Suicide in India: a systematic review.

BACKGROUND: Suicide is an important cause of death in India but estimated suicide rates based on data from India's National Crime Records Bureau are unreliable. AIM: Systematically review existing literature on suicide and the factors associated with suicide in India. METHODS: PubMed, PsycINFO, EMBASE, Global Health, Google Scholar and IndMED were searched using appropriate search terms. The abstracts of relevant papers were independently examined by both authors for possible inclusion. A standardized set of data items were abstracted from the full text of the selected papers. RESULTS: Thirty-six papers met inclusion criteria for the analysis. The heterogeneity of sampling procedures and methods of the studies made meta-analysis of the results infeasible. Verbal autopsy studies in several rural locations in India report high suicide rates, from 82 to 95 per 100,000 population - up to 8-fold higher than the official national suicide rates. Suicide rates are highest in persons 20 to 29 years of age. Female suicide rates are higher than male rates in persons under 30 years of age but the opposite is true in those 30 years of age or older. Hanging and ingestion of organophosphate pesticides are the most common methods of suicide. Among women, self-immolation is also a relatively common method of suicide. Low socioeconomic status, mental illness (especially alcohol misuse) and inter-personal difficulties are the factors that are most closely associated with suicide. CONCLUSION: The quality of the information about suicide in India is quite limited, but it is clearly an important and growing public health problem. Compared to suicides in high-income countries, suicide in India is more prevalent in women (particularly young women), is much more likely to involve ingestion of pesticides, is more closely associated with poverty, and is less closely associated with mental illness

Alcohol use and alcohol-use disorders among older adults in India: a literature review.

OBJECTIVES: With changing attitudes to alcohol and an increasing life span in India, the prevalence of alcohol use and misuse in successive cohorts of older people is likely to increase. In this paper, we attempt to review the most recent evidence covering alcohol use and alcohol-use disorders in the Indian elderly. METHODS: PubMed, PsycINFO and Indmed databases were searched using relevant keywords. Papers meeting eligibility criteria were selected through a sequential process of screening title, abstract and full text. Data were extracted into Excel sheets. RESULTS: There was a dearth of pan-national studies. There were several methodological issues with many studies especially related to measurement. A substantial proportion of individuals above the age of 50 years are current consumers of alcohol and the prevalence is generally higher in urban compared to rural areas. Older women are generally likely to be alcohol abstainers. The general trend appears to be a reduction in current drinking among successive age cohorts over the age of 50. Alcohol consumption in the older adults is associated with educational status, health status, chronic morbidity, employment status, socioeconomic status, auditory/locomotor impairment and asthma. CONCLUSION: Alcohol use and misuse is a problem among the Indian older adults. With socio-demographic changes that will further increase longevity, this problem is likely to increase and policy-makers need to plan for it. Future research needs to improve validity and reliability in study methodology, as well as add to the current evidence base

The psychometric properties of GHQ for detecting common mental disorder among community dwelling men in Goa, India.

BACKGROUND: There have not been many attempts to validate screening measures for common mental disorders (CMD) in low- and middle-income countries. The aim of this study was to examine the criterion validity of the General Health Questionnaire 12 (GHQ-12) in a community-based study from Goa, India. METHOD: Concurrent and convergent validity of the GHQ-12 were assessed against the Mini International Neuropsychiatric Interview (MINI) and World Health Organization Disability Assessment Scale (WHODAS) for CMD and functional status through the secondary analysis of a community cohort of men from Goa, India. Criterion validity of the GHQ-12 was determined using ROC analyses with the MINI case criterion as the gold standard. Concurrent validity was assessed against the gold standard of WHODAS functional disability and number of disability days. RESULTS: In a sample of men (n=773), the GHQ-12 showed high internal reliability (Cronbach's alpha of 0.82) and acceptable criterion validity (Area under the receiver operating characteristic curve being 0.71). It had adequate psychometric properties for the detection of CMD (sensitivity of 68.75%; specificity of 73.14%) with the optimal cut-off score for identification of CMD being 2. CONCLUSION: In order to optimize the usefulness and validity of the GHQ-12, a low cut-off point for CMD may be beneficial in Goa, India. Further validation studies for the GHQ-12 should be conducted for continued validation of the test for use in the community

Psychometric properties of the AUDIT among men in Goa, India.

AIMS: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening questionnaire used to detect alcohol use disorders. The AUDIT has been validated in only two studies in India and although it has been previously used in Goa, India, it has yet to be validated in that setting. In this paper, we aim to report data on the validity of the AUDIT for the screening of AUDs among men in Goa, India. METHODS: Concurrent and convergent validity of the AUDIT were assessed against the Mini International Neuropsychiatric Interview (MINI) and World Health Organisation Disability Assessment Scale (WHODAS) for alcohol abuse, alcohol dependence, and functional status respectively through the secondary analysis of data from a community cohort of men from Goa, India. RESULTS: The AUDIT showed high internal reliability and acceptable criterion validity with adequate psychometric properties for the detection of alcohol abuse and dependence. However, all of the optimal cut-off points from ROC analyses were lower than the WHO recommended for identification of risk of all AUDs, with a score of 6-12 detecting alcohol abuse and 13 and higher alcohol dependence. CONCLUSIONS: In order to optimize the utility of the AUDIT, a lowered cut-off point for alcohol abuse and dependence is recommended for Goa, India. Further validation studies for the AUDIT should be conducted for continued validation of the tool in other parts of India

Interventions to increase help-seeking for mental health care in low-and-middle-income countries: a systematic review

Mental health problems are a significant and growing cause of global burden of disease. While evidence-based interventions are available, the treatment gap is particularly large, especially in low- and middle-income countries (LMIC). One of the reasons for this large treatment gap is demand-side barriers. The aim of this systematic review is to identify and synthesise the evidence on interventions to reduce these barriers and improve help-seeking for mental health problems in LMICs

The onset and progression of alcohol use disorders: A qualitative study from Goa, India.

Quantitative evidence about the burden of alcohol use disorders (AUDs) needs to be complemented with a nuanced qualitative understanding of explanatory models to help supplement public health strategies that are too often steeped uncritically in biomedical models. The aim of this study was to identify the role of various factors in the onset and persistence of AUD and recovery from AUD. This was a qualitative study nested in a population cohort from Goa, India. In-depth interviews of men with incident, recovered, and persistent AUD covered topics such as changes in drinking habits over time, perceptions and experiences about starting/stopping drinking, and so on. Data were analyzed using thematic analysis. Reasons to begin drinking included social drinking, functional use of alcohol, stress, and boredom. Progression to problematic drinking patterns was characterized by drinking alone, alternating between abstinent and heavy drinking periods, and drinking based on the availability of finances. Some enablers to reduce/stop drinking included consequences of drinking lifestyle and personal resolve; some barriers included availability of alcohol at social events and stress. Some reasons for persisting heavy use of alcohol included lack of family support, physical withdrawal symptoms, peer pressure, stress, and easy availability. This article offers a strong conceptualization and nuanced understanding of AUD across a spectrum of developmental courses. This adds to the limited literature on explanatory models of AUD in India and identifies potential targets for prevention and treatment strategies for AUD in low- and middle-income country settings

Assessing potential nondirected altruistic kidney donors: a case note audit

Kidney transplantation is now generally accepted as the preferred mode of renal replacement therapy, as it has superior long-term survival compared with dialysis treatment. However, kidney transplantation is limited by the shortage of donor organs; currently, approximately 7,500 patients are on the transplant list for a kidney donation in the UK

Barriers and Facilitators to the Implementation of Mental Health and Psychosocial Support Programmes Following Natural Disasters in Developing Countries: a Systematic Review

Background: Climate change is leading to more frequent and intense natural disasters, with developing countries particularly at risk. However, most research concerning mental health and natural disasters is based in high-income country settings. It is critically important to provide a mental health response to such events, given the negative psychosocial impacts they elicit. The aim of this systematic review is to explore the barriers and facilitators to implementing mental health and psychosocial support (MHPSS) following natural disasters in developing countries. Methods: Eight databases were searched for relevant quantitative and qualitative studies from developing countries. Only studies reporting barriers and/or facilitators to delivering MHPSS in response to natural disasters in a low- or middle-income country were include and full texts were critically appraised using the McGill University Mixed Methods Appraisal Tool (MMAT) .Reported barriers and facilitators were extracted and analysed thematically. Results: 37 studies were included in the review, reflecting a range of natural disaster settings and developing countries. Barriers to implementing MHPSS included cultural relevance, resources for mental health, accessibility, disaster specific factors and mental health stigma. Facilitators identified included social support, cultural relevance and task-sharing approaches. Conclusion: A number of practical approaches can be used to facilitate the implementation of MHPSS in developing country settings. However, more research is needed on MHPSS in the developing country natural disaster context, especially in Africa, and international policies and guidelines need to be re-evaluated using a decolonial lens

Stigma towards dependent drinking and its role on caregiving burden:A qualitative study from Goa, India

INTRODUCTION: Stigma towards alcohol use disorders is prevalent in India and can lead to social exclusion and hamper treatment access and outcomes. Family members of individuals with dependent drinking are often their primary caregivers and play a key role in decisions around help-seeking, treatment and recovery. The nature and role of stigma in caregiving, and the consequent burden on family caregivers of those with dependent drinking, has not been qualitatively studied in India. METHODS: We conducted in-depth interviews with: (i) men with probable alcohol dependence (n = 11); (ii) family caregivers (n = 12); and (iii) doctors with experience of treating alcohol dependence (n = 13) in community settings in Goa. Data were analysed using inductive thematic analysis. RESULTS: Two primary themes were identified from the data: (i) stigma in the form of ignorance, prejudice and discrimination; and (ii) the impact of this stigma on caregiving decisions and the mental health of caregivers. DISCUSSION AND CONCLUSIONS: We found that stigma functioned as a barrier to a proper course of treatment and care, as well as a detrimental factor for caregiver's mental health and caregiving decision-making. Stigma towards dependent drinking in the forms of ignorance, prejudice and discrimination is prevalent within homes, workplaces and health systems and might exacerbate the caregiving burden among female family caregivers. Policies, educational programs and campaigns aimed at preventing stigma in these forms would likely enable access to more inclusive and appropriate health services, benefit the health of family caregivers and improve the treatment outcomes of drinkers

Epidemiological features of alcohol use in rural India: a population-based cross-sectional study.

OBJECTIVES: We sought to estimate the proportion of adults in Sehore District, India, who consumed alcohol, and the proportion who had behaviours consistent with alcohol use disorders (AUDs), using the Alcohol Use Disorders Identification Test (AUDIT). Among men who drank, we identified individual-level, household-level and community-level factors associated with AUDIT scores. Men with AUDs (AUDIT score ≥ 8) reported on whether and where they had sought treatment, and about alcohol-related internal stigma. DESIGN: Population-based cross-sectional study. SETTING: Rural villages and urban wards in Sehore District, Madhya Pradesh, India. PARTICIPANTS: n=3220 adult (≥ 18 years of age) residents of Sehore District. PRIMARY OUTCOME MEASURE: Score on the AUDIT. RESULTS: Nearly one in four men (23.8%) had consumed alcohol in the past 12 months, while few (0.6%) women were consumers. Among drinkers, 33.2% (95% CI 28.6% to 38.1%) had AUDIT scores consistent with hazardous drinking, 3.3% (95% CI 2.1% to 5.1%) with harmful drinking and 5.5% (95% CI 3.8% to 8.0%) with dependent drinking. We observed that AUDIT scores varied widely by village (intraclass correlation=0.052). Among men who had recently consumed alcohol, AUDIT scores were positively associated with depression, having at least one child, high-quality housing, urban residence, tobacco use and disability. AUDIT scores were negatively associated with land ownership, out-of-pocket healthcare expenditure and participation in the national employment programme. While 49.2% of men with AUDs felt embarrassed by their problems with alcohol, only 2.8% had sought treatment in the past 12 months. CONCLUSIONS: A need exists for effectively identifying and treating adults with AUDs. Health promotion services, informed by commonly-expressed stigmatised beliefs held among those affected by AUDs and which are targeted at the most affected communities, may be an effective step in closing the treatment gap