Indian Journal of Psychological Medicine最新文献

Background: Post-partum depression (PPD) adversely affects maternal and child health, yet evidence for integrated mother-child interventions remains limited in low-resource settings. We evaluated the impact of SPRING (Sustainable Programme Incorporating Nutrition and Games), an integrated mother-child psychosocial home-visiting intervention, on PPD outcomes in rural India.

Method: A cluster-randomized controlled trial evaluated the intervention's impact across 120 villages (24 clusters). Mother-infant dyads were identified through house-to-house surveillance, with PPD measured at 12 months post-partum using the Patient Health Questionnaire-9 (PHQ-9). While the intervention aimed to improve child growth and development by indirectly addressing maternal mental health, this article reports specifically on PPD outcomes.

Results: Among 2007 mothers completing assessments, PPD prevalence was 13.1%, with no significant difference between arms (RR = 0.98, 95% CI: 0.69-1.39, p = .90). No effect of intervention was found on PPD (mean PHQ-9 score 1.8 [SD 2.68] in the intervention group and 1.9 [SD 2.79] in the control group; effect size -0.02; 95% CI: -0.11, 0.07; p = .68). Analyses were intention-to-treat.

Conclusions: The lack of measurable impact in our study highlights two key considerations. First, integrated mother-child psychosocial interventions may require more targeted strategies to address depressive symptoms and reduce PPD. Second, implementation challenges, such as coverage and uptake, likely influence effectiveness. Notably, at least one in eight mothers in our study experienced PPD at 12 months post-partum, aligning with other Indian studies. This persistent burden, alongside unmet mental health needs, emphasizes the urgency for future integrated mother-child interventions to include PPD-specific components and critically monitor implementation, especially in rural settings.

Background: The mental health (MH) treatment gap in India is particularly pronounced in underserved and rural areas. Community Health Officers (CHOs) play a crucial role in addressing this gap at the primary care level. A pan India digitally driven MH capacity-building program was designed to integrate MH care into primary care settings by training CHOs and supporting them through Collaborative Video Consultations (CVCs). We aimed to examine the profile of MH cases through CVCs by CHOs trained under a pan-India, digitally enabled MH capacity-building program, and to describe the diagnostic patterns and types of handholding provided across three Indian states.

Methods: This cross-sectional study analyzed 591 CVC records from CHOs of Karnataka, Maharashtra and Bihar from November 15, 2022 to July 31, 2024, who underwent a six-session online training program on MH care, followed by real-time video consultations with MH professionals for case discussions and patient management. Descriptive statistics and crosstabulations were used for data analysis.

Results: Most CVCs were from adult patients aged 19-60 years (79.69%), with women more frequently identified with common mental disorders (CMD) (25.42%) and men more commonly having severe mental disorders (SMD) (12.20%) and substance use disorders (SUD) (16.61%). Among states, Bihar had the highest number of CVCs (38.92%). CHOs provided handholding through referrals, counseling, and follow-ups.

Conclusions: The program demonstrated the effectiveness of CVCs in empowering CHOs to identify and manage MH conditions. The consultation-based collaborative model facilitated accurate diagnoses and timely interventions, bridging the MH treatment gap in rural and underserved regions. Continued investment in CHO training, digital infrastructure, and follow-up care is essential for sustaining the program's impact on primary MH care.

Background: Alcohol use disorder (AUD) is accompanied by cognitive impairments, including attentional bias towards cues linked to alcohol. Most studies on attentional biases have focused on participants in intoxicated states, with limited research on differences between chronic and occasional users. This study aimed to examine attentional biases in chronic alcohol users compared to occasional users using eye-tracking.

Methods: In this cross-sectional study, 71 male participants (36 chronic users and 35 occasional users) were recruited from a tertiary care center in India. Eye-tracking assessments were conducted using free-viewing of emotional and landscape images, and viewing of alcohol related stimuli. For each task, variables such as the number of fixations, fixation duration, scan path, and anti-saccade rates were calculated.

Results: No statistically significant difference was found between chronic alcohol users and occasional users in fixation metrics, scan path length, or anti-saccade rates for emotional, landscape, or alcohol related stimuli. Chronic alcohol users had slightly longer fixation durations and greater scan path lengths on alcohol-related stimuli, but these differences were not significant (p > .05).

Conclusions: Our findings suggest that chronic alcohol users may not always display prominent attentional biases in a sober state. The prolonged abstinence duration (>2 months) contributed to the absence of significant biases in our study. The slightly longer scan path length for alcohol-related images among chronic users may indicate that they were possibly avoiding these images. The findings also highlight the need for a state-dependent approach and the importance of assessing variables like craving in future research.

Background: Hair concentrations of cortisol and dehydroepiandrosterone (DHEA) are increasingly recognized as non-invasive, retrospective biomarkers of hypothalamic-pituitary-adrenal axis function. The ratio of these hormones may reflect the balance between catabolic and anabolic activity, potentially serving as a composite marker of chronic stress. Despite its theoretical relevance, the clinical utility of the hair cortisol: DHEA ratio remains unclear. This PROSPERO-registered systematic review, done according to PRISMA guidelines, aimed to evaluate the association between the hair cortisol: DHEA ratio and perceived stress in adults with chronic stress exposure.

Methods: A comprehensive search of five electronic databases and grey literature was conducted up to March 5, 2025. Studies were eligible if they included adults (≥18 years) with at least 4 weeks of documented chronic stress exposure and reported both hair cortisol and DHEA concentrations alongside validated perceived stress measures. Meta-analyses were performed for correlation coefficients and group comparisons. Risk of bias was assessed using a modified Downs and Black checklist.

Results: Eight studies (five cross-sectional, three cohort; n = 60-210) met inclusion criteria. A meta-analysis of two studies using validated stress scales showed no significant association between the hair cortisol/DHEA ratio and perceived stress (ρ = 0.09; 95% CI: -0.07 to 0.26; I² = 0%). However, a separate analysis of three studies comparing high- versus low-stress groups revealed a moderate, statistically significant pooled effect (Hedges' g = 0.69; 95% CI: 0.14-1.24; p = .01) with substantial heterogeneity (I² = 77.17%). Risk of bias ranged from moderate to low, but the overall certainty of evidence was rated very low due to small sample sizes and inconsistent findings.

Conclusion: The hair cortisol: DHEA ratio has biological plausibility as a marker of chronic stress, but current evidence is insufficient to support its clinical application. Further standardized, longitudinal studies are needed to establish its diagnostic and prognostic value.

Prospero registration: CRD420251003364.

Background: Mentoring primary care doctors (PCDs) improves their competency and aids in integrating psychiatric care into primary care, especially in resource-constrained settings. This study evaluates the socio-demographic, diagnostic, and treatment profiling of instant collaborative video consultations (i-CVCs) and the diagnostic (domain-wise and disorder-wise) and treatment concordance of PCDs with tele-psychiatrists.

Methods: This was a cross-sectional study that was a part of a digitally driven capacity-building program that provided tele-mentoring to PCDs via i-CVCs with tele-psychiatrists. A total of 382 i-CVCs conducted between November 2022 and July 2024 were analyzed for diagnostic and treatment profiling. Concordance between PCDs and tele-psychiatrists was assessed using Cohen's kappa (n = 358).

Results: Among the domain-wise diagnostic distribution by the tele-psychiatrist, the majority were classified as common mental disorders (CMDs) (47.7%), and among the disorder-wise distribution, the majority was depressive disorder (22.5%). The analysis revealed very good to good diagnostic agreement between PCDs and tele-psychiatrists across major domains: SUD (κ = 0.96), SMD (κ = 0.81), and CMD (κ = 0.75), all with p < .001. Disorder-wise concordance was highest for alcohol disorders (κ = 0.96). Treatment concordance also showed moderate agreement for all the major classes of psychotropic medications (κ = 0.5 to 0.6; p < .001), including antidepressants, antipsychotics, benzodiazepines, and nicotine replacement therapy. i-CVC support was primarily sought for diagnostic/treatment confirmation and clarification on dosage strategies.

Conclusions: i-CVCs facilitate real-time learning and improve confidence in managing psychiatric disorders within live primary care clinics, demonstrating a scalable approach to address the treatment gap.