Cost of implementing the QualityRights programme in public hospitals in Gujarat providing mental healthcare.

Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems' perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (₹) 0.59 million to ₹ 2.59 million [1United States Dollars (US $) = ₹ 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.

Mental health concerns of interns posted in COVID-19-affected regions of Maharashtra.

Background: Healthcare providers faced the challenge of managing coronavirus disease 2019 (COVID-19)-infected patients. At the onset of the spread of the coronavirus infection across the globe, awareness of the treatment modalities was poor. Interns were relatively new to treating patients as they had just started their clinical postings in February or March 2020. Working in the COVID-19 wards with the sudden influx of a large number of patients, treating them with ever-changing guidelines did cause increased physical and mental stress. Thus, to understand the impact of coronavirus infection on interns this study was conducted. Materials and Methods: An online survey was conducted among interns of various medical colleges of Nagpur, Mumbai, Pune, and Miraj using Google Forms. Participation was anonymous and voluntary. Responses were accepted for 1 week from March 27, 2020, till April 3, 2020. Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder 7 Scale (GAD-7) (9) were used to assess anxiety and depression. Result: Our study showed that 36.3% of the interns who were posted for COVID-19 duty had depression, whereas 34% had anxiety symptoms. Anxiety and depression were comparable in interns posted for COVID-19 duty and those posted in other clinical departments. Young age, female gender, and perceived risk of contracting COVID-19 were the predictors for anxiety and depression. Conclusion: There was a high level of anxiety and depression among interns working in hospitals during the COVID-19 pandemic irrespective of whether they were posted for COVID-19 duty or not. Reporting such information is important to plan further management of mental health needs.

Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India.

BACKGROUND: Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. AIMS: To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. METHOD: This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. RESULTS: Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50-0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). CONCLUSIONS: To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services.

Rate and risk factors of nocturnal enuresis in school going children.

PURPOSE: The purpose is to find out the rate of nocturnal enuresis in school going children (5-12 years) and the risk factors associated with it. MATERIALS AND METHODS: The parents of children aged between 5 and 12 years studying in two primary schools in Ahmedabad completed a self-administered semi-structured questionnaire comprising of enuresis, sociodemographic profiles, and risk factors. Children with enuresis and those without were compared on demographic characteristics and risk factors using Chi-square and t-test for categorical and quantitative data respectively. The data were analyzed using SPSS version 17. RESULTS: The response rate was 86.54% as 1904 responses were collected out of 2200. The overall rate of nocturnal enuresis was 6.7% (according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition definition of nocturnal enuresis). As the age increased, the rate of nocturnal enuresis declined. A positive family history was seen in 36.6% of children with enuresis. Enuresis was found to be more frequently in lower socioeconomic class. It was a neglected problem, only 20.6% of children received some kind of treatment. CONCLUSION: The rate of nocturnal enuresis was 6.7% in school going children. Strong correlation was found with family history. Although the rate was high, most of the children with enuresis were not treated.

An exploratory study of fears among adolescent students from an urban cohort in India.

BACKGROUND: Normal fear is an adaptive response to a real or imagined threat. Fears occur in children and adolescents at varying levels while they negotiate different developmental phases. OBJECTIVE: The present study aimed at assessing the types of fears in children and adolescents between the ages of 11 and 19 years. Age and gender based differences in these fears were also studied. MATERIALS AND METHODS: The study sample consisted of 2010 adolescents from an urban setting between the ages of 11 and 19 who filled in a proforma questionnaire for socio-demographic details and also filled in the Fear Survey Schedule for Children-Revised (FSSC-R). Statistical analysis of the data was done along with the use of descriptive statistics. RESULTS: The prevalence of fears among adolescents was found to be 85.17% in the total sample. Girls reported a significantly greater number of fears (p<0.0001) and greater levels of fear (p<0.0001) than boys. Age however, did not affect the number of fears reported. Girls scored significantly higher on all the subscales of the FSSC-R. 'Failing a test' emerged as the most common fear expressed by the sample. Girls expressed a greater fear for snakes and earthquakes than boys. CONCLUSION: Girls expressed fears to a greater extent than boys and adolescents demonstrated a high level of fears in general. There is a need for further studies in this direction to elucidate the nature of fears in this population.

Comparison of suicide attempts in schizophrenia and major depressive disorder: an exploratory study.

INTRODUCTION: Schizophrenia and major depressive disorder (MDD) are among the most common psychiatric diagnoses associated with suicide. There is a dearth of published research systematically comparing suicidal behavior in schizophrenia and MDD. The present study aimed to compare suicide attempts in schizophrenia and MDD. METHODS: In this hospital-based, cross-sectional study, 50 outpatients each of schizophrenia and MDD were evaluated for their sociodemographic characteristics. In subjects with a history of suicide attempt(s), additional information related to the attempt(s) was obtained. Suicide Intent Scale (SIS) was used to assess the suicidal intent and Mini International Neuropsychiatric Interview (MINI) was used to measure the current suicidal risk. RESULTS: Thirty-four percent and 44% of patients with schizophrenia and MDD, respectively, attempted suicide. The attempters in schizophrenia compared to those in MDD were younger and more likely to be single (unmarried, separated or divorced). Suicidal intent was stronger in schizophrenia, while the attempters with MDD were more often preoccupied with a death wish and reported that stressful life events influenced the attempt. There were no differences in the attempt methods of the two groups. Current suicidal risk was higher in attempters compared to the non-attempters in schizophrenia as well as MDD. DISCUSSION: Suicide attempts in schizophrenia and MDD have similar features, with quite a few notable differences, which have been discussed at length in the present paper.

Validity of the construct of post-traumatic stress disorder in a low-income country: interview study of women in Gujarat, India.

The validity of the clinical construct of post-traumatic stress disorder (PTSD) has been questioned in non-Western cultures. This report describes in-depth interviews exploring the experiences of women who were traumatised by the communal riots in Ahmedabad, India, in March 2002. Three specific narratives are presented which describe experiences that closely resemble re-experiencing, avoidance and hyperarousal. Thus, symptoms described as characteristic features of PTSD in biomedical classifications are clearly expressed by the women in our study, and are attributed by them to trauma and grief. We conclude that PTSD may be a relevant clinical construct in the Indian context.

Escitalopram Versus Citalopram and Sertraline: A Double-Blind Controlled, Multi-centric Trial in Indian Patients with Unipolar Major Depression.

The present randomized, double blind, parallel group, controlled, multi-centric trial was designed to evaluate the efficacy and tolerability of escitalopram in comparison with citalopram and sertraline in the treatment of major depressive disorder. Outpatients (N=214) with an ongoing/newly diagnosed ICD-10 major depressive episode and a Hamilton Rating Scale for Depression (HAM-D) score of > 18 were randomly assigned to citalopram, 20-40 mg/day (74 patients), escitalopram, 10-20 mg/day (69 patients) and sertraline, 50-150 mg/day (71 patients), for a 4-week double-blind treatment period, with dosage adjustment (after 2 weeks of treatment) according to the response to treatment. Clinical response was evaluated by the 17 items HAM-D and the Clinical Global Impression (CGI) scales, which were recorded at baseline and at weekly intervals. Tolerability was evaluated by observed/spontaneously reported adverse changes in laboratory parameters (baseline and after 4 weeks). Response rate was defined as a decrease in HAM-D score by 50% from baseline and remission rate was defined as a HAM-D score of < 8. Response rate at the end of two week were 58% for escitalopram (10mg/day), 49% for citalopram (20mg/day) and 52% for sertraline (50-100mg/day). Response rate at the end of four week were 90% for escitalopram (10-20mg/day), 86% for citalopram (20-40mg/day) and 97% for sertraline (100-150mg/day). The Remission rates at the end of four weeks were 74% for escitalopram, 65% for citalopram and 77% for sertraline. Adverse experiences were reported by 45% of patients in escitalopram group, 58% patients in citalopram and 56% patients in the sertraline group. Additionally, there were lesser dropouts and lesser requirement for dose escalation in escitalopram than in citalopram and sertraline group. In conclusion Escitalopram, the Senantiomer of the citalopram is a safe and effective antidepressant in the Indian population. It has potentially superior efficacy than citalopram and a comparable efficacy to sertraline with fewer side effects than both citalopram and sertraline.