotion-based, problem-based, and dysfunctional coping, and spearman's correlation was done to determine any correlation between sociodemographic variables and the coping strategies. RESULTS: A total of 84 valid and complete responses were included in the study. There is a variable distribution of mean scores for problem-focused, emotion-focused, and dysfunctional strategies. Age and marital status had a positive correlation with problem-focused and emotion-focused strategies meaning that older adults and married people used these strategies predominantly. Higher designation used problem-focused coping predominantly. Dysfunctional coping strategies had no correlation with any of the sociodemographic variables. CONCLUSION: Sociodemographic factors affecting the coping mechanisms in medical professionals differ from those of the general population seen in previous studies. Within the group of medical professionals, those with higher age, higher designation and married had predominantly adaptive strategies. Interventions targetting maladaptive components of emotion-focused strategies and dysfunctional strategies should be aimed at a younger age group, unmarried people, interns, and residents among the medical professionals to better cope with this COVID scenario.","PeriodicalId":113988,"journal":{"name":"INDIAN JOURNAL OF MENTAL HEALTH AND NEUROSCIENCES","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134398134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psychological Morbidity Among Post-COVID-19 Patients: A Cross-sectional Study from Chennai, South India covid -19后患者的心理发病率:来自印度南部钦奈的横断面研究
Pub Date : 2021-01-01 DOI: 10.32746/ijmhns.2021.v4.i1.48
D. Devi, V. Monica, R. Santhosh, V. Raghavan, P. Poornachandrika
Background: The COVID-19 pandemic is a global health threat and is by far the largest outbreak of atypical pneumonia, since the SARS outbreak in 2003. A range of psychiatric morbidities such as persistent depression, anxiety, panic attacks, delirium and suicidality were observed in the post infectious state across the world. Hence, the aim of the study was to understand the psychological status of the patients affected by COVID during their post-COVID follow-up period and to examine the socio-demographic and clinical factors associated with high psychological morbidity. Materials and Methods: A cross sectional study conducted in the post-COVID follow up clinic, at a tertiary care hospital between the months of August - November 2020, using a semi structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS) and Insomnia Severity Index (ISI) for depression, anxiety and insomnia, respectively. Results: The study results indicate that the prevalence of depression and anxiety among post-COVID-19 patients was 21.9% and 11.9%, respectively. Insomnia was observed among 21.7%Among various sociodemographic and clinical variables examined, it was observed that female gender, patients with ongoing stressors and patients with post-COVID-19 persistent physical symptoms were found to be associated with greater depression and anxiety among the study population. Conclusions: Persistent physical symptoms and ongoing life stressors are found to be associated with depression and anxiety among post-COVID-19 patients. Hence, periodic screening for individuals with persisting physical symptoms and care for the vulnerable population such as those with ongoing stressors will provide a significant advantage in the follow up of the mental health of the patients affected with COVID-19.
背景:2019冠状病毒病(COVID-19)大流行是一种全球健康威胁,是自2003年SARS暴发以来迄今为止最大规模的非典型肺炎暴发。在世界范围内,在感染后状态下观察到一系列精神疾病,如持续抑郁、焦虑、恐慌发作、谵妄和自杀。因此,本研究的目的是了解新冠肺炎患者在随访期间的心理状态,并探讨与心理高发病率相关的社会人口和临床因素。材料与方法:一项横断面研究于2020年8月至11月在一家三级保健医院的covid后随访诊所进行,使用半结构化形式和评分量表,如患者健康问卷-9 (PHQ-9)、医院焦虑和抑郁量表(HADS)和失眠严重程度指数(ISI),分别用于抑郁、焦虑和失眠。结果:研究结果显示,新冠肺炎后患者抑郁和焦虑的患病率分别为21.9%和11.9%。在检查的各种社会人口学和临床变量中,发现女性、持续压力源患者和covid -19后持续身体症状患者与研究人群中更大的抑郁和焦虑相关。结论:持续的躯体症状和持续的生活压力因素与covid -19后患者的抑郁和焦虑有关。因此,对持续存在身体症状的个体进行定期筛查,并对弱势群体(如持续存在压力源的人群)进行护理,将为COVID-19患者的心理健康随访提供显着优势。
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引用次数: 0
Lockdown: A Focus on Emotions & Coping in Adolescents 锁定:关注青少年的情绪和应对
Pub Date : 2020-07-01 DOI: 10.32746/ijmhns.2020.v3.i2.35
Yamini Kannappan, Tinu Thamby, Aishwariya Ramesh, H. Tharoor
Objective: The COVID lockdown has been the most significant life-changing experience this year. The sudden implementation of measures such as social distancing, closure of institutions, and restriction of movement may have affected the psychological well-being of adolescents. Keeping this in mind the present exploratory pilot study is an attempt to study and determine the psychological impact on adolescents during the lockdown. Material and Method: Data was collected from a sample of 461 adolescent respondents aged 14 to 20 years through an online survey Statistical Analysis: Descriptive statistics and Spearman’s correlation in SPSS version 24 Results: The majority of the study population (85.7%) reported happiness or a relaxed state of mind, and the next common emotion was boredom. Amongst the 69% of participants also conveyed that stressful/negative thoughts, lack of direct contact with friends were the predominant stressor. Coping behaviors highlighted were spending time with family (93.6%), communicating with friends (96.1%), engaging in hobbies (88.7%), talking to relatives (79.6%), studying (72.7%), and exercising (70.9%). In contrast, the majority (73.3%) indulged in excessive sleep or increased usage of social media platforms or apps. Conclusion: This study is the only survey to document adolescents’ mental health in India during the Covid-19 lockdown. The study highlights that happiness and boredom reflected the young mind of these adolescents, and significantly only one third reported any physical or mental health impact with the lockdown.
目标:新冠肺炎疫情封锁是今年最重要的改变生活的经历。突然采取诸如保持社交距离、关闭机构和限制行动等措施,可能会影响青少年的心理健康。考虑到这一点,目前的探索性试点研究是试图研究和确定封锁期间对青少年的心理影响。资料与方法:通过在线问卷调查收集了461名年龄在14 - 20岁之间的青少年的数据。统计分析:SPSS version 24中的描述性统计和Spearman相关分析结果:大多数研究人群(85.7%)报告了快乐或放松的心态,其次是无聊。69%的参与者还表示,压力/消极的想法,缺乏与朋友的直接接触是主要的压力源。主要的应对行为是与家人共度时光(93.6%)、与朋友交流(96.1%)、从事业余爱好(88.7%)、与亲戚交谈(79.6%)、学习(72.7%)和锻炼(70.9%)。相比之下,大多数人(73.3%)沉迷于过度睡眠或增加社交媒体平台或应用程序的使用。结论:这项研究是唯一一项记录印度青少年在Covid-19封锁期间心理健康状况的调查。该研究强调,快乐和无聊反映了这些青少年的年轻心态,值得注意的是,只有三分之一的人表示封锁对身体或精神健康有影响。
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引用次数: 0
Prevalence and family factors associated with loneliness during COVID-19: A cross-sectional study from South India COVID-19期间与孤独感相关的患病率和家庭因素:来自南印度的横断面研究
Pub Date : 2020-07-01 DOI: 10.32746/10.32746/ijmhns.2020.v3.i2.52
G. Sanjana, V. Raghavan
Background: Loneliness can affect anyone at any point in their life. It can be detrimental to the wellbeing and quality of life of individuals and communities. In the ongoing COVID-19 pandemic, loneliness is considered as a public health crisis. Hence, the objectives of the study were to estimate the prevalence of loneliness and family related factors associated with loneliness among general population in south India. Materials and Methods: The study employed a crosssectional online survey design. The data was collected in the first phase of the lockdown in 2020 from adults in Southern India. Socio-demographic profile and family related variables were collected using a semistructured proforma. Loneliness was assessed by UCLA loneliness scale. Results: Of 573 total respondents to the survey, aged between 18-65 years, 43% were male and 57% were female. The overall prevalence of loneliness was 63% (358/573). No significant gender differences were observed in the prevalence of loneliness. Family discord was associated with higher rates of loneliness (p less than 0.01). Other factors associated were younger age and being single. Conclusion: Rates of loneliness during the COVID-19 lockdown were high in Southern India. Findings suggest that interventions should prioritize younger people. Increasing social support and improving interpersonal skills, which in turn would help reduce family discord and may reduce the impact of COVID-19 on loneliness.
背景:孤独可以影响任何人在生活中的任何阶段。它可能对个人和社区的福祉和生活质量有害。在正在进行的COVID-19大流行中,孤独被视为一种公共卫生危机。因此,本研究的目的是估计印度南部普通人群中孤独感的患病率以及与孤独感相关的家庭相关因素。材料与方法:本研究采用横断面在线调查设计。这些数据是在2020年封锁的第一阶段从印度南部的成年人中收集的。使用半结构化的形式表格收集社会人口统计资料和家庭相关变量。孤独感采用UCLA孤独感量表进行评估。结果:在573名受访者中,年龄在18-65岁之间,43%为男性,57%为女性。孤独感的总体患病率为63%(358/573)。在孤独感的普遍程度上,没有观察到显著的性别差异。家庭不和与较高的孤独率相关(p < 0.01)。其他相关因素还包括年轻和单身。结论:在新冠肺炎封锁期间,印度南部的孤独率很高。研究结果表明,干预措施应优先考虑年轻人。增加社会支持,提高人际交往能力,从而有助于减少家庭不和,并可能减少COVID-19对孤独感的影响。
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引用次数: 1
Psychosocial issues of antenatal mother with COVID 19: A case report COVID - 19产前母亲的社会心理问题:1例报告
Pub Date : 2020-07-01 DOI: 10.32746/10.32746/ijmhns.2020.v3.i2.30
S. S., N. M, K. P., B. A.
We present a case report of an antenatal mother who was diagnosed with COVID- 19. The psycho-social stressors experienced by her and the psychological intervention provided to her through telephone have been documented. The importance of post discharge telephone support or tele-psychiatry during the pandemic is also elucidated in this paper.
我们提出了一个病例报告的产前母亲谁被诊断为COVID- 19。她所经历的心理社会压力源以及通过电话向她提供的心理干预均已记录在案。本文还阐述了疫情期间出院后电话支持或远程精神病学的重要性。
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引用次数: 0
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INDIAN JOURNAL OF MENTAL HEALTH AND NEUROSCIENCES
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