Beyond Numbers - Recent Understanding of Emotional Needs of Persons Diagnosed with Cancer 2007-2018.

Epidemiology is a vital tool of public health. The usefulness of epidemiology is not only about numbers of persons' ill in the community but also to understand the associations, the presentation, identification of new syndromes, to map the historical trends, and calculate morbid risk. The emotional impact of the diagnosis of cancer is well-recognized. Indian cancer research relating to the psychosocial aspects has been largely limited to counting the numbers with psychiatric syndromes. The review covers 12 years of the Indian research in psycho-oncology to understand the different aspects of epidemiology. During the review period, there are growing number of epidemiological studies (29); psychiatric morbidity ranges from 41.7% to 46%; and prevalence rate ranges from 4.4% to 97.8% for anxiety and 1.2%-89.9% for depression; majority of the studies have used one-stage screening for assessment, which is not the ideal method of identifying mental disorders. The severity of the disorders is presented only in nine studies. Quality of life is the most common associated dimension of the studies. There is the absence of studies of posttraumatic growth, resilience, and spirituality. This review calls for greater rigor in the planning of studies of emotional impact, especially the use of two-stage method, longitudinal studies, studies of different types of cancer and in different stages, include additional measures such as disease burden, coping, resilience, spirituality, and the family/social factors to understand the emotional aspects of living with cancer. There is a need for describing the emotional aspects of living with cancer (lived-in experiences) beyond the clinical syndromes.

Mental health of survivors of 1984 Bhopal disaster: A continuing challenge.

Bhopal disaster is an important milestone in Indian Industrial Psychiatry. The disaster was not only the biggest industrial disaster but also one in which complex forces have joined hands to demy the mental health needs of the population. Though the biggest general population epidemiological study over 5 years was carried out to understand the mental health impact of the disaster, the findings of this study did not get reflected in mental health care for the population. Furthermore, the needed longitudinal studies and evaluation of the interventions were not undertaken. There was no sharing of information with the survivors about the impact of the disaster on their health and well-being and sharing of skills for self-care. A result of these factors is the extreme degree of dissatisfaction in the population. Looking back, it would have met the needs of the Bhopal population, if the mental health services were community based and reaching the population, rather than the clinic-based approaches, there was a wide range of services, especially rehabilitation, continuous research into the changing mental health needs of the population and the effectiveness of interventions and most importantly, there was a continuous dialogue with the population and sharing of information with the general population. These are the tasks for the immediate future to reorganize the focus of mental health initiatives in Bhopal. Many lessons can be learnt from the Bhopal disaster and the continuing tragedy for the population.

Covert medication - Multiple situations, varied options.

Mental health interventions in low and middle income countries, with limited resources of human and other resources, requires that they be viewed from multiple viewpoints. This applies to the issue of covert medication, which on the face should not be practiced at all, in an ideal care situation. In India, it would be better to consider the use of covert medication, in differing situations and with the varying levels of involvement of patients and their families in a planned manner and with an open approach. Such an approach could meet the care needs of patients as well as protect the rights of the patients.

Living with schizophrenia in India: gender perspectives.

This study explores gender issues from a sociocultural perspective related to stigma among people suffering from schizophrenia in India. Stigma experiences were assessed by conducting semistructured interviews with 200 patients attending urban or rural psychiatry clinics. The resulting narratives were examined by thematic content analysis. Men with schizophrenia reported being unmarried, hid their illness in job applications and from others, and experienced ridicule and shame. They reported that their experience of stigma was most acute at their places of employment. Women reported experiences of stigma in relation to marriage, pregnancy, and childbirth. Both men and women revealed specific cultural myths about their illnesses and described how these had negatively affected their lives. Information gathered from this study can be useful to understand the needs of individuals who suffer from schizophrenia to improve the quality of their treatment, and plan culturally appropriate interventions to counter stigma and discrimination.

From local to global - Contributions of Indian psychiatry to international psychiatry.

Indian psychiatrists have actively engaged with world psychiatry by contributing to understanding and care of persons with mental disorders based on the religious, cultural and social aspects of Indian life. The contributions are significant in the areas of outlining the scope of mental health, classification of mental disorders, understanding the course of mental disorders, psychotherapy, traditional methods of care, role of family in mental health care and care of the mentally ill in the community settings.

Psycho-social outcomes for persons with bipolar-I disorder: Eight-year follow-up of a rural cohort from south India.

BACKGROUND: Assess psycho-social outcomes in a rural cohort of patients with bipolar-I disorder (BD). METHODS: Detailed evaluations were performed using the Longitudinal Interval Follow-up Evaluation (LIFE) assessments of community-based BD patients in southern India. Several subjective and objective outcome measures were examined. RESULTS: Only half the cohort could be described as having a good overall outcome, with persistent difficulties in inter-personal relationships in a substantial proportion of patients. Separation or divorce, or co-morbid alcohol dependence impacted a higher proportion of female patients compared to males. CONCLUSIONS: In spite of the small cohort size, this longitudinal study indicates mixed outcomes for BD patients in this setting, with several patients showing enduring psycho-social and global impairments. Even though symptomatic recovery for BD patients might be better in developing countries compared to those observed in developed nations, the notion of better psycho-social outcomes for BD in developing countries needs closer re-examination in larger cohorts.

Mass violence and mental health--recent epidemiological findings.

There is growing awareness of the mental health impact of all types of mass violence. The exposure of large population groups, mostly having no mental health problems prior to the exposure, and the subsequent development, in a significant proportion of the population, of a variety of psychiatric symptoms and disorders represent both a challenge and an opportunity for psychiatrists. There is sufficient evidence from the variety of mass violence/conflict situations, that a significant proportion of the exposed population develop different mental disorders. There are vulnerable groups like women, children, widows, orphans, elderly, disabled, those exposed to severe pain and loss of body parts. There is also a consistent finding of the dose-response to the amount of trauma and the prevalence of mental disorders. There is growing recognition that there is need to consider a variety of syndromes, in addition to post-traumatic stress disorder (PTSD) like acute stress disorder (ASD), depression, complicated bereavement reactions, substance use disorders, poor physical health, fear, anxiety, physiological arousal, somatisation, anger control, functional disability and arrest or regression of childhood developmental progression. The challenge is to reach all of the ill persons and provide mental health services. The opportunity provided by this field is to develop a better understanding of issues of resilience, recovery and effectiveness of public health approaches to mental health care.

Mental health consequences of war: a brief review of research findings.

Among the consequences of war, the impact on the mental health of the civilian population is one of the most significant. Studies of the general population show a definite increase in the incidence and prevalence of mental disorders. Women are more affected than men. Other vulnerable groups are children, the elderly and the disabled. Prevalence rates are associated with the degree of trauma, and the availability of physical and emotional support. The use of cultural and religious coping strategies is frequent in developing countries.

The course of bipolar disorder in rural India.

AIM: To examine the naturalistic course of bipolar disorder in a rural, community-based, partially treated cohort. METHODS: All patients diagnosed with bipolar disorder during an epidemiological survey (n=34) in a rural area in India were followed longitudinally using standardized instruments, and the life-chart method used to examine their course. RESULTS: Seven (26%) of the 27 patients evaluated directly had not received any treatment whatsoever. Four patients (15%) had experienced rapid-cycling at some time; patients without rapid-cycling had experienced a mean 0.22 episodes/year. Episodes of mania accounted for 72% of all episodes. None of the variables examined appeared to predict the total number of episodes experienced by individual patients, although rapid-cycling occurred significantly more often if the patients had not received any psychopharmacological treatment. CONCLUSIONS: A mania-predominant course was observed in this small cohort, similar to reports from other developing countries.

Is it possible to carry out high-quality epidemiological research in psychiatry with limited resources?

PURPOSE OF REVIEW: This review covers the epidemiological research from developing countries to identify the scope of research in the various aspects of epidemiology and the strengths of research. The period covered is June 2004 to June 2005. The literature survey used searches of Medline, key psychiatric journals and personal correspondence with leading psychiatric researchers from developing countries. RECENT FINDINGS: There is a new interest in epidemiological studies in developing countries. These studies have been driven by three factors, namely international collaboration; specific situations like disasters, terrorism and severe acute respiratory syndrome; and international attention to specific topics like maternal depression. There is limited long-term research on specific conditions. There are a number of leads suggesting local social-cultural factors contribute to the distribution of psychiatric problems. Child psychiatry continues to be low in priority. There is also lack of research in areas such as personality disorders and organic psychiatric disorders. SUMMARY: It is possible to carry out high quality epidemiological research in developing countries. Such research has provided new insights into the distribution, causation, course and outcome of mental disorders. There is need for greater attention to the development of epidemiological assessment tools to suit local conditions. Specific centers/institutions developing long-term research interests on specific subjects would be valuable for future efforts. There is also need to widen the conditions to be studied.

Human resources for mental health - challenges and opportunities in developing countries.

Human resources for mental health are a challenge in all countries. In countries rich and poor, there is a big gap between the need for mental health services and the availability of those services. In an unusual way, the barriers to mental healthcare appear to be universal, which is not true of non-psychiatric healthcare. Nonetheless, the World Health Report 2001 and the World Health Organization's Atlas project have recorded extremely low levels of service in most developing countries (World Health Organization, 2001a,b). The recruitment of consultant psychiatrists from low- and middle-income countries, discussed in the October 2004 issue of International Psychiatry (Ndetei et al, 2004; Jenkins, 2004), raises a number of challenges for both developing and developed countries.

Mental health promotion in post-conflict countries.

Meeting the mental health needs of those persons in conflict and post-conflict situations in the eastern Mediterranean region (EMR) is an important goal of the World Health Organization. Of the 22 countries in the EMR, 85% of the population has been affected by conflict in the past two decades. This has resulted in a high prevalence of mental disorder, most commonly depression, post-traumatic stress disorder and anxiety. A number of innovative, culturally sensitive interventions have been developed to meet the mental health needs of the populations. These include the use of 'focusing' in Afghanistan, the Education for Peace Programme in Lebanon, the United Nations Relief and Works Agency's work with refugees in Gaza, life skills education in Iran and the training of professionals in Afghanistan. In post-conflict situations there are six levels of interventions needed: first, increasing resilience; second, making the family the focus for effective support; third, encouraging community solidarity and traditional methods of support: fourth, using the media in mental health promotion; fifth, the integration of mental health skills of caring for the population with general services; and sixth, focusing on long- rather than short-term measures.