Domestic violence and psychological problems in married women during COVID-19 pandemic and lockdown: A community-based survey.

BACKGROUND: Following the declaration of Coronavirus disease-2019 as a pandemic, a nation-wide lockdown was announced in India. This led to increase in psychological problems, especially in women. OBJECTIVES: To assess the prevalence of psychological problems and domestic violence (DV) in married women during the pandemic and lockdown in a panchayat in Southern India and to study the association of socio-demographic and clinical variables with psychological problems. MATERIALS AND METHODS: A cross-sectional study was undertaken in 209 married women of 18-55 years residing in a village panchayat of northern Kerala, India. Socio-demographic variables and clinical variables, like depressive symptoms, anxiety symptoms, perceived stress and DV, among others, were evaluated. The participants were interviewed by trained community health workers in the post-lockdown period. RESULTS: The prevalence of depressive symptoms was found to be 10.0 %, anxiety symptoms 7.2 % and perceived stress 66.0 %. Severe DV was reported by 6.2 %; but at least one form of DV was experienced by 25.8 % of the women. Significant positive correlation was observed for DV with depression and anxiety. DV was also found to be a significant predictor of depression (adjusted OR [aOR] = 4.26, P = 0.006) and anxiety (aOR=4.34, P=0.02). Being a homemaker (aOR=4.51, P = 0.03) and having past history of mental illness (aOR=5.39, P = 0.03) were also found to increase the risk for depression significantly. CONCLUSION: There is a high prevalence of psychological problems in married women during the pandemic and lockdown. DV was found to be a significant predictor of depression and anxiety in this population.

Validation of Malayalam Version of Everyday Abilities Scale for India.

BACKGROUND: Cognitive impairment is usually associated with impairment in everyday activities. Scales to assess activities of daily living, like the Everyday Abilities Scale for India (EASI), have been employed as screening tools for dementia or major neurocognitive disorder. EASI had not been validated in Malayalam. This study's objective was to validate the Malayalam version of EASI (M-EASI) in those aged ≥60 years. METHODS: In a study undertaken in a tertiary care center, those aged ≥60 years attending psychiatry, neurology, or geriatric clinic of general medicine departments were evaluated using M-EASI and the Malayalam version of Addenbrooke's Cognitive Examination (M-ACE). A total of 304 participants were recruited for this questionnaire validation. Information for M-EASI was obtained from a reliable informant. RESULTS: The mean age of the sample was 70.04 years (standard deviation-7.33). The majority of them were males (58.6%) and educated up to primary school (42.4%), while the majority of the informants were sons/daughters/siblings (47.7%) and were females (73.7%). Taking M-ACE scores as the gold standard for diagnosing MNCD according to Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria, there were 162 cases of MNCD and 142 normal controls. Cronbach's α was 0.91. At an optimal cut-off of 4.5, adequate sensitivity (77.8%), and specificity (75.4%) were observed. The positive predictive value was 78.6%, and the negative predictive value, 74.5%. CONCLUSION: M-EASI has adequate psychometric properties as a screening tool for MNCD.

Domestic Violence as a Risk Factor for Attempted Suicide in Married Women.

High rates of suicide attempts and domestic violence (DV) in women of reproductive age group have been reported from South India, but the association between them was not studied. Hence, this study was undertaken to assess whether DV is a risk factor for attempted suicide in married women of reproductive age group. A hospital-based case-control study with 77 incident cases of attempted suicide in married women of the age group of 18 to 45 years and 153 controls belonging to the same age group, without history of suicide attempt, was undertaken over a period of 6 months. Univariate and multivariate analyses were done. The crude odds ratio (cOR) for DV was found to be 6.15 (95% confidence interval [95% CI] = [2.95, 12.82], p value = .0001). Other statistically significant risk factors included younger age group (below 30 years); gross family income > Rs. 5,000; higher occupational status of spouse; having poor social support; having a family history of psychiatric disorders, substance use disorders, and suicide/suicide attempt; higher impulsiveness scores; having higher scores of stressful life events over the past 12 months, and alcohol use disorder in husband. Islamic faith was found to be a significant protective factor. On logistic regression, DV was found to be an independent risk factor for attempted suicide in this study population (adjusted OR = 3.79, 95% CI = [1.35, 10.62], p value = .011). Age groups, stressful life events, impulsiveness, and alcohol use disorder in husband were the confounders adjusted for in logistic regression along with other significant risk and protective factors. Significant dose-response relationship was also observed between DV and attempted suicide. In accordance with the stress-diathesis model for suicidal behavior, DV is found to be a stressor which precipitates suicide attempt in those with diathesis like family history of psychiatric disorders. Clinical, research, and policy implications of the findings are discussed.

Experience of Domestic Violence and Psychological Morbidity in Spouses of Alcohol-Dependent Males.

BACKGROUND: Prevalence of both domestic violence (DV) and alcohol use is reported to be high in Kerala. The prevalence of DV and psychological morbidity in spouses of alcohol-dependent males has not been studied objectively. METHODS: This cross-sectional study was undertaken to study the occurrence of DV and psychological morbidity-major depressive disorder (MDD), anxiety disorders, and adjustment disorders-in spouses of alcohol-dependent males attending the de-addiction center of a tertiary care hospital in South India. Sixty consecutive cases, aged 18-55 years, were recruited after getting informed consent. They were assessed using Domestic Violence Questionnaire (DVQ), Mini International Neuropsychiatric Interview Schedule, and a questionnaire to assess adjustment disorder. The association of DV with psychological morbidities was also studied. RESULTS: DV was reported by 41 (68.3%, 95% confidence interval [CI] = 55.0-79.7) cases. At least one psychiatric morbidity was observed in 51 (85.0%, 95% CI = 72.9-92.5) cases-MDD in 15 (25.0%, 95% CI = 15.1-38.1), anxiety disorders in 6 (10%, 95% CI = 4.1-21.2), and adjustment disorder in 32 (53.3%, 95% CI = 40.1-66.1) cases each. No statistically significant association was observed between DV and any of the psychiatric disorders. However, DVQ scores showed significant correlation with years of marriage (Pearson's r = 0.268, P < 0.05) and with stressful life events over the past 1 year (Pearson's r = 0.424, P < 0.05). CONCLUSIONS: High rates of DV and psychological morbidity were seen in spouses of alcohol-dependent males.