Development of A Suicide Prevention Training Module for Social Work Students in India.

Introduction: Social workers constitute a significant task force that serves diverse populations experiencing psychosocial challenges in their daily lives. Lack of suicide prevention content/training in the Master of Social Work program may affect the student's self-esteem/ability to intervene when they come across a person with suicidality in the field. Developing a suicide prevention training module for social work students would be a suitable measure for upbringing their skills in dealing with individuals with suicidality. Method: The purpose of the present study was to develop a suicide prevention training module for social work students at the postgraduate level. The researcher conducted two Focused Group Discussions (FGD) each with social work students (n = 13) and social work educators (n = 15) on an online platform. Notes were taken during the discussion, and the contents were videotaped. The videotaped content was transcribed, and content analysis was used to analyze the data. The content that emerged from the FGD with social work students and educators was discussed in later FGD with mental health experts (two psychiatrists, one psychologist, two psychiatric social workers, and two mental health nurses). The discussion with experts clarified what components to retain for the training program. Results: Five major themes and 22 sub-themes emerged from the two FGDs each with students and educators, and one FGD with mental health professionals are described. The five major themes were understanding of suicidality, understanding suicide education in the master of social work curriculum, experience with suicidality, training content suggestion, and suggestions for future implications. Conclusions: The present study identified the need for suicide prevention training in postgraduate-level social work students. Furthermore, a lack of suicide prevention training was observed indicating the incorporation of suicide education in the postgraduate curriculum.

Multicomponent Behavioural Intervention during Pregnancy to Reduce Home Exposure to Second-Hand Smoke: A Pilot Randomised Controlled Trial in Bangladesh and India.

BACKGROUND: Pregnant women exposed to second-hand smoke (SHS) are at increased risk of poor birth outcomes. We piloted multicomponent behavioural intervention and trial methods in Bangalore, India, and Comilla, Bangladesh. METHODS: A pilot individual randomised controlled trial with economic and process evaluation components was conducted. Non-tobacco-using pregnant women exposed to SHS were recruited from clinics and randomly allocated to intervention or control (educational leaflet) arms. The process evaluation captured feedback on the trial methods and intervention components. The economic component piloted a service use questionnaire. The primary outcome was saliva cotinine 3 months post-intervention. RESULTS: Most pregnant women and many husbands engaged with the intervention and rated the components highly, although the cotinine report elicited some anxiety. Forty-eight (Comilla) and fifty-four (Bangalore) women were recruited. The retention at 3 months was 100% (Comilla) and 78% (Bangalore). Primary outcome data were available for 98% (Comilla) and 77% (Bangalore). CONCLUSIONS: The multicomponent behavioural intervention was feasible to deliver and was acceptable to the interventionists, pregnant women, and husbands. With the intervention, it was possible to recruit, randomise, and retain pregnant women in Bangladesh and India. The cotinine data will inform sample size calculations for a future definitive trial.

Exploring the feasibility, acceptability and preliminary effects of a nurse delivered mhealth intervention for women living with HIV in South India: a pilot randomized controlled trial.

PURPOSE: We evaluated the feasibility, acceptability and preliminary efficacy of a standardized nurse delivered mobile phone intervention to improve adherence to antiretroviral treatment and clinical outcomes. METHODS: Feasibility and acceptability of the phone intervention was assessed with rates of eligibility, completed visits, and attritions. Intervention fidelity was assessed by checking recorded calls and feedback. Efficacy was assessed using a randomized controlled trial in which 120 women living with HIV and psychosocial vulnerabilities, were randomized to Treatment as Usual (TAU = 60) or TAU plus the mobile phone intervention (N = 60). Trained basic nurses delivered the theory-guided, standardized mobile phone intervention for mental health issues and psychosocial risk factors to improve antiretroviral treatment (ART) adherence and retention in care and improve clinical outcomes. Blind raters performed the assessments at 6, 12 and 24 weeks post-randomization. RESULTS: Adherence diminished over time in the TAU only group, while it was sustained in the TAU Plus group, only dropping at 24 weeks after the intervention had been discontinued. Among participants with depressive symptoms (CESD ≥ 16), the intervention had significant improvement in adherence rates (p < 0.01), psychological quality of life (p < 0.05) and illness perception (p < 0.05) compared to those in the TAU only group. Greater improvements of quality of life subscales were observed in the TAU Plus group among participants with less psychological vulnerability (PSV < 2). HIV RNA was not significantly different between the groups at week 24. CONCLUSIONS: The mobile-delivered counseling intervention was feasible and acceptable and shows promise among women living with HIV and psychosocial vulnerabilities in rural South India. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02319330 [Registered on: December 18, 2014].

Development of a tool for infant facial emotion recognition (InFER) for postpartum mothers with mental illnesses.

Understanding deficits in recognition of infant emotions in mothers with mental illnesses is limited by the lack of validated instruments. We present the development and content validation of the infant facial emotion recognition tool (InFER) in India to examine the ability of mothers to detect the infants' emotions. A total of 164 images of infant faces in various emotional states were gathered from the parents of four infants (two male and two female: up to 12 months old). Infant emotion in each image was identified by the respective mother. Content validation was carried out by 21 experts. Images with ≥70% concordance among experts were selected. The newly developed tool, InFER, consists of a total 39 infant images representing the six basic emotions. This tool was then administered among mothers during their postpartum period-10 healthy mothers and 10 mothers who had remitted from any schizophrenia spectrum disorder, bipolar affective disorder or major depressive disorder. The mean age and mean years of education for both groups were comparable (age∼25 years, education ∼15 years). A significant difference was found between the two groups in their ability to recognize infant emotions (Mann-Whitney U = 12.5; p = 0.004). InFER is a promising tool in Indian settings for understanding maternal recognition of infant emotions.

La comprensión de los déficits en el reconocimiento de las emociones del infante en madres con enfermedades mentales está limitada por la falta de instrumentos validados. Presentamos el desarrollo y la validación de contenido de una herramienta para reconocer la emoción facial del infante (InFER) en la India. para examinar la habilidad de las madres para detectar las emociones del infante. Se recogió un total de 164 imágenes de caras de infantes en varios estados emocionales, aportadas por los progenitores de 4 infantes (dos varones y dos niñas: de hasta 12 meses de edad). La mamá respectiva identificó la emoción del infante en cada imagen. La validación del contenido la llevaron a cabo 21 expertos. Para la construcción de esta herramienta se seleccionaron las imágenes que presentaban el ≥70% de concordancia entre los expertos. La recientemente desarrollada herramienta, InFER está compuesta de un total de 39 imágenes de infantes las cuales representan las seis emociones básicas. Esta herramienta entonces se puso en práctica entre madres durante su período de postparto ­10 madres saludables y 10 madres que habían sido remitidas en relación con cualquiera de los trastornos de la gama de la esquizofrenia, el trastorno afectivo bipolar o un trastorno depresivo mayor. El promedio de edad y el promedio de años de educación en ambos grupos eran comparables (edad ∼25 años, educación ∼15years). Una diferencia significativa se encontró entre los dos grupos en cuanto a su habilidad de reconocer las emociones del infante (Mann­Whitney U = 12.5; p = 0.004). InFER es una herramienta prometedora en entornos de la India para comprender el reconocimiento materno de las emociones del infante.

La compréhension des déficits dans la reconnaissance des émotions du bébé chez les mères ayant des maladies mentales est limitée par le manque d'instruments validés. Nous présentons le développement et la validation du contenu d'un outil de reconnaissance de l'émotion faciale du nourrisson (InFER) en Inde afin d'examiner la capacité des mères à détecter les émotions du bébé. Un total de 164 images de visages de bébés dans des états émotionnels variés ont été assemblées de parents de 4 bébés (deux garçons et deux filles: jusqu'à l'âge de 12 mois) L'émotion du bébé dans chaque image a été identifiée par la mère respective. La validation du contenu a été faite par 21 experts. Des images avec ≥70% de concordance entre les experts ont été sélectionnées pour la construction de l'outil. Ce nouvel outil, InFER, consiste en un total de 39 images de bébés représentant les six émotions de base. Cet outil a ensuite été utilisé chez des mères durant leur période postpartum ­ 10 mères en bonne santé et 10 mères s'étant remises soit d'un trouble du spectre schizophrénique, soit d'un trouble affectif bipolaire ou d'un trouble dépressif majeur. La moyenne d'âge et la moyenne d'années d'éducation pour les deux groupes étaient comparables (âge∼25ans, éducation ∼15ans). Une différence importante a été trouvée entre les deux groupes dans leur capacité à reconnaître les émotions du bébé (Mann­Whitney U = 12,5; p = 0,004). InFER est un outil prometteur dans les contextes de l'Inde pour comprendre la reconnaissance maternelle des émotions du bébé.

Experience and Reporting of Postnatal Depression Across Cultures: A Comparison Using Anchoring Vignettes of Mothers in the United Kingdom and India.

Postnatal mental health is often assessed using self-assessment questionnaires in epidemiologic research. Differences in response style, influenced by language, culture, and experience, may mean that the same response may not have the same meaning in different settings. These differences need to be identified and accounted for in cross-cultural comparisons. Here we describe the development and application of anchoring vignettes to investigate the cross-cultural functioning of the Edinburgh Postnatal Depression Scale (EPDS) in urban community samples in India (n = 549) and the United Kingdom (n = 828), alongside a UK calibration sample (n = 226). Participants completed the EPDS and anchoring vignettes when their children were 12-24 months old. In an unadjusted item-response theory model, UK mothers reported higher depressive symptoms than Indian mothers (d = 0.48, 95% confidence interval: 0.358, 0.599). Following adjustment for differences in response style, these positions were reversed (d = -0.25, 95% confidence interval: -0.391, -0.103). Response styles vary between India and the United Kingdom, indicating a need to take these differences into account when making cross-cultural comparisons. Anchoring vignettes offer a valid and feasible method for global data harmonization.

Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Outcome of capacity building in mental health for well-being volunteers.

Introduction: Volunteering is any activity in which time is given to assist another individual, group, or organization. It assists people who want to get involved in philanthropic programs that help volunteers develop awareness and lead healthier personal and social lives. Several volunteers have received specialized training in the fields in which they volunteer, such as health, mental health, education, or emergency rescue. Volunteers are rendering intervention in different areas in mental health. They are providing psychosocial support to the individuals, groups, community, promoting mental health through conducting various mental health awareness programs in the community. There is a growing concern about mental health in India due to the inaccessibility of services. The National Institute of Mental Health and Neuro Sciences (NIMHANS) being a premier institute for mental health, is devising innovative approaches to mental health care to reach the unreachable. One such initiative was to build the capacity of volunteers in the community who are interested in working for the cause of mental health. Methods: The objective of this study was to evaluate the outcome of the well-being volunteer program. This study used a descriptive cross-sectional research design, wherein all the 136 trained well-being volunteers (WBVs) were included as the study sample. The data was collected from the volunteers who attended the WBV program, which was initiated by NIMHANS Centre for Well-being (NCWB) and the Department of Psychiatric Social Work NIMHANS. A questionnaire on the outcome of the Well Being Volunteers program was developed for the study, and the Volunteer Motivation Inventory scale was used to collect the data from the WBVs. SPSS software was used to analyze the data. Ethical clearance was sought from the Institute Ethics Committee of NIMHANS. Results: The WBV program enhanced volunteers' knowledge of mental health and benefited the volunteers in their personal and social life. They were also able to implement a satisfactory level of mental health-related volunteer activities in the community. Conclusion: Results of present study and the available literature suggest that engaging in voluntary services improves mental health knowledge. WBV program has provided opportunity to Volunteers to participate in mental health delivery system at different levels.

Evaluation of a manual-based training program in changing auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health.

Background: Globally, maternal mental health has been recognized as a priority public health issue. While it is crucial to integrate maternal mental health into mother and child health services, research on strengthening the knowledge and skills of primary healthcare providers on maternal mental health is limited in India. Aim: To evaluate the effectiveness of a manual-based training program in improving auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health. Methods: The present study adopted an experimental design among ANMs (N = 110) working at primary health centers, Karnataka, India. The participants were randomly assigned to either experimental group (n = 53) or control group (n = 57). The training program delivered interactive sessions based on a facilitator's manual developed specifically for ANMs in India. The assessments were done in both groups at baseline, after the intervention, at three months and at six months using self-rated questionnaires and a case vignette. The descriptive and inferential statistics were used to analyze the data. Results: After the training program the mean knowledge, attitudes and skills scores were significantly increased in the experimental group (P < 0.001) and significant differences were found between the mean scores of the groups at 3 months and 6 months follow-up (P < 0.05). Conclusion: The training program was found to have a positive impact in enhancing ANMs' knowledge, attitudes, and skills related to maternal mental health in India as there is dearth for mental health professionals in primary care settings.

Development and validation of an instrument for the assessment of internet use in the Indian context.

Background: Internet usage is increasing in the young population. Over 560 million internet users, India is the second-largest online market globally, which necessitates the development of an Internet use assessment tool in the Indian context. Methods: Samples of 560 individuals aged from 16 to 40 years participated. Data were coded in excel sheet for STATA 14.0 analysis evolved to item response theory. Cronbach's alpha was used to determine the internal consistency; concurrent validity was performed using the "Internet Addiction Test." Descriptive statistics, analysis of variance, confirmatory factor analysis, and Pearson's correlation were also determined. Results: The developed instrument has the Cronbach's alpha reliability value (25 items) of 0.893, which indicates high internal consistency and has a concurrent value of 0.800. Factor analysis of 23 items revealed that the variance of 64.481 revealed all the items loaded in the rotated component matrix. The final 18 items got the item discrimination index was >1.0 with three-factor structure. Conclusion: The developed reliable and valid instrument can be used for identifying the patterns of internet usage across various settings (research, educational, mental health/clinical, and workplace).

Formation of a stakeholder group of women with a lived experience of Post-partum Psychoses (PP) - Experience from a perinatal psychiatry service in India.

Our paper describes the process of creating a stakeholder group for service development and research in Postpartum Psychosis (PP) at a Perinatal Psychiatry Service in India. We involved women who have recovered from PP as `experts by experience' in identifying areas that need attention from a research and service perspectives. A total of 13 group meetings were conducted, in which 9 group meetings involved women with lived experiences of PP and 4 group meetings were with the family members involved in the care of women during the PP episode. Of the 58 participants, 23 women and two family members expressed their willingness to participate in future stakeholder meetings. Involvement of women with PP and their caregivers as stakeholders in mental health decision-making appears feasible in a LMIC setting and should be encouraged.

Feasibility and Acceptability of a joint mother infant yoga intervention in mothers admitted to an inpatient mother baby unit.

Mothers with severe mental illness in the postpartum may have problems in bonding with their infants and there is a need to develop effective and acceptable interventions. Yoga has been shown to improve social cognition as well as increase oxytocin levels and maybe of value. This paper describes the feasibility and acceptability of a mother-infant yoga intervention in 14 mothers with severe mental illness admitted to a Mother Baby Unit in India. Mothers found the module acceptable and completion rates for mother-infant dyads were adequate.

Child Maltreatment and Intimate Partner Violence in Mental Health Settings.

Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.

Women with mental illness seeking conception counselling at a specialist perinatal psychiatry service in India.

AIMS: To study the clinical and sociodemographic profile of women with mental illness seeking conception counselling at perinatal psychiatry service. To compare women seeking preconception counselling (PCC) to that of those who sought help after unplanned pregnancy with exposure (UPE) to psychotropics. MATERIAL AND METHODS: Data was extracted from the clinical records of women between the year 2014-2017 who attended perinatal outpatient services. The details collected included sociodemographic details, illness details, contraception, infertility treatment and detailed treatment history. RESULTS: Of the 766 women who consulted perinatal psychiatry services (2014-17), 179 (23.37%) had consulted for conception counselling. Out of that 104 (58.1%) sought PCC, and 75 (41.9%) had UPE to psychotropics. PCC was sought by women with higher education, those having a severe mental illness, and a longer duration of illness. Women with medical comorbidities and receiving infertility treatment also sought PCC. Also, women who had earlier undergone PCC been more likely to seek PCC for further pregnancies. CONCLUSIONS: Women with mental illness should be counselled regarding planned pregnancies, contraception, and the impact of psychotropics on pregnancy and foetus. Also, liaison with other specialities like obstetricians, sonologist and paediatricians is essential.

Gender Transformative Interventions for Perinatal Mental Health in Low and Middle Income Countries-A Scoping Review.

Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. In the context of Low and Middle Income Countries (LMIC), a leading risk factor is gender disparity. Addressing gender disparity, by involving fathers, mothers in law and other family members can significantly improve perinatal and maternal healthcare, including risk factors for poor perinatal mental health such as domestic violence and poor social support. This highlights the need to develop and implement gender-transformative (GT) interventions that seek to engage with men and reduce or overcome gender-based constraints. This scoping review aimed to highlight existing gender transformative interventions from LMIC that specifically aimed to address perinatal mental health (partner violence, anxiety or depression and partner support) and identify components of the intervention that were found to be useful and acceptable. This review follows the five-stage Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Six papers that met the inclusion criteria were included in the review (four from Africa and two from Asia). Common components of gender transformative interventions across studies included couple-based interventions and discussion groups. Gender inequity and related factors are a strong risk for poor perinatal mental health and the dearth of studies highlights the strong need for better evidence of GT interventions in this area.

"It seemed like my fault for wanting to become a mother "-Experiences and perceptions related to motherhood in women with severe mental illness.

BACKGROUND: Women with mental illness experience unique challenges during their motherhood. However, little is known about their own perceptions and unmet needs in the process of childbearing. A qualitative study design with a social constructivist paradigm was used to explore lived experiences of mothers with severe mental illness (SMI) during the childbearing period. METHODS: Semi-structured in-depth interviews were conducted with 30 mothers recruited through purposive sampling. This was followed by inductive thematic analysis. Rigor was established through triangulation and respondent validation. This paper focuses on the perceptions during the pre-conception and pregnancy period. RESULTS: Emergent categories (themes) were thoughts/feelings about childbearing (ambivalence about being a mother/having a baby, fantasies about childbearing/rearing, guilt about pregnancy), the impact of mental illness (stigma, effect of symptoms on their self-care including healthcare, concerns about effect of medications on fetus), unmet needs (lack of emotional support, unanswered doubts about effects of illness on pregnancy, child and motherhood, wanting to be considered as "potential mothers"), and caregivers' reactions (discrimination, anger/abuse, selective support). The centrality of motherhood and balancing the "dual role" of a patient and mother were the overarching categories after analysis. CONCLUSION: Mothers with SMI prize motherhood but navigate through it with various adverse experiences. The results of this study, grounded in their voices, provide critical insights for service and policy provisions in perinatal psychiatry.