Medical attribution of common mental disorders in a rural Indian population

Srinivasan, Krishnamachari; Isaacs, Anton Neville; Villanueva, Elmer Virgil; Lucas, Anupa; Raghunath, Deepthi

doi:10.1016/j.ajp.2010.07.008

Cited by 11 publications

(10 citation statements)

References 13 publications

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“…[45] In a case-vignette based study, respondents showed a preference for lay help over medical help even when they labeled the illness as mental disorder. [46] Special diets, tonics, appetite stimulants, and sleeping pills were strongly endorsed, but awareness of psychiatric medications was negligible. [47] Another major contributing factor is the lack of mental health-care services and resources in most parts of the country.…”

Section: Discussionmentioning

confidence: 99%

Twelve-month prevalence and treatment gap for common mental disorders: Findings from a large-scale epidemiological survey in India

Sagar

Pattanayak

Chandrasekaran

et al. 2017

Indian J Psychiatry

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Background:Common mental disorders, such as mood, anxiety, and substance use disorders, are significant contributors to disability globally, including India. Available research is, however, limited by methodological issues and heterogeneities.Aim:The present paper focuses on the 12-month prevalence and 12-month treatment for anxiety, mood, and substance use disorders in India.Materials and Methods:As part of the World Health Organization World Mental Health (WMH) Survey Initiative, in India, the study was conducted at eleven sites. However, the current study focuses on the household sample of 24,371 adults (≥18 years) of eight districts of different states, covering rural and urban areas. Respondents were interviewed face-to-face using the WMH Composite International Diagnostic Interview after translation and country-specific adaptations. Diagnoses were generated as per the International Classification of Diseases, 10th edition, Diagnostic Criteria for Research.Results:Nearly 49.3% of the sample included males. The 12-month prevalence of common mental disorders was 5.52% - anxiety disorders (3.41%), mood disorders (1.44%), and substance use disorders (1.18%). Females had a relatively higher prevalence of anxiety and mood disorders, and lower prevalence of substance use disorders than males. The 12-month treatment for people with common mental disorders was 5.09% (range 1.66%–11.55% for individual disorders). The survey revealed a huge treatment gap of 95%, with only 5 out of 100 individuals with common mental disorders receiving any treatment over the past year.Conclusion:The survey provides valuable data to understand the mental health needs and treatment gaps in the Indian population. Despite the 12-month prevalence study being restricted to selected mental disorders, these estimates are likely to be conservative due to under-reporting or inadequate detection due to cultural factors.

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Section: Discussionmentioning

confidence: 99%

Twelve-month prevalence and treatment gap for common mental disorders: Findings from a large-scale epidemiological survey in India

Sagar

Pattanayak

Chandrasekaran

et al. 2017

Indian J Psychiatry

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“…To test the screening hypothesis, with 25 PHCs per screening condition, 80% power and α = 0.05, the minimum detectable effect in a Poisson regression is 2.1 times as many co-morbid cases identified with the enhanced compared to the standard screening [ 102 ]. Although this is a large effect, we deemed it attainable, given the documented under-reporting of mental health in standard care [ 10 , 11 ], and the intensive nature of our enhanced screening.…”

Section: Methodsmentioning

confidence: 99%

“…In India, the prevalence of common mental disorders (CMD) including depressive and anxiety disorders has been estimated to affect 30-34% of primary care patients [ 3 , 8 ]. The majority of patients with CMD visiting primary health care centers (PHCs) present with multiple somatic symptoms and are often misdiagnosed, resulting in the receipt of ineffective, symptomatic treatments [ 9 , 10 ]. In a survey of 12,886 patients visiting a clinic in South India who were participating in a community mental health program it was observed that major depressive disorder and dysthymia accounted for 34% and 22%, respectively, of the total burden of mental illness [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Improving mental health through integration with primary care in rural Karnataka: study protocol of a cluster randomized control trial

et al. 2018

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BackgroundPeople who are diagnosed with both mental and chronic medical illness present unique challenges for the health care system. In resource-limited settings, such as rural India, people with depression and anxiety are often under-served, due to both stigma and lack of trained providers and resources. These challenges can lead to complications in the management of chronic disease as well as increased suffering for patients, families and communities. In this study, we evaluate the effects of integrating mental health and chronic disease treatment of patients in primary health care (PHC) settings using a collaborative care model to improve the screening, diagnosis and treatment of depression in rural India.MethodsThis study is a multi-level randomized controlled trial among patients with depression or anxiety and co-morbid diabetes, or cardiovascular disease. Aim 1 examines whether patients screened at community health-fairs are more likely to be diagnosed and treated for these co-morbid conditions than patients screened after presenting at PHCs. Aim 2 evaluates the impact of collaborative care compared to usual care in a cluster RCT, randomizing at the level of the PHCs. Intervention arm PHC staff are trained in mental health diagnoses, treatment, and the collaborative care model. The intervention also involves community-based “Healthy Living groups” co-led by Ashas, using cognitive-behavioral strategies to promote healthy behaviors. The primary outcome is severity of common mental disorders, with secondary outcomes being diabetes and cardiovascular risk, staff knowledge and patient perceptions.DiscussionIf effective, our results will contribute to the field in five ways: 1) expand on implementation research in low resource settings by examining how multiple chronic diseases can be treated using integrated low-cost, evidence-based strategies, 2) build the capacity of PHC staff to diagnose and treat mental illness within their existing clinic structure and strengthen referral linkages; 3) link community members to primary care through community-based health fairs and healthy living groups; 4) increase mental health awareness in the community and reduce mental health stigma; 5) demonstrate the potential for intervention scale-up and sustainability.Trial registrationhttp://Clinicaltrials.gov: NCT02310932 registered December 8, 2014 URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932; Clinical Trials Registry India: CTRI/2018/04/013001 retrospectively registered on April 4, 2018.

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“…Our previous work in a rural mental health clinic in South India (The Maanasi project at the Community Health Training Center, Mugalur), examined the delivery of comprehensive psychiatric care by trained community health workers (CHWs) in collaboration with primary care providers (PCP) and psychiatrists (K. Srinivasan, Isaacs, Villanueva, Lucas, & Raghunath, 2010). In this model, following a monthly visit with a physician at the Primary Health Center (PHC), the CHWs conducted home visits for patients with depression.…”

Section: Introductionmentioning

confidence: 99%

Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study

Bhat

Goud

Pradeep

et al. 2020

Cult Med Psychiatry

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Introduction: Low rates of follow up with mental health treatments, and medication nonadherence are common among patients with Major Depressive Disorder (MDD), more so in lowmiddle income countries (LMIC). While mobile mental health has the potential to address this problem in resource-poor settings, the feasibility and acceptability of its use in rural women is unknown. We aimed to explore barriers to access and adherence to mental health treatment, and the feasibility of using mobile health to address these barriers among women with MDD in rural south India. Methods: Six focus groups were conducted among women with MDD (n=69) seeking care at a rural community health center in South India. Discussion centered on barriers to mental health treatment access and adherence and attitudes toward use of technology in addressing these barriers. We transcribed the discussions and analyzed them using qualitative analysis software. Results: Reasons for non-adherence were: transcultural explanatory model of illness; structural, financial and social barriers to access, and medication side-effects. Women were unenthusiastic about mobile health solutions due to illiteracy, lack of family support, unfamiliarity with use of mobile devices, lack of access to mobile phones and preference for in-person clinical consultation. Conclusions: This qualitative study examines the acceptability of mobile-mental health as a strategy to address barriers to depression treatment access and adherence among women in a rural setting. There are several barriers to adoption of mobile mental health technology in LMIC. It is important to address these barriers before implementing mobile health based solutions.

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Medical attribution of common mental disorders in a rural Indian population

Cited by 11 publications

References 13 publications

Twelve-month prevalence and treatment gap for common mental disorders: Findings from a large-scale epidemiological survey in India

Twelve-month prevalence and treatment gap for common mental disorders: Findings from a large-scale epidemiological survey in India

Improving mental health through integration with primary care in rural Karnataka: study protocol of a cluster randomized control trial

Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study

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