Systematic review of interventions to reduce mental health stigma in India

Kaur, Amanpreet; Kallakuri, Sudha; Kohrt, Brandon A.; Heim, Eva; Gronholm, Petra C.; Thornicroft, Graham; Maulik, Pallab K.

doi:10.1016/j.ajp.2020.102466

Cited by 37 publications

(18 citation statements)

References 31 publications

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“…This is the first systematic review examining ISC in LMICs, providing a categorisation of these studies and a novel definition of ICS interventions in LMICs. This is in contrast to previous reviews that have focused on subtypes of ISC (Ando et al ., 2011 ; Clement et al ., 2013 ; Janoušková et al ., 2017 ) and included studies from both HICs and LMICs, or considered different types of contact intervention strategies together (Clay et al ., 2020 ; Hartog et al ., 2020 ; Kaur et al ., 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

Makhmud

Thornicroft

Gronholm

2022

Epidemiol Psychiatr Sci

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Aims Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs). Methods MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to ‘stigma and discrimination’, ‘intervention’, ‘indirect social contact’, ‘mental health’ and ‘low- and middle-income countries’. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results. Results Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations. Conclusions ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

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Section: Discussionmentioning

confidence: 99%

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

Makhmud

Thornicroft

Gronholm

2022

Epidemiol Psychiatr Sci

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“…Finally, we note that only two factors, social and resource support, were associated with lower levels of novel-onset mental health symptoms, neither of which was protective for men. Broader availability of mental health services, outreach, and norms shifting regarding the acceptability of discussing and using mental health services is needed to support individuals through, and beyond, this mental health crisis [42]. For example, at the study site, mental health services are not provided in the local public health center, which provides proximate and affordable care.…”

Section: Discussionmentioning

confidence: 99%

COVID-19-Related Financial Hardship, Job Loss, and Mental Health Symptoms: Findings from a Cross-Sectional Study in a Rural Agrarian Community in India

Chatterji

McDougal

Johns

et al. 2021

IJERPH

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Several countries, including India, imposed mandatory social distancing, quarantine, and lockdowns to stop the spread of the SARS-CoV-2 virus. Although these measures were effective in curbing the spread of the virus, prolonged social distancing, quarantine, and the resultant economic disruption led to an increase in financial stress and mental health concerns. Prior studies established a link between the first lockdown and an increase in mental health issues. However, few studies investigated the association between post-lockdown financial hardship, job loss, and mental health. In this study, we examined the association between COVID-19-related financial hardship, job loss, and mental health symptoms approximately nine months after the end of the first nationwide lockdown in India. Job loss was associated with higher reporting of mental health symptoms among men (aIRR = 1.16) while financial hardship was associated with poor mental health symptoms among women (aIRR = 1.29). Conversely, social support and government aid were associated with better mental health symptoms among women. Our findings highlight the need for financial assistance and job creation programs to aid families in the recovery process. There is also an urgent need for improving the availability and affordability of mental health services in rural areas.

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“…Policies should acknowledge stigma as a major barrier to old age mental healthcare, even in the family context, and lay out plans to address it. Community-level interventions are a common strategy in India to reduce stigma [ 86 ], and this level should be considered important.…”

Section: Discussionmentioning

confidence: 99%

The architecture of the primary mental healthcare system for older people in India: what public policies tell us

Kafczyk

Hämel

2021

Int J Ment Health Syst

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Background Old age mental healthcare is an issue that cuts across old age, general health, and mental healthcare policies. While strengthening the primary mental healthcare system in India is a common strategy across policy fields to improve the mental health of older persons, very little is known about the system’s planned architecture. This study explores public policy strategies for and approaches to the mental health of older persons, focusing on the primary healthcare (PHC) level and the role of the family. Methods A document analysis of 39 key public national policy documents (2007 – 2019) from three thematically grouped policy fields (mental health, old age, and general health) was conducted. Results Comprehensive community-based primary mental healthcare – focusing on vulnerable population groups including older persons – has been strengthened significantly since 2007. The promulgated approaches and strategies build on traditional community-based approaches to mental healthcare in India. They focus on (a) integrating community health workers into primary mental healthcare, (b) empowering the community to participate in healthcare planning, implementation, and monitoring, (c) supporting the family through a family-led approach to mental healthcare, and (d) integrating traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) services into primary mental healthcare. Conclusions While all policy fields address mental PHC, they do so in different ways, and approaches and strategies that promote an integrated perspective across policy fields are lacking. To realize the policies vision, strengthening PHC will be essential. Further research should evaluate strategies and approaches in light of social developments, such as eroding family norms and the poor state of the public health system in India, in order to assess their opportunities, challenges, and overall feasibility, with the benefits older people would experience taking centre stage in these inquiries.

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Systematic review of interventions to reduce mental health stigma in India

Cited by 37 publications

References 31 publications

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

COVID-19-Related Financial Hardship, Job Loss, and Mental Health Symptoms: Findings from a Cross-Sectional Study in a Rural Agrarian Community in India

The architecture of the primary mental healthcare system for older people in India: what public policies tell us

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