Survey on the psychosocial impact of COVID-19 on the Sri Lankan mental healthcare system and the needs of frontline healthcare workers in the post-covid era.

Introduction: The COVID-19 pandemic severely strained the health care in Sri Lanka. The subsequent economic crisis compounded this issue. Priority was given to treating those afflicted with COVID-19 and preventing its spread, and healthcare staff faced immense difficulties dealing with the situation. The psychosocial impact of COVID on health care staff has not been properly assessed or addressed. Objectives: A study was conducted to identify the psychosocial impact of COVID-19 among four different categories of health care workers, and perform a needs assessment among these groups. Methods: A convenient sample of frontline health workers, mental health teams, 1926 mental health helpline workers and 1990 Suwa Sariya emergency ambulance service staff were assessed via a self-administered questionnaire for mental health impact, work capacities and needs. Results: Among frontline workers (n=188), 42.5% experienced anxiety symptoms, 12.8% depressive symptoms and 4.1% suicidal thoughts. Most (58.9%) lacked a psychological support system at the workplace. Only 20% have accessed specific programs or services at their workplace to obtain support for mental health issues, and all have benefitted from them. All categories of health workers lacked training and resources. Conclusion: The findings demonstrate that a significant amount of health care workers undergo psychological problems in the course of their work especially in the aftermath of the COVID-19 pandemic. The analysis reveals that Sri Lanka lacks structured psychological support systems for health workers and needs more resources and training. Psychological support for health workers through strengthening resources and training should be prioritised when planning service development.

Psychological wellbeing and mental health amongst medical undergraduates: A descriptive study assessing more than 1,000 medical students in Sri Lanka.

BACKGROUND: Studies from around the world have shown higher rates of anxiety, depression, alcohol and other drug use, and burnout in medical students. AIMS: The aim of this study was to identify the socio-demographic factors and severity of difficulties Sri Lankan medical students face regarding psychological wellbeing and burnout. METHOD: This one-off survey used a cross-sectional design, assessing substance use, psychological wellbeing, and burnout using the CAGE, GHQ-12, and OLBI. The survey was open to all medical students in six universities in Sri Lanka. Chi-square analysis was used to assess the statistical significance related to categorical dependent variables and one-way ANOVA for continuous dependent variables. RESULTS: A higher prevalence of diagnosed mental health conditions was found following admission to the medical course in comparison prior to admission. Sixty-two percent of students had a score of more than 2 on the GHQ-12 indicating caseness. The OLBI identified exhaustion in 79% of students. The CAGE questionnaire was positive in 4.8% of students. CONCLUSIONS: Only a small proportion of students are recognizing their mental health difficulties and seeking help. Further understanding is required as to why this is, as well as re-evaluation of the demands of the curriculum. Effective ways of regularly identifying and providing practical and evidence-based support for mental health problems in medical and other undergraduates need to be identified and introduced.

Dhat syndrome: Systematic review of epidemiology, nosology, clinical features, and management strategies.

BACKGROUND: Dhat syndrome is a culture-bound syndrome prevailing in the Indian subcontinent, first described in the 1960s. Over time, newer studies are exploring various aspects of Dhat syndrome, including its epidemiology, nosology, clinical features, and management predominantly in South Asia. We aimed to review the epidemiology, nosology, clinical presentation, and management of Dhat syndrome over the last six decades through a systematic review of studies. METHODS: We searched PubMed and Scopus using the following search terms - "Dhat syndrome," "Semen loss syndrome," "Semen loss anxiety" together with the Boolean operator OR. We collected the articles from inception till March 2021. We included articles in the English language published in peer-reviewed journals. RESULTS: A total of 89 articles were included in the analysis. Most of the articles were published in the last decade (2011-2020). Most of the publications were cross-sectional studies and of unsatisfactory quality. Most of the studies lack representativeness of the population; hence the generalizability of the findings was poor. Most of the articles discussed phenomenology (64%), overview (52.8%), and cultural basis of Dhat syndrome. The comorbidities associated with Dhat syndrome were discussed in 37.1% of the articles. The nosological status of Dhat syndrome and management of Dhat syndrome was discussed in 18% of publications each; whereas, the outcome of Dhat syndrome was discussed in 5.6% of articles. CONCLUSION: Though Dhat syndrome is a commonly diagnosed entity in the South Asian population, the research on Dhat syndrome is sparse and of poor quality.

"Telepsychiatry" in the time of COVID-19: Overcoming the challenges.

Telepsychiatry, the application of telemedicine in the field of psychiatry is defined as the use of electronic communication and information technologies to provide or support clinical psychiatric care at a distance. COVID 19 and its implications related to physical distancing for patients and service providers has made tele- psychiatry and e-consultations an attractive option. Psychiatry, more than any other field in medicine stands to benefit through tele-psychiatry as a physical examination may not be always necessary to arrive at a diagnosis. Some have gone on to suggest that tele psychiatry is likely to replace in person psychiatric assessments pertaining to certain clinical situations. The article reviews the existing evidence for tele-psychiatry and addresses the challenges and pitfalls in the South Asian context.