Simplified Sample Size Formulas for Detecting a Medically Important Effect.

The sample size is just about the most common question in the minds of many medical researchers. This size determines the reliability of the results and helps to detect a medically important effect when present. Some studies miss an important effect due to inappropriate sample size. Many postgraduate students and established researchers often contact a statistician to help them determine an appropriate sample size for their study. More than 80 formulas are available to calculate sample size for different settings and the choice requires some expertise. Their use is even more difficult because most exact formulas are quite complex. An added difficulty is that different books, software, and websites use different formulas for the same problem. Such discrepancy in the published formulas confounds a biostatistician also. The objective of this communication is to present uniformly looking formulas for many situations together at one place in their simple but correct form, along with the setting where they are applicable. This will help in choosing an appropriate formula for the kind of research one is proposing to do and use it with confidence. This communication is restricted to the sample size required to detect a medically important effect when present - known to the statisticians as the test of hypothesis situation. Such a collection is not available anywhere, not even in any book. The sample size formulas for estimation are different and not discussed here.

Comparative efficacy of repetitive transcranial magnetic stimulation protocols for obsessive-compulsive disorder: A network meta-analysis.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been found to be helpful for the treatment of obsessive-compulsive disorder (OCD). However, the relative efficacy of different rTMS protocols is unclear. OBJECTIVE: To conduct a systematic review and network meta-analysis (NMA) of published literature to compare the relative efficacy of different rTMS protocols for decreasing Yale-Brown Obsessive Compulsive Severity (Y-BOCS) scores in patients with OCD. METHOD: Relevant articles published between 1985 to September 2023 were searched from the Cochrane Central Register of Controlled Trials, PubMed and PsycInfo. Double or single-blinded randomized controlled studies conducted on patients with OCD comparing an active rTMS protocol with either another active or sham rTMS protocol were included. Network meta-analysis (NMA) was conducted using a frequentist approach. Standardized mean difference (SMD) of change in Y-BOCS scores was calculated employing Hedge's g. Pairwise meta-analysis using random effects model was conducted which was extended to the NMA using restricted maximum likelihood estimation procedure. Surface under the cumulative ranking (SUCRA) probabilities were used to rank the interventions. RESULTS: Excitatory rTMS of the bilateral dorsolateral prefrontal cortex (DLPFC), inhibitory rTMS of right DLPFC, inhibitory as well as excitatory rTMS of bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and inhibitory rTMS of bilateral supplementary motor area (SMA) were superior to sham stimulation. The DLPFC and mPFC/ACC protocols had a higher probability of being among the top-ranked interventions. The majority of studies had a modest sample size and at least some concerns in the risk of bias assessment. CONCLUSION: rTMS targeting either the medial or lateral prefrontal cortices is a promising intervention for resistant OCD. There is a need to confirm these findings in large systematic studies.

Protective effect of bilingualism on aging, MCI, and dementia: A community-based study.

INTRODUCTION: Lifelong bilingualism is associated with a delayed age at onset of dementia, but evidence from community-based studies is limited. We investigated the relationship between bilingualism and the prevalence of cognitive impairment in a linguistically diverse community. METHODS: A door-to-door community study was conducted from January to December 2021 in urban Bengaluru, India. 1234 individuals aged ≥60 years participated in the study. Participants were diagnosed with no cognitive impairment (NCI), mild cognitive impairment (MCI), or dementia using established diagnostic criteria. RESULTS: Dementia prevalence was higher in monolinguals (4.9%) than bilinguals (0.4%) (P = .001). The prevalence of MCI was also higher in monolinguals (8.5%) than bilinguals (5.3%) (P = .001). The study also revealed better cognitive function in bilinguals than monolinguals with NCI, after controlling for confounding variables. DISCUSSION: The current study provides significant support for the protective effect of bilingualism on cognitive impairment in an urban community with extensive bilingual interactional contexts in everyday life. HIGHLIGHTS: Bilingualism has been demonstrated to protect against dementia and mild cognitive impairment in a linguistically diverse community with extensive code-switching contexts. Bilingual older individuals had superior baseline cognitive performance compared to monolingual older individuals. Bilingualism was found to have an independent effect on general cognition after adjusting for major social determinants of health in the group without cognitive impairment.

Effectiveness of lifestyle intervention on prevention/management of antipsychotic-induced weight gain among persons with severe mental illness: A systematic review and meta-analysis.

Individualized lifestyle interventions using motivational interviewing (MI) approach are recommended for persons with severe mental illness (SMI) for effective weight management. The aim of this meta-analysis was to assess the effectiveness of various lifestyle interventions that addressed obesity among persons with SMI. Twelve RCTs were assessed by individual reviewers using revised cochrane risk-of-bias tool (RoB 2). The standardized mean difference (SMD) was calculated with a 95% CI. The age of participants was between 18 and 70 years. Waist circumference showed an SMD of -0.09 (-0.22, 0.03), weight -0.03 (-0.10, 0.15) and BMI -0.07 (-0.07, 0.22). The findings in this meta-analysis revealed that though lifestyle interventions were statistically insignificant in reducing antipsychotic induced weight gain among persons with SMI, they show changes in intervention group. Psychosocial management along with lifestyle interventions, and MI are effective in the management of antipsychotic induced weight gain.

Resilience and self-compassion among persons with depressive disorders: Prerequisite for a positive mental health approach.

Background: Treatment gap for common mental health problems, especially of the depressive disorders is consequential in developing countries like India. Positive mental health domains like resilience and self-compassion have been long hailed as protective factors against depression and viable for use in therapeutic aspects. The objectives were to find an association between resilience, self-compassion, and depression. Methods: The study was conducted using a cross-sectional design among 75 respondents who were seeking treatment for major depressive disorders from a tertiary care center during the second wave of COVID-19. Three scales were administered online, namely Beck's Depression Inventory-II (BDI-II), Connor Davidson Resilience Scale (CD RISC-25), and Self-Compassion Scale-Short Form (SCS-SF). Spearman's rank correlation test, Chi-square with Fisher's exact test, and Kruskal Wallis H test were used to study the relationships and differences in average scores with respect to the severity of depression. Results: Most of the respondents had moderate depressive features along with moderately high levels of resilience (CD RISC 25) and self-compassion (SCS-SF) scores. Resilience and self-compassion were found to have no significant relationship with respect to the severity of depression. There was a weakly positive correlation between resilience and self-compassion among those with moderate and severe depression. Conclusion: Since the individuals with depression had higher scores on resilience and self-compassion, the levels of depression remained at moderate levels of severity despite the devastating impact of the second wave of COVID-19 in the Indian sub-continent. Results are to be interpreted with respect to psychosocial contexts arising during the COVID-19 pandemic. Mental health programs can incorporate the variables of resilience and self-compassion in intervention among individuals with depression which have likely been beneficial in their process of recovery.

Effectiveness of intervention package on knowledge and attitude regarding functional needs and quality of life of elderly patients with psychiatric illness, among nursing interns.

OBJECTIVE: To develop and assess the effectiveness of the intervention package on knowledge and attitude regarding meeting the functional needs and improving the quality of life of elderly patients with psychiatric illness, among nursing interns. MATERIALS AND METHODS: The study was carried out among 60 nursing interns of a tertiary government mental health setting. After the pretest, the educational intervention package on functional needs and quality of life of elderly patients with psychiatric illness was administered to the study group in four sessions. Posttest data collection was performed using the same questionnaires after 2 weeks after the last session. RESULTS: There was a statistically significant improvement in the knowledge and attitude of nursing students following the sessions of the intervention package. Pretest data showed that there is a positive correlation between the knowledge and attitude of study subjects. Overall knowledge has significantly improved after attending the intervention program (Z = 6.701, P < 0.001). Moreover, the overall attitude level has significantly improved after attending the intervention program (Z = 6.741, P < 0.001). CONCLUSION: The educational intervention package on functional needs and quality of life of elderly patients with psychiatric illness was effective in improving the knowledge and attitude regarding functional needs and quality of life of elderly patients with psychiatric illness, among nursing interns. Similar packages may be incorporated into the nursing curriculum in training future nurses for their better practice in this area.

Effectiveness of Short-Term Lifestyle Modification on Reducing Body- Weight-Related Parameters in Persons with Severe Mental Illness: A Randomized Controlled Trial.

Background: Persons with severe mental illness (SMI) reportedly have a high mortality rate due to metabolic syndrome (MS). However, lifestyle modification (LM) offers effective management of some components of MS. This study aimed to evaluate the effectiveness of LM in reducing body-weight-related parameters in SMIs. Method: Eighty participants with SMI were assigned randomly to either LM (n = 40) or treatment as usual (TAU; n = 40) groups using block randomization (eight blocks of n = 10). The LM group and their caregivers received a structured LM package that included nutrition counselling, recommendations on a balanced diet, and physical activity. The two groups were assessed on body weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and quality of life (QOL) at baseline and after three months. Thirty-one LM and 33 TAU participants completed the study. Results: The LM and TAU groups were comparable on sociodemographic and clinical characteristics and baseline variables of body weight, BMI, WC, and WHR (all P > 0.08). Repeated-measures analysis of variance (RM ANOVA) showed that the LM group had significantly reduced body weight, BMI, WC, and WHR (all P < 0.001) than the TAU group. Similarly, the LM group also showed improvement in their QOL (P < 0.001), whereas TAU showed no improvement. Conclusions: LM is an effective way to reduce body-weight-related parameters of MS and improves the QOL among persons with SMI in the short term. The caregivers' inclusion during LM contributed to the weight reduction. However, the long-term effect of the intervention could not be assessed.

Clinical Profile, Course and Outcomes of Male Inpatients with Mental Illness Charged with Homicide: A Chart Review from an Indian Tertiary Care Hospital.

Background: The relationship between imprisonment and mental illness is bidirectional. The clinical outcomes of prisoners with mental illness have not been widely studied, especially in developing countries. This study was conducted to assess the same among male inpatients under judicial custody with charges of homicide. Methods: A retrospective chart review of male forensic ward inpatients admitted between January 1, 2003, and December 31, 2016, was conducted. Diagnosis in the files was based on the International Classification of Diseases (ICD)-10 criteria. The Clinical and Global Improvement-Severity (CGI-S) scale was used to measure the severity of illness. Mean CGI-S assessment was carried out at baseline, end of 1 year, 5 years, and 15 years. The data were analyzed using descriptive statistics, Friedman's test, and Dunn's post hoc test. Results: Schizophrenia spectrum disorders and other psychotic disorders, mood disorders, and alcohol use disorders were diagnosed in 62(49.6%), 22(17.6%), and 44(35.2%) subjects, respectively. Forty-one (32.8%) subjects had at least one readmission. The average CGI-S score for the total subjects was 5 (markedly ill) at baseline and 2 (borderline ill) at the end of their latest contact with the tertiary care hospital. For the 34 subjects (27.2%) who had follow-up information of 15 years, the average CGI-S score was 1 (normal, not at all ill) at the end of 15 years (P < 0.001). Conclusion: Clinical outcomes of prisoners with mental illness seem promising, subject to the seamless availability of services. Studies from other parts of the country are required for a more systematic understanding of the requirements of care.

Effectiveness of anger management program on anger level, problem solving skills, communication skills, and adjustment among school-going adolescents.

BACKGROUND: Anger is a natural feeling which is essential for survival, however, which can impair functioning if it is excessive. Adolescents need to be equipped with skills to cope with their anger for the promotion of their health and safety. This study aims to examine the effectiveness of anger management program on anger level, problem solving skills, communication skills, and adjustment among school-going adolescents. MATERIALS AND METHODS: An experimental, pre-test-post-test control group design with a multistage random sampling was adopted to select 128 school-going adolescents aged between 13 and 16 years. Experimental group received six sessions of anger management program, while control group received one session on anger management skill after the completion of post-assessment for both the groups. Sessions included education on anger, ABC analysis of behavior and relaxation training, modifying anger inducing thoughts, problem solving, and communication skills training. Assessment done after the 2 months of anger management program. Data were analyzed through descriptive and inferential statistics. RESULTS: Study reveals the improvement in the problem solving skills (81.66 ± 4.81), communication skills (82.40 ± 3.82), adjustment (28.35 ± 3.76), and decreased anger level (56.48 ± 4.97). Within the experimental and between the experimental and control group, post-test mean scores differed significantly (P < 0.05). CONCLUSION: The results revealed that the anger management program was effective in decreasing anger level and increasing problem solving skills, communication skills, and adjustment among school-going adolescents.

Bonding and Infants' Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission.

Background: Maternal mental health has specific implications for bonding and infants' mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants' development and quality of life (QOL), in case of mothers with severe mental illnesses in remission. Methods: The study included 41 mother-infant dyads from the outpatient perinatal psychiatry services and the mother-baby unit of the current study center. Symptom status, self-reported bonding, mother-infant interactions, and infants' development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively. Results: Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants. Conclusion: The association between mothers' bonding and infants' mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother-infant bonding, development, and quality of life.

Fitness to re-join job: Neuropsychiatric perspective.

Objectives: Evaluating "Fitness to Re-join Job" and certification in persons with Neuro-Psychiatric Disorders is an indispensable professional responsibility. However, there is little documented guidance on clinically approaching this particular issue. This study aimed to study the sociodemographic, clinical, and employment profile of patients who sought fitness to re-join their job from the tertiary neuropsychiatric center. Materials and Methods: This study was carried out at the National Institute of Mental Health and Neurosciences in Bengaluru, India. A retrospective chart review was adapted for the purpose. One hundred and two case files referred to medical board for fitness to rejoin the duty were reviewed from January 2013 to December 2015. Apart from the descriptive statistics, the Chi-square test or Fisher exact test was used to test the association between categorical variables. Results: Patients' mean (standard deviation) age was 40.1 (10.1) years; 85.3% were married, and 91.2% were male. Common reasons for seeking "fitness certification" were work absenteeism (46.1%), illness affecting the work (27.4%), and varied reasons (28.4%). The presence of neurological disorders, sensory-motor deficits, cognitive decline, brain damage/insult, poor drug compliance, irregular follow-ups, and poor or partial treatment response were associated with an unfitness to rejoin the job. Conclusion: This study shows that work absenteeism and the impact of illness on work are common reasons for referral. Irreversible neurobehavioural problems and deficits impacting work are common reasons for unfitness to rejoin the job. There is a need for a systematic schedule to assess the fitness for the job in patients with neuropsychiatric disorders.

Multivariate Bayesian Arm-Based Network Meta-Analysis of Pharmacological Interventions for the Treatment of Acute Bipolar Mania in Adults.

Background: In a network meta-analysis (NMA), multiple treatments can be compared simultaneously by aggregating pieces of evidence from direct as well as indirect treatment comparisons in different randomized controlled trials (RCTs). Conventional NMA are performed using a normal approximation approach and can be applied for arm-level binary outcome data as well. This study aimed to estimate the treatment effects within a Bayesian framework using a binomial likelihood for a multivariate NMA model. Methods: The dataset consists of 57 RCTs comparing the effect of ten pharmacological drugs and a placebo for acute bipolar mania in adults. The binary outcomes of interest were treatment response and all-cause dropouts measured three weeks from the baseline. Binomial distribution was adopted for the number of events and the probability of event occurrence modeled on the logit scale. Jeffrey's Beta prior was considered for the heterogeneity and inconsistency of standard deviation (SD) parameters. Cholesky and spherical decomposition strategies were adopted for the between-study variance-covariance matrix. Deviance information criterion (DIC) indices were computed to determine the model fit. All results pertaining to Markov chain Monte Carlo simulations and all analyses were carried out in WinBUGS software. Results: The estimated common heterogeneity SDs were similar, and the DIC values did not provide any evidence for superiority between the two decomposition strategies. The correlation (95% credible interval) between the outcomes was estimated as -0.31 (-0.71, -0.02) and -0.37 (-0.73, -0.03) for the Cholesky and spherical decompositions, respectively. Gelman-Rubin convergence statistics were stable, and Monte Carlo errors for all the parameters were around 0.005. Overall, olanzapine, paliperidone, and quetiapine were both significantly more effective and acceptable than a placebo when both the study outcomes were considered simultaneously. Conclusions: The findings favoring olanzapine, paliperidone, and quetiapine possess an excellent concordance with the one adopted in clinical practice, and the Canadian Network for Mood and Anxiety Treatments and Royal Australian and New Zealand College of Psychiatrists guidelines recommend these as first-line drugs for treating bipolar disorder.

Prevalence of suicidal ideations and suicide attempts in patients with tuberculosis: A systematic review and meta-analysis.

OBJECTIVE: Suicide and suicidal behaviors are reported to be common in patients with Tuberculosis (TB). This systematic review and meta-analysis aimed to quantitively assess the prevalence of suicidality and identify the factors associated with suicidality in patients with TB. METHODS: We searched databases PubMed, SCOPUS, Web of Science, PsycINFO, and Google Scholar for studies that reported the prevalence of suicide, suicidal ideations, or suicide attempts in patients with TB. We assessed the quality of studies with the Newcastle Ottawa scale. Random-effects models were used to calculate the pooled prevalence with 95% confidence intervals (CI). RESULTS: Nine studies (8770 participants) were included. Pooled prevalence for current suicidal ideations within the last year was 8.5% [95% CI: 5.8%12.3%]. Pooled prevalence for current suicidal attempts within the last year was 3.1% [2.2%- 4.5%]. Suicide was reported in 0.92% of TB patients at the end of 2 years, whereas 2.2% to 8.4% of all TB deaths were reported due to suicide. Factors associated with suicidality were female gender, TB retreatment, comorbid HIV, presence of another chronic medical illness, psychological distress, and comorbid psychiatric illnesses. CONCLUSION: The prevalence rates of suicidal ideation and attempts were higher in patients with TB than in the general population. Integrating mental health services with TB programs will help develop interventions for high-risk individuals. Prospero registration number: CRD42021281849.

Development of a scale to assess the determinants of positive coping in parents of children with intellectual disability.

Identifying the determinants of positive coping is a critical step in empowering the parents of children with intellectual disability. In this context, this study aims to develop a scale to assess the determinants of positive coping. Accordingly, culturally relevant items were pooled, got validated by experts and refined. The scale was administered to 150 parents of children with intellectual disability. Factor analysis done through polychoric correlation helped reduce the items. Cronbach's alpha coefficients were established for reliability testing. The validity of the new scale was examined with the subjective wellbeing on a visual analogue scale and Family Interview for Stress and Coping in Mental Retardation. The new scale has a Cronbach's alpha of 0.71 and an intraclass correlation of 0.64. After factor analysis, 12 items were retained in the final version. This study also identified specific factors associated with positive coping. The new scale can be used with parents of children with intellectual disabilities to identify the determinants of positive coping.

Treatment strategies for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A network meta-analysis of randomised controlled trials.

OBJECTIVES: Treatment-resistant obsessive-compulsive disorder is a chronic debilitating illness. We conducted a network meta-analysis [NMA] to compare the efficacy of all interventions in SRI-resistant OCD from published Randomised controlled trials [RCT]. METHODS: We performed an NMA of RCTs in SRI resistant OCD from all modalities of treatments; pharmacological, psychological, neuromodulation, neurosurgery including deep brain stimulation. The design-by-treatment interaction inconsistency model within the frequentist framework was adopted with a change in Yale-Brown Obsessive-Compulsive Scale score as the primary outcome. We conducted sensitivity analyses excluding studies examining neurosurgical interventions, deep brain stimulation, studies in the paediatric population, and studies from a single geographical region. We also conducted analyses of interventions categorised into treatment groups. RESULTS: 55 RCTs examining 19 treatments or placebo involving 2011 participants were included in the NMA. Ondansetron [Standardised mean difference -2.01 (95% CI: -3.19, -0.83)], deep TMS [- 1.95 (-3.25, -0.65)], therapist administered Cognitive Behavioural Therapy [CBT-TA] [-1.46 (-2.93, 0.01)] and aripiprazole [-1.36 (-2.56, -0.17)] were ranked as the best four treatments on using the Surface Under the Cumulative Ranking [SUCRA] percentage values (85.4%, 83.2%, 80.3%, 67.9% respectively). While all four interventions had large effect sizes, CBT[TA] narrowly missed statistical significance in our analysis. In sensitivity analyses, deep TMS was ranked as the best treatment strategy for SRI-resistant OCD. The small number of subjects in individual studies, higher confidence interval limits, and wider prediction interval for most agents warrant a cautious interpretation. CONCLUSIONS: Considering the principal analysis and sensitivity analyses together, deep TMS, ondansetron, CBT[TA], and aripiprazole may be considered a first-line intervention for SRI-resistant OCD in adults. OTHER: This work was not funded. The NMA has been registered with PROSPERO, [Registration number: CRD42020173589].

Mental health literacy on youth depression and suicides for teachers and its impact on knowledge, attitudes and help facilitation: A preliminary study.

Background: Depression and suicide are among the most prevalent mental health problems among the adolescents in India. However, help seeking is very poor due to lack of knowledge on mental health among youth and significant individuals in their life. Imparting knowledge to teachers becomes important as youth spend most of their time in the educational set up. The present study aimed at examining the effect of mental health literacy on depression and suicidal behaviours on knowledge, attitudes and help facilitation of teachers. Materials and Methods: The study adopted a stratified sampling method and a sample (N = 102) of high school teachers (8th-12th standard) from both private and government institutions in Bangalore were included in the study. A pre- and post-assessment, single group design with a follow-up after 3 months was adopted. Data were collected using the socio-demographic data sheet and questionnaire prepared to assess the knowledge, attitudes and help facilitation. Results: The mean age of the teachers was 41.74 years, with 80% female respondents and 58.8% of the sample with master's degrees and diplomas in teaching. There was a significant increase in knowledge about the symptoms, consequences of depression and attitude toward depression and suicide. About 16% of the sample had taken steps to help students with distress and facilitated help seeking at 3-month follow-up. Conclusion: Mental health literacy programme has positive impact on the knowledge and helps in improving support and help facilitation behaviours among teachers.

Work-life balance among mental health professionals in a tertiary care neuropsychiatry centre in India.

Background: Stress and distress are common among Mental Health Professionals (MHP). MHPs avoid seeking professional help to address their stress, leading to increased vulnerability to stress and mental health conditions. Inadequately addressed stress directly impacts their service delivery and well-being. However, a serious dearth of literature from India has examined the extent of work-life balance (WLB) stress and psychological distress (PD) among MHP. Aim: This cross-sectional study aims to assess WLB and examine the relationship between perceived stress (PS), PD, burnout, and WLB among MHP in a tertiary care neuropsychiatry center. Methods: Using stratified random sampling, 101 MHP were evaluated using Pareek's work-life balance scale, Stamm's professional quality of life (ProQoL) scale, WHO's self-reporting questionnaire, and Cohen's perceived stress scale. Data were analyzed using appropriate parametric or non-parametric tests. Results: The overall mean score on WLB was 80.45 (SD = 10.21), the PS scale was 24.86 (SD = 6.87), the burnout score was 22.68 (SD = 6), the ST score was 21.18 (SD = 6.35), and PD score was 5.07 (SD = 5.23). The level of WLB score was average to below average among 64% of participants. There is a positive correlation between WLB and compassion satisfaction (CS) and a negative correlation between ST and PS. The study found that the nature of the job, CS, and PD shall predict WLB. Conclusion: Stress, burnout, ProQoL, and WLB of MHPs vary significantly by job, income, and staying with family, indicating that MHPs are equally vulnerable to stress and burnout and imbalanced WLB, which require appropriate interventions.

Experiential Avoidance as a Mediator of the Relationship between Dispositional Mindfulness and Problematic Smartphone Use.

Background: Experiential avoidance (EA) and mindfulness are the two important transdiagnostic process and outcome variables in psychological formulation and treatment. While smartphones have a large utility value, they also have the potential for adverse impacts on functioning. Studies have separately shown associations among EA, dispositional mindfulness (DM), and problematic smartphone use (PSU). However, there is a lack of study exploring the associations and mediation relationship among these variables together in an Indian context. The current study aims to explore the associations of PSU, DM, EA, and sociodemographic factors; including the mediating effect of EA between DM and PSU in the Indian adult context. Methods: Four hundred and thirty-four participants (M age = 25.4, standard deviation = 2.6, 58.8% females) were recruited for an online survey using a cross-sectional design. Data were collected using sociodemographic questionnaire, Smartphone Addiction Scale-Short Version, brief EA scale, and Mindfulness Attention Awareness Scale. Statistical analyses comprised multiple regression, mediation analysis, and significance in sociodemographic variables. Results: Both EA and DM significantly predicted PSU with a 37% variance; however, DM had an inverse relationship. EA as a mediator could account for a quarter of the effect, PM = 24.4%, ab = -0.14, 95% CIcs (-0.19, -0.09). Conclusion: The current study implicates the monitoring and treatment planning for PSU from a transdiagnostic perspective in the Indian context.

Beliefs and expectations on digital learning and examinations among adult learners of a tertiary level health-care institution.

BACKGROUND: Coronavirus disease 2019 (COVID-19) constrained the regular teaching in educational institutions and hampered the teaching-learning process across the globe. E-learning method is widely used in higher education in the current situation. the objective is to assess the beliefs and expectations of the students on e-learning among adult learners of a tertiary level health-care institution. MATERIALS AND METHODS: A single group pre-post design was adopted. Microsoft Go two-in-one devices were used to find the effectiveness of e-learning, including digital exam solution. Depending on the availability of device, 25 participants were selected for the study from three different steams. A 5-point Likert scale was used for assessing the quality, adoptability, and acceptance of digital education developed by the researchers. Chi-square/Fisher's exact or McNemar's test was used to test the association between independent or related categorical variables. Comparison of the average score between different courses was performed using the Kruskal-Wallis test. RESULTS: Twenty-two participants who completed the final assessment were retained for the analysis. Majority of the participants believed that e-learning helps to achieve personal learning goals or objectives and bridge skill or knowledge gaps and caters to learning preferences. However, the overall quality score across the study groups was found to be statistically insignificant (Kruskal-Wallis statistic: 1.26; P value: 0.533). CONCLUSION: The findings show that the adult learners in higher education, irrespective of their age differences, believe that intense e-learning support with Microsoft Go two-in-one device has a complementary effect on their learning outcome.