Cyberbullying: A study of its extent, coping resources, and psychological impact among college students.

Introduction: Bullying is an aggressive act with a hostile intent to dominate, abuse, or intimidate an individual(s) with a lesser social or physical power, repeatedly over a period of time. Though bullying can manifest in any social situation, its pernicious presence in the educational institutions has become a source of concern to all stakeholders. With their self-esteem and world view entwined in cyberspace, the present generation of young adults derive their social status and self-worth through affirmations through the internet via social networking sites. Cyberspace is an ideal environment for bullies as it is relatively anonymous, allows the participation of a large audience, and is almost impossible to supervise. Aim: To estimate the extent, coping resources, and psychological impact of cyberbullying among Indian college students. Methodology: This cross-sectional study was carried out among undergraduate medical students of Sikkim. Cyberbullying, cybervictimization, coping strategies used by students, self-esteem, and levels of depression, anxiety, and stress were estimated using standardized self-report scales. Results: Out of 213 medical students, more than half of the college students (60.6%) were victims of cyberbullying. Coping strategies commonly used by cybervictims were technical coping, support from friends, and assertively confronting the bully online. Victims of cyberbullying had significantly more depression, anxiety, stress, and lower self-esteem (p values <0.05) compared to students who did not experience cyberbullying. Conclusion: This study illuminates the extent and nature of cyberbullying among Indian medical students. The negative mental health consequences of cyberbullying are worrying. Mental health professionals and stakeholders need to create an awareness and formulate strategies to combat cyberbullying in colleges.

Improving depression and perceived social support enhances overall quality of life among myocardial infarction survivors: necessity for integrating mental health care into cardiac rehabilitation programs.

Background: Depression and low perceived social support (PSS) have been found to deleteriously affect quality of life (QoL) among myocardial infarction (MI) survivors. The complex relationship between these variables has not been assessed. We wanted to assess first the prevalence of depression among MI survivors and whether depression mediates the effect of PSS on QoL and, second, whether the physical and social domains of QoL mediated the effect of depression and PSS on the emotional domain. This cross-sectional study was done among MI survivors using Cardiac Depression Scale, MacNew Quality of Life After Myocardial Infarction Questionnaire and Multidimensional Scale of Perceived Social Support to assess for depression, QoL and PSS respectively. Results: A total of 103 MI survivors were included in the study, and the mean age was 59.66 (± 10.42) years. Depression was found in 21.36% of the participants. The indirect effect of PSS on QoL with depression as a mediator was significant (b = 0.15, p < 0.001, 95% CI 0.12, 0.18). The direct effect of PSS on QoL controlling for depression was also significant (b = 0.05, p < 0.001, 95% CI = 0.02, 0.07). Depression as a mediator in the relationship explained 75.3% of the effect of PSS on QoL. PSS and depression did not have a significant direct effect on emotional QoL, but it became significant when the physical and social domains were included in the model. The total indirect effects of PSS and depression on emotional QoL were b = 0.16, p < 0.001, 95% CI = 0.05, 0.17 and b = - 0.05, p < 0.001, 95% CI = 0.06, - 0.03, respectively. Conclusion: Depression and poor PSS impair physical and social domains, which impairs the emotional domain of QoL; as such, overall QoL is undermined. As limited physical and social activity because of depression and poor PSS may increase the risk of further cardiovascular events, a holistic approach which includes mental health care is warranted.

Internalized and Perceived Stigma and Depression in Pulmonary Tuberculosis: Do They Explain the Relationship Between Drug Sensitivity Status and Adherence?

Background: Adherence to medication for tuberculosis (TB) has been found to be deleteriously affected by psychosocial issues, including internalized and perceived stigma (IPS) and depression, usually resulting in the emergence of multidrug-resistant TB (MDR-TB). The objective of the study was to find the prevalence of depression among patients receiving treatment for pulmonary TB, and how stigma and depression affect the relationship between drug sensitivity status (DSS) and treatment adherence. Method: It was a cross-sectional observational study conducted between January 2019 and July 2020 in two centers in Sikkim, India. The Patient Health Questionnaire-9 (PHQ-9), Internalized Social Stigma Scale (ISSS), and Tuberculosis Medication Adherence Scale were used to assess depression, IPS, and medication adherence, respectively. A path analysis was performed with DSS, treatment adherence, IPS, and depression. Education in years was included in the model as it was significantly correlated with IPS. Results: A total of 71 patients who were on drug-sensitive TB (DS-TB) regimen (n = 26) and MDR-TB regimen (n = 45) participated in the study. Notably, 56.3% (n = 40) of the participants were found to have depression. Among the depressed participants, 32.5% were on the DS-TB regimen and 67.5% were on the MDR-TB regimen. The path analysis indicated that IPS and depression were serially mediating the relationship between DSS and treatment adherence (ß = -0.06, p < 0.05, 95% CI = -3.20, -0.02). Finally, years of education had an exogenous predictor role, not only directly affecting IPS (ß = -0.38, p < 0.001, 95% CI = -0.99, -0.31) but also affecting treatment adherence through IPS and depression (ß = 0.08, p = 0.02, 95% CI = 0.03, 0.47). This indicated that with more years of education, the IPS decreases, which decreases depression and ultimately leads to better adherence. Conclusion: We found an important relationship between different psychosocial factors which may affect treatment adherence. Patients who have higher IPS are more likely to develop depression which negatively affect adherence. Patients on the MDR-TB regimen have higher stigma. There is an urgent need to integrate mental health services with TB Control Programs.

Assessing burden and its determinants in caregivers of chronic kidney disease patients undergoing haemodialysis.

Background: Caregivers face a lot of adversities while supporting their near ones undergoing haemodialysis, and their burden is often ignored by health professionals. The paucity of research in the Indian context has kept their needs out of sight. Aim: To explore the level of burden in the caregivers of patients with chronic kidney disease (CKD) undergoing haemodialysis and to assess whether patient related variable affects the burden. Methods: Fifty-one patients and their caregivers from two dialysis units in Sikkim, India, were assessed cross-sectionally. The Zarit Caregiver Burden Scale (ZCBS) was administered to measure the caregiver burden. The Patient Health Questionnaire-9 (PHQ-9) and the Charlson's Comorbidity Index (CCI) assessed the patient's depression and medical comorbidities, respectively. Descriptive analysis was done for the sociodemographic and clinical variables. Chi-square test was used to find the association between the categorical data. Kruskal-Wallis tested the association between categorical and quantitative variables. Results: Mean age of patient was 46.13 (±13.15) years and that of the caregiver was 44.78 (±12.14) years. 68.6% of caregivers had mild to severe levels of caregiver burden. Caregivers who were unemployed and educated till secondary school were more likely to report caregiver burden. Female gender, older caregivers, and caregivers attending patients with a longer history of haemodialysis reported a more severe burden. Conclusion: The level of burden in caregivers of CKD patients is significant and is affected by various factors, which, in turn, also affects patient's wellbeing. Further research in this area is needed in our country for better management of patients and policymaking.

Social networking sites and its relation to social comparison and psychological well-being among medical university students.

BACKGROUND: Social networking sites (SNSs) have become an indispensable part of young adults in India. The content on one's profile and that of others on social media makes social comparison easier among young adults leading to poor mental health and life dissatisfaction. AIMS: To assess the relationship between the pattern of SNS use among young adults and depression, anxiety, and social comparison. MATERIALS AND METHODS: This was a cross-sectional study among medical students done using a questionnaire consisting of pattern of SNS use and scales for social comparison, depression, and anxiety. RESULTS: We collected data from 220 students (mean age 20.44 years). Impression management was associated with higher social comparison, depression, and anxiety scores. Social comparison had a significant correlation between depression and anxiety scores. CONCLUSION: A complex association exists between duration or time spent on SNS use and psychopathology.

Sleep Quality and Daytime Sleepiness among the Clinicians Working in a Tertiary Care Center in Sikkim, India.

BACKGROUND: Doctors in India have increased workload and are at risk for poor sleep and excessive daytime sleepiness which have not been explored much. METHODS: One hundred doctors selected by convenience sampling from different departments of the hospital were assessed cross-sectionally. Physical parameters which were assessed included height, weight, blood pressure, and diabetes status. Other variables assessed included durations of duty hours and social media usage. Sleep quality and daytime sleepiness were assessed with the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively. RESULTS: Mean age of the participants was 35.3 years with a SD of 6.21. In all, 42% were female. The overall prevalence of poor quality of sleep was 28.3%. Among the participants, junior and senior residents were the most affected; 45% of the junior residents were having a poor quality of sleep. Daytime sleepiness was significantly more common among the junior residents as compared with doctors of other designations (P =0.02). The mean duration of duty hours was highest for the junior residents. Male participants were more likely to be obese and to have systemic hypertension. No significant difference was found for social media usage among different designations or gender. CONCLUSION: Poor sleep quality and excessive daytime sleepiness are highly prevalent among the doctors, especially those who are lower in the hierarchy. Interventions for physical and psychological morbidity among the doctors and strict implementation of guidelines governing duty hours and call schedule of junior physicians are recommended.

Cognitive Impairment and its Correlates in Chronic Kidney Disease Patients Undergoing Haemodialysis.

BACKGROUND: Cognitive Impairment (CI) has been found to be quite common amongst patients with Chronic Kidney Disease (CKD) undergoing haemodialysis (HD). The presence of these deficits could affect patient's adherence to diet regimens, treatment and also reduce their Quality of Life. The presence of depression in such patients can further lead to CI. We wanted to assess the prevalence of CI in CKD patients undergoing haemodialysis, socio-demographic and patient related variables affecting CI, and also the relationship between depression and cognition. METHODS: Fifty patients undergoing haemodialysis from two dialysis units were assessed. The Montreal Cognitive Assessment (MoCA) scale and Patient Health Questionnaire-9 (PHQ-9) were administered to patients. Descriptive analysis was done for the socio-demographic and clinical variables. Chi square test was used to find the association between the categorical data. Kruskal-Wallis test was used to determine the association between categorical and quantitative variables. RESULTS: Mean age of patient was 50.32 (±12.4) years. Mean duration of dialysis was 18.8 (±15.11) months. The prevalence of depression in the patients was 42%. Cognitive impairment was present in 44% of the patients. There was a significant relationship between education level and recall (χ2=31.7, df=12, p=.002) as well as orientation (χ2=29.78, df=8, p=.000) domains of cognition. Also, there was a significant relationship between socio-economic status and global cognition score (χ2=81.13, df=48, p=.002). There was a negative correlation between duration of dialysis and cognition. Significant relationships were found between depression and various cognitive domains. CONCLUSIONS: The prevalence of CI in haemodialysis patients is high. It is also affected by factors such as education level, socio-economic status, duration of dialysis and presence of depression. Insight into CI is essential for its early identification during the course of illness, so that patient precise treatment decisions can be made.

Delirium in medical intensive care units: Incidence, subtypes, risk factors, and outcome.

BACKGROUND: Delirium is a frequent yet underdiagnosed neuropsychiatric condition encountered in intensive care units (ICUs). Being both a preventable and potentially reversible process associated with significant morbidity and mortality, understanding risk factors that predispose and precipitate delirium in any given patient are critical in ICUs. AIMS AND OBJECTIVES: The aim of this study is to evaluate the incidence, motor subtypes, risk factors, and clinical outcome of delirium in the medical ICU. MATERIALS AND METHODS: We used a prospective study design on a cohort of consecutive medical ICU admissions of a tertiary care teaching hospital. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose and motor subtype delirium, respectively, along with a checklist to assess risk factors. RESULTS: Of the 280 ICU admissions, 88 (31.4%) developed delirium. Hypoactive delirium was the most common motor subtype (55.7%). The detection rate of delirium was 12.5% (lowest for hypoactive delirium at 2.04%). Age, gender, and years of education did not significantly predict delirium (all P > 0.05). Tobacco use, chronic liver disease, and past episodes of delirium significantly predisposed, while mechanical ventilation, hypoxia, fever, raised levels of bilirubin and creatinine, and benzodiazepine administration significantly precipitated ICU delirium. Delirium was significantly associated with longer ICU stay (t = 4.23, P = 0.000) and 1-month postdischarge mortality (χ 2 = 6.867, P = 0.009). CONCLUSION: Detection of delirium is challenging, especially in ICU patients on mechanical ventilation and hypoactive delirium. Screening and monitoring for predisposing and precipitating risk factors can greatly improve the odds of detection and intervention as ICU delirium is associated with significant morbidity and mortality.

Body dissatisfaction and its relation to Big Five personality factors and self-esteem in young adult college women in India.

INTRODUCTION: Eating disorders are increasingly becoming common among men and women across the world. Body dissatisfaction is found to be one of the prominent risk factors for the development and maintenance of eating disorders. Research suggests that the internalization of culturally unattainable ideals is in fact mediated by self-esteem and personality factors such as high neuroticism, perfectionism, and impulsiveness. Studies on body image concerns in the cultural context of the Indian population are limited. We aimed to study the prevalence of body image dissatisfaction and its association with self-esteem and personality traits among young Indian women. MATERIALS AND METHODS: Using a cross-sectional design we studied on 555 female college students of North India. Data was collected using self-reported questionnaires: Sociodemographic pro forma, Body Shape Questionnaire (-8C), Rosenberg's Self-Esteem Scale, and Mini-International Personality Item Pool. RESULTS: The mean age of the participants in the study was 22.24 years (±2.75). Twenty-seven percent of the participants had moderate-to-severe body concern. Body shape dissatisfaction significantly correlated with higher body mass index (BMI) (rs = 0.12, P = 0.003) and lower self-esteem (rs = -0.22, P < 0.001). Among the personality traits, only neuroticism (beta = 0.35, P = 0.01) and conscientiousness (beta = 0.29, P = 0.031) significantly predicted body shape dissatisfaction. CONCLUSION: A significant percentage of young women in this study had a negative body image associated with higher BMI, lower self-esteem, high neuroticism, and high conscientiousness. Thus, consideration of individual variations in personality traits and self-esteem is important understanding body image concerns. This can help in selection of better interventions in the treatment of body image dissatisfaction.

Study of sociodemographic correlates, anxiety, and depression among opioid dependents admitted in treatment centres in Sikkim, India.

BACKGROUND: People with opioid use disorder have significant anxiety and depression which can be because of neuroplastic changes due to use of opioid or because of use as a self-medication to relieve depression and anxiety. During the last one decade, opioid use has reached an alarming proportion in Sikkim, India; but, any research related to anxiety and depression among opioid users has not been done. AIMS: To assess for depression and anxiety disorders among the opioid dependence syndrome (ODS) participants and its severity, and to find the association with the sociodemographic characteristics. METHOD: One hundred participants from three different drug detoxification and rehabilitation centres who were diagnosed with ODS as per the ICD-10, Diagnostic Criteria for Research were assessed cross-sectionally with the Addiction Severity Index to find out the substances abused and psychiatric morbidity. Anxiety, depression, and mania were graded with the Hamilton rating scales for anxiety and depression, and the Young Mania Rating Scale. RESULTS: Mean age of participants was 29.6 (±6.24) years. Ninety six per cent were males. Most of the participants were using multiple opioid preparations. Thirty four per cent were using dextropropoxyphene containing pain killer followed by six per cent using codeine containing cough syrup. Eighty two per cent had depression; however, only 13% were found to have severe depression. Fifty six per cent had anxiety and six per cent were found to have mania. Most of the participants with ODS were single, attended at least secondary education, from urban locality, and were from high socioeconomic status. CONCLUSION: anxiety and depression are highly prevalent among ODS people. Treatment should not be limited to management of ODS but also the comorbid psychiatric illness.

Socioeconomic characteristics of alcohol and other substance users, seeking treatment in Sikkim, North East India.

OBJECTIVES: The present study was conducted to generate information for better understanding of socioeconomic and CAGE characteristics of alcohol and other substance users who were undergoing treatment in Sikkim. SUBJECTS AND METHODS: Socioeconomic and CAGE questionnaire was administered to alcohol and other substance abusers of Sikkim (n = 241) who were undergoing treatment in different treatment centers of Sikkim. Information was collected on printed instrument after taking participant's consent and data was statistically analyzed. RESULTS: Male participants (93.8%) outnumbered female (6.2%). Majority of the sample were either in the school dropout group or school completed (36.1%) group. Most of the samples were occupationally unemployed, urban residents, Nepali by ethnicity, single, and Hindu (48.5%) by religion. Minimum age for starting of alcohol and drug was 5 years and 7 years respectively. Knowledge about AIDS and its transmission was satisfactory. All the four CAGE characteristics were present in majority of samples. CONCLUSIONS: Climate, geographical location, wide and easy availability of alcohol in Sikkim make this state vulnerable for alcohol abuse. Alcohol drinking among parents, sibling and friends found to be important risk factor. Outreach to the community for better acceptability of treatment is an important area to fill the gap of treatment demand and treatment supply.

Experimental therapeutic intervention with alpha tocopherol in ethanol induced testicular injuries in rats.

Infertility is well-established harmful effect in chronic alcoholism and so far, there is no effective treatment for this condition. The study was conducted to determine the effects of alpha tocopherol on ethanol induced testicular injuries in male albino rats of Wistar strain. Five groups (n=6) of animals were used. Group I served as control. Group II received daily 1.6g ethanol/kg body weight/day for 4 weeks orally. Group III received 1.6g ethanol+80mg alpha tocopherol/kg body weight/day for four weeks orally. Group IV received 1.6g ethanol/kg body weight for/day 4 weeks and followed by 80mg alpha tocopherol/kg body weight/day for four weeks orally. Group V received 1.6g ethanol/kg body weight/day orally for 4 weeks, followed by 4 weeks abstinence. Twently-four hours after the last treatment the rats were sacrificed using anesthetic ether. Testes were removed and used for the estimation of extent of lipid peroxidation and tissue levels of antioxidants and steroidogenic enzymes. Alpha tocopherol treatment increased the activities of testicularΔ(5), 3ß-HSD. Moreover, the treatment was also associated with significant decrease in testicular oxidative stress. Ethanol-induced oxidative stress and decreased steroidogenesis can be reversed by treatment with alpha tocopherol.

Alcohol abuse-duration dependent decrease in plasma testosterone and antioxidants in males.

Ethanol is a testicular toxin and it causes fertility abnormalities with low sperm count and impaired sperm motility in men. The present study was designed to investigate plasma testosterone level and hypothalamic pituitary gonadal (HPG) axis function in alcoholic men and also effect of ethanol on systemic oxidative stress. Forty six male alcohol abusers in the age group 20-40 years were selected. Fifty five, males in the same age group served as control. Alcohol abusers had significantly low plasma testosterone with low luteinizing hormone and follicle stimulating hormone. In addition they had significantly high thiobarbituric acid reactive substances (TBARS), superoxide dismutase and glutathione S-transferase, and low glutathione, ascorbic acid, catalase, glutathione reductase and glutathione peroxidase. Moreover, serum testosterone level in alcoholics negatively correlated with duration of alcohol abuse, and TBARS. Duration dependent decreased serum testosterone level in alcohol abusers might be due to 1) increased oxidative stress which can damage Leydig and supporting Sertoli cells and 2) impaired HPG axis.

A profile of substance abusers using the emergency services in a tertiary care hospital in Sikkim.

BACKGROUND: Sikkim, a state in Northeast India with a population of more than 500,000 and inhabited by indigenous population of Lepchas, Bhutias and Nepalis, lies in the foothills of the Himalayas sharing borders with Tibet, Nepal and Bhutan. Northeast India is a major source of injection drug users (IDUs) and associated HIV/AIDS. Alcohol use is traditionally prevalent in Sikkim and recently, IDU behaviour has also been reported, although systematic information on epidemiology and treatment availability of substance abuse in Sikkim is not available. AIM: To study the sociodemographic and drug use profile of substance abusers using the emergency services in a tertiary care hospital. METHODS: A retrospective chart review was used. Patients with history of current drug use seeking emergency services for any medical or surgical consequence incident to substance abuse from July 2000 to June 2005 (60 months) were included in the study. Data were generated from emergency case register, hospital records and case sheets. SPSS 10.0 was used for data analysis. RESULTS: Out of 54 patients seeking emergency services with substance abuse (1.16% of all psychiatric consultations), alcohol abusers were 77.8% and other opioid abusers 14.8%. Prevalence of IDU was 16.66%. Common opioids abused were dextrpropoxyphene and pentazocine, both analgesics. A significant number of patients (46.3%) had a history of >20 days/month frequency of abuse. Median of duration of abuse with all drugs was 12 years, while that with IDU population was 3 years. Alcohol withdrawal was the commonest cause (57.4%) of reporting to the emergency. Psychiatric comorbidity was found among 7.4%. Commonest medications used were chlordiazepoxide and clonidine, for withdrawal and naltrexone, for substitution. No standardized treatment protocol for substitution treatment was available. CONCLUSIONS: This is an initial attempt to study the sociodemographic and drug use profile of substance abusers in Sikkim. Demographic and socioeconomic characteristics of substance abusers seeking emergency services are not significantly different from treatment-seeking substance abusers in other parts of India. IDU behaviour has been detected and low median duration of use suggests an emerging problem and need for urgent harm reduction. Alcohol withdrawal was the commonest cause of seeking emergency services, which is related to high prevalence of alcohol abuse in Sikkim. No standardized substitution treatment is available for substance abusers, which may lead to higher rates of relapse.