ABSTRACT
Introduction COVID -19 and the climate crisis have caused unprecedented disruptions across the world. Climate change has affected the mental health and wellbeing of children and adolescent. Young people with a mental illness and without social support are at an increased risk of climate change induced mental ill-health. COVID-19 resulted in a marked increase of psychological distress. Increase in depression, anxiety and insomnia have increased due to the upheavals that people were experiencing including loss of livelihood and breaking of social bonds. Methods This exploratory study adopted a cross sectional survey design using quantitative methods to understand the perceptions, thoughts, and feelings of young people on both the climate and COVID-19 crises, their concerns, and desires for the future and to understand their sense of agency to contribute to the changes that they want to see. Findings The findings show that most of the respondents from the sample studied reported nearly similar interference of climate change and COVID-19 on their mental wellbeing. Their climate concern and COVID-19 concern scores were comparable. Tangible experiences of extreme weather events, that were personally experienced or that impacted their family members had a negative impact on their lives, while action around improving the environment had a positive impact. Loss of income, loss of mobility and loss of social contact due to COVID-19 had negative impacts on the respondents, while indulging in leisure activities and bonding with the family had positive impacts. Although the majority of the participants reported having both climate and COVID agency, it did not translate into action to improve the environment. Interpretation Young people's activism on climate change and COVID-19 has a positive impact on their mental wellbeing hence more opportunities and platforms must be provided to enable young people to take action on both these crises.
ABSTRACT
BACKGROUND: Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India. METHODS: We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings. RESULTS: Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project. CONCLUSION: Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION: The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
ABSTRACT
INTRODUCTION: In India about 95% of individuals who need treatment for common mental disorders like depression, stress and anxiety and substance use are unable to access care. Stigma associated with help seeking and lack of trained mental health professionals are important barriers in accessing mental healthcare. Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health integrates a community-level stigma reduction campaign and task sharing with the help of a mobile-enabled electronic decision support system (EDSS)-to reduce psychiatric morbidity due to stress, depression and self-harm in high-risk individuals. This paper presents and discusses the protocol for process evaluation of SMART Mental Health. METHODS AND ANALYSIS: The process evaluation will use mixed quantitative and qualitative methods to evaluate implementation fidelity and identify facilitators of and barriers to implementation of the intervention. Case studies of six intervention and two control clusters will be used. Quantitative data sources will include usage analytics extracted from the mHealth platform for the trial. Qualitative data sources will include focus group discussions and interviews with recruited participants, primary health centre doctors, community health workers (Accredited Social Health Activits) who participated in the project and local community leaders. The design and analysis will be guided by Medical Research Council framework for process evaluations, the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, and the normalisation process theory. ETHICS AND DISSEMINATION: The study has been approved by the ethics committee of the George Institute for Global Health, India and the Institutional Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Findings of the study will be disseminated through peer-reviewed publications, stakeholder meetings, digital and social media platforms. TRIAL REGISTRATION NUMBER: CTRI/2018/08/015355.
Subject(s)
Mental Disorders , Mental Health , Community Health Workers , Humans , India , Mental Disorders/psychology , Mental Disorders/therapy , Randomized Controlled Trials as Topic , Referral and ConsultationABSTRACT
PURPOSE: We report findings from a survey on the mental health impact of COVID-19 factoring environmental adversities among older adolescents (15-19 years) living in urban slums in India. METHODS: We report survey results of 3490 older adolescents. Patient Health Questionnaire-9 was used to assess depression, slum adversity questionnaire for slum conditions, and for COVID-19 infection we recorded self-reported positivity status. Sociodemographic details were also collected. Additional sub-group analyses of sample who had depression and tested positive for COVID-19 infection was conducted. We used univariate and multivariate logistic regression models to identify factors and COVID-19 infection that were associated with depression. RESULTS: Adolescents with adversities were three times more likely to report depression. Adolescents who reported COVID-19 infection were about two times more likely to have depression. Sub-group analyses showed that adolescents having experienced adversities and girls were more likely to report depression following COVID-19 infection. CONCLUSIONS: There is a need for an intersectional research framework that incorporates stress arising out of a pandemic, social disadvantage, and systemic inequities. Such a framework will help to assess mental health issues of developmentally vulnerable groups residing in disadvantageous conditions.