Is cesarean section a clinical marker for psychiatric and sleep disorder in young mothers? A cross-sectional study from rural South India.

Background: Gestation and postnatal period are important stages in a woman's life. The type of delivery, vaginal delivery (VD) or cesarean Section (CS), is determined by maternal and fetal factors and their mutual fit. The type of delivery has consequences on the health and well-being of the mother and the newborn. Postpartum psychiatric disorders have been found to be both positively and negatively associated with the mode of delivery and demographic and clinical variables of the postpartum mothers. In view of the foregoing, a comprehensive investigation of the demographic and clinical variables and a range of psychiatric disorders among postpartum women delivered both vaginally and by CS in a rural tertiary care hospital in South India was proposed. Materials and Methods: All consecutive women delivered vaginally and by CS attending Maternal and Child Clinic within 42 days of delivery were approached. Following informed consent and application of inclusion and exclusion criteria, 121 women delivered vaginally and 124 women delivered by CS were assessed using Mini International Neuropsychiatric Interview (MINI) and Pittsburgh Sleep Quality Index (PSQI). The data obtained were entered into MS Excel 2010 version and further analyzed using STATA v13. Results: Both groups were matched on most demographic and clinical variables except age and whether pregnancy was planned or not. Postpartum depression was the most frequent diagnosis in both groups, with significantly more cases following CS compared to VD. Other psychiatric disorders were also found to be more following CS. The quality of sleep (QOS) was significantly poor following CS. QOS was significantly poor in the presence of a coexisting psychiatric disorder. Conclusion: This study has limitations in terms of being cross-sectional and disability being defined by cutoff scores on MINI and PSQI.

Postexposure psychological sequelae in frontline health workers to COVID-19 in Andhra Pradesh, India.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 has engulfed the globe since December 2019. Healthcare workers remain at the forefront of this battle, and like prior pandemics face mental health challenges along with physical risks. We aimed to study the perceived stress and possible posttraumatic stress in the frontline workers exposed to active COVID-19 duties in the state of Andhra Pradesh, India. METHODOLOGY: A special voluntary, anonymous, survey-based Google questionnaire was designed with mandatory consent form and queries to clarify inclusion exclusion criteria. Tools included valid, reliable self-administered scales, namely General Health Questionnaire 12, Perceived Stress Scale and Impact of Events Scales-Revised. A purposive sampling method was adopted, by posting the survey questionnaire on WhatsApp groups of doctors, interns, and nurses working on active COVID-19 duty in Andhra Pradesh. RESULTS: About 69.7% of the frontline workers recorded higher perceived stress and definitive posttraumatic stress disorder (PTSD) was found in 34.8%, with psychological distress recorded in 53%. CONCLUSION: The higher levels of perceived stress discovered in the vast majority with definitive PTSD features in a third of the sample indicates the need for provision of mental health support proactively among frontline workers on active COVID-19 duty.

Association of educational stress with depression, anxiety, and substance use among medical and engineering undergraduates in India.

BACKGROUND: Students pursuing higher education are subject to high stress levels which could be associated with dysfunctional coping. Maladaptive coping is known to be operative in manifesting as psychopathology as depression, anxiety, suicidal ideation, and substance abuse. This study aimed to elaborate the psychological morbidity among professional undergraduates in general and medical students in particular, its evolution over the years and its psychosocial correlates. METHODOLOGY: The study examined medical students (n = 202) and age-matched engineering students (n = 145) belonging to the first and final year for psychological stress and coping, educational stress, domestic and professional concerns, depression, anxiety, and substance abuse. Psychometric scales along with demographic questionnaire were used to assess and quantify stress and psychological morbidity. RESULTS: Medical students had higher levels of stress (psychological and education related) and higher psychological morbidity (depression and anxiety). Stress scores correlated positively with depression and anxiety scores and negatively with substance use score. Psychological stress other than educational stress was noted to be predictors of alcohol use in the sample. CONCLUSION: Our study elucidates that medical students face higher levels of psychological and education-related stressors and have higher levels of psychological morbidity than students from engineering colleges. Psychoactive substances are used as a form of self-medication to alleviate stress.

Burnout and coping strategies among residents of a private medical college in South India: A cross-sectional study.

BACKGROUND: Burnout is evident in various professions increasingly so in the health-care field, where doctors are involved with direct interactions with dependent patients. Burnout is evident even in residents due to working in demanding and testing conditions which has a negative influence not only on their profession, but also patient care. AIMS: (1) To measure the levels of burnout among the residents and (2) to assess the relationship between severity of burnout and coping strategies. SETTINGS AND DESIGN: It is cross-sectional observational study set in a private medical college with residency program. MATERIALS AND METHODS: Online self-administered questionnaire was sent to all residents, out of these, 100 residents consented and completely filled the questionnaires and were included in the analysis with a response rate of 55.6%. The questionnaire consisted of sociodemographic variables, Maslach Burnout Inventory, and Brief COPE. RESULTS: Residents who reported burnout as high in two dimensions of emotional exhaustion and depersonalization are 31.82%. The 2nd year residents scored high on burnout measures when compared to 1st and 3rd year residents. It was observed that as the degree of emotional exhaustion and depersonalization increased from low to high, the frequency of the maladaptive coping strategies also increased. CONCLUSION: Based on these findings it can be concluded that burnout is frequent in residents. Further research is essential to identify the factors that contribute to burnout in residents.

Cross sectional assessment of empathy among undergraduates from a medical college.

BACKGROUND: Empathy is essentially a desirable quality among clinicians and can be developed during medical education. Studies from outside India have shown that higher empathy is related to better competency and choice of specialty may be related to empathy levels in them. Change in empathy levels among undergraduate medical students with progressive training has been often ascribed to reasons such as curriculum content, timing of clinical rotations. Gender differences in empathy levels also vary among different countries. Since many of such factors differ in India there is a need therefore to understand empathy and its correlates among medical students in India. METHOD: A cross sectional study was undertaken in a large medical college among the undergraduates of first, third, fifth, seventh and ninth semesters to measure their empathy levels. The evaluation was done using the Jefferson's Scale for Physician's Empathy- Student version. RESULTS: The study revealed highest empathy at entry level and a significant fall by seventh semester (p = 0.002). Female students had significantly higher empathy levels than male students (p = 0.012) across all semesters. The variance in empathy scores according specialty chosen is not statistically significant (p = 0.2468). CONCLUSION: The progressive decline in empathy levels with years in medical college here is seen much later than in western studies. Female students are more empathetic than male students. The relation of mean empathy scores and choice of specialty is inconclusive and at variance from other studies.

Cognitive and emotional effects of renal transplantation.

BACKGROUND: Recent studies have shown a high prevalence of depression and cognitive changes in patients with end-stage renal disease (ERSD) and renal transplant recipients. There are few data available on the cognitive and emotional changes in patients undergoing renal transplantation in India. AIM: To evaluate the changes in cognitive profile and depression in renal transplant recipients. METHODS: Thirty consecutive patients undergoing renal transplantation were evaluated 1 month before and 3 months after successful renal transplant with Beck Depression Inventory (BDI), Weschler Adult Performance Intelligence Scale (WAPIS), Luria Nebraska Neuropsychological battery (LNNB) and Life satisfaction scale. RESULTS: Our study revealed an 86.7% prevalence of depression in ESRD patients as compared to 56.7% in post renal transplant patients. Analysis of neurocognitive functions on LNNB did not reveal any significant impairment. Furthermore, analysis of the Life satisfaction scale revealed most of the patients scored high satisfaction levels despite the stress of their disease. Results on WAPIS brought out significant improvement in intelligence quotient (IQ) after renal transplantation. CONCLUSION: Successful renal transplant is associated with improvement in depression, IQ and life satisfaction.