Indian Journal of Psychological Medicine最新文献

Background: Though integrating psychiatric care into primary care is thought to be a pivotal step, a huge gap remains in translating this training into clinical practice at primary health centers (PHCs) in India. To address this, we aim to explore the perspectives of the primary care doctors (PCDs) from an implementation research angle.

Methods: An anonymous online survey with a semi-structured questionnaire gathered PCDs' perspectives on integrating primary care psychiatry training into India's healthcare system, focusing on Acceptability, Adoption, Appropriateness, and Feasibility subsets based on the conceptual framework for implementation outcomes. The survey reached 7,200 PCDs via a pan-India mental health capacity-building program, with 124 PCDs from 5 states participating. A 134 PCDs completed the Fidelity questionnaire. PCDs were grouped by mental health training status for comparative analysis. A mixed-method analysis was conducted on the data.

Results: Overall, PCDs reported high ratings across the subsets of Acceptability (91.1%-91.9%), Feasibility (75.8%-91.9%), Adoption (87.9%-93.5%), and Appropriateness (89.5%-92.7%). Clinical practice outcomes in terms of Fidelity (33.6%-52.2%) remained limited. Mental health training was significantly linked to increased comfort in managing mental health issues at PHCs (Acceptability subset, χ² = 4.79, p = .02), a greater readiness to start screening for mental health disorders (Adoption subset, χ² = 4.73 p = .03) and increased prescription practice at PHC for mental health disorders (Fidelity subset, χ² = 4.01, p = .04). Qualitative data analysis identified barriers such as stigma, time constraints, limited access to medications, staff shortages, and inadequate follow-up systems that hindered effective integration of mental health care at PHCs.

Conclusions: Though psychiatry training of PCDs improves resource availability, addressing systemic challenges is essential for ensuring effective mental health service delivery at the primary care level.

Background: India has made significant strides in digital mental health capacity building over the past decade. This pan-India initiative was implemented through National Institute of Mental Health and Neurosciences (NIMHANS) to enhance the delivery of primary mental healthcare by digitally training medical officers (MOs), community health officers (CHOs), and field-level workers (FLWs) of India.

Methods: Between October 2022 and June 2024, the program engaged MOs, CHOs, and FLWs of Karnataka, Maharashtra, Telangana, Uttarakhand, Bihar, Goa, Kerala, and West Bengal in a standardized six-week-district-wise digital training module curated to identify and manage commonly prevalent psychiatric disorders in primary care settings. Onsite training was conducted for participants in Tripura and Telangana. Participant engagement and changes in knowledge, attitude, and practice (KAP) scores were analyzed for each cadre along with ongoing support through real-time collaborative video consultations (CVCs).

Results: The program engaged 42,192 participants (7248 MOs, 18,993 CHOs, and 15,951 FLWs) across nine Indian states. Overall, participants attending ≥50% of training revealed higher engagement in CHOs of Bihar (80.51%), followed by MOs of Goa (69.7%), followed by FLWs of West Bengal (64.57%). Paired t-test analysis of KAP scores showed post-training statistically significant (p < .05) improvement for MOs of Karnataka, Maharashtra, Telangana (onsite), and Goa; CHOs of Karnataka, Maharashtra, Telangana (onsite), Tripura (onsite) and Bihar; and FLWs of Karnataka, West Bengal, and Kerala. A total of 1,320 CVCs were conducted, assisting the management of psychiatric disorders in the community.

Conclusion: Digital capacity building is a viable, scalable, and practical approach for mental health training of frontline workers to improve their clinical KAP.

Background: Multiple challenges, including limited technical knowledge, privacy concerns, or financial constraints to afford a smartphone, limit the introduction and implementation of a mobile application-based intervention aimed at supporting medication adherence for people with schizophrenia (SZ) in a low-resource setting. Recognising these barriers, this study aimed to explore the perceived acceptability of a mobile application specifically designed to improve medication adherence among individuals with SZ and their caregivers (CG).

Methods: A total of 64 individuals diagnosed with SZ, who had been in remission for the past six months, and 36 CG, attending the outpatient psychiatry department of a tertiary care teaching institution, were recruited based on predefined selection criteria. The SZ and CG participants were interviewed separately using an adapted version of the Treatment Acceptability and Preference Scale (TAPS), which assessed their perceptions of the appropriateness, suitability, effectiveness, and willingness to use a mobile application. TAPS was administered immediately after describing the proposed features and potential utility of the mobile application designed to improve medication adherence.

Results: There were no significant differences in demographic characteristics between SZ and CG, except that CG were significantly more likely to be employed than individuals with SZ (p = .02). Comparison of TAPS scores between the two groups revealed no significant difference in perceptions regarding the acceptability of the mobile application. However, a greater proportion of CG (63.9%) compared to individuals with SZ (56.25%) considered the mobile application to be appropriate. Correlation analysis indicated that younger age (p = .004) and higher levels of education (p = .01) were significantly associated with higher TAPS scores.

Conclusion: The mobile application was generally acceptable to patients and CG, with younger and more educated participants showing higher acceptability.

Background: Adolescent boys with addictive behaviours often have comorbidities. India has scarce free short-term rehabilitation facilities for them. The Ministry of Social Justice funds one centre per state. In our centre in Kerala state, a low budget allowed full-time treatment staff of two counsellors and two nurses only. A yoga therapist, a clinical psychologist, and a psychiatrist visit part-time. This study aimed to develop a comprehensive care model within such staff constraints.

Methods: We collected screening and assessment tools from child psychiatry clinics and through a literature search. We chose activities and worksheets from adolescent-specific workbooks on therapeutic (e.g., motivational enhancement, mindfulness) and positive psychology (e.g., managing emotions or relations) techniques. The psychiatrist trained the counsellors in their application.

Results: We utilised pre-available Malayalam (the local vernacular) versions of the Alcohol, Smoking, and Substance Involvement Screening Test and Strengths and Difficulties Questionnaire. We translated and content-validated DBD Rating Scale, Teen Addiction Severity Index, and Adolescent Smoking Consequences Questionnaire. From 11 workbooks, we chose 123 activities, considering patient needs and cultural relevance, and translated 17 worksheets. Counsellors found the CBT Toolbox for Children and Adolescents the most useful workbook. Of the 49 inpatients from the past year, 41 had dual diagnoses, the commonest being conduct-dissocial disorder. Chart review revealed that 46 patients found the activities comprehensible and acceptable. Frequent staff change was a challenge.

Conclusions: We developed an adaptive, low-cost, feasible, and acceptable care model for addictive behaviours and common comorbidities. Its acceptability and effectiveness need to be evaluated in larger, more diverse samples.

Background: Many studies suggest that urban upbringing might increase the risk of developing schizophrenia (SCZ). However, the precise brain changes associated with urban upbringing remain poorly understood. In this study, we investigated how urban upbringing might influence cortical gyrification, a brain feature that reflects early structural development.

Methods: The study included 70 Healthy Controls (HC) and 87 individuals diagnosed with SCZ, all aged between 18 and 50 years. Participants and their caregivers were interviewed to collect information about birthplace and upbringing location. Based on data from the Indian Census (1971-2011), upbringing locations were categorized into three groups: rural, town, and city. An urbanicity index was calculated using a previously established method. Brain anatomical MRI images were processed using FreeSurfer. Regression analysis was conducted using the QDEC interface, with the gyrification index (GI) as the dependent variable, and urbanicity index, sex, and age as predictors.

Results: In the entire sample, a significant positive association was observed between the urbanicity index and the GI in the left supramarginal gyrus (BA40; p = .001), left rostral middle frontal gyrus (BA10; p < .001), and both the left and right lateral occipital gyri (BA18; p = .001). Additionally, a significant interaction effect between the diagnosis and urbanicity index was found in multiple brain regions.

Conclusions: These findings suggest that urban living has a significant influence on brain development. Identifying such risk factors and underlying mechanisms could help develop prevention strategies and guide improvements in urban planning.