Social determinants of mental health – Let's not lose the impetus this time! Naresh Nebhinani, Debasish Basu Indian Journal of Social Psychiatry 2019 35(3):155-157

Substance use and family burden: A narrative review Surendra Kumar Mattoo, Abhishek Ghosh, Aniruddha Basu Indian Journal of Social Psychiatry 2019 35(3):158-163 In the beginning, the concept of family burden was applied to chronic psychiatric disorders, especially schizophrenia, and substance abuse has been included much later. In this review, the association between burden of care and substance abuse is discussed. The predictors and the mediators of family burden are mentioned. Stress-coping-resilience model is invoked to understand the interaction among several factors. Finally, a possible way to deal with family burden is conjectured.

Strategies toward building preventive mental health Shanmugiah Arumugam Indian Journal of Social Psychiatry 2019 35(3):164-168 Preventive aspect of mental health deals with identification, monitoring, and controlling risk factors. Mental health promotion leads to positive mental health and thus reduces the prevention of psychiatric morbidity. The concept of mental health promotion relies on the identification of mental health determinants at various contexts. The determinants include the risk factors for the development of mental health issues and protective factors for positive mental health. The risk factors are of macrofactors such as poverty, illiteracy, war, displacement, and discrimination. Microfactors play at individual, family, social, and community level. The risk factors also vary across the life span of the individual. The protective factors are at play in various contexts such as public health policy, empowerment, strengthening the community, and improving the protective factors of the individuals such as self-esteem, family atmosphere, and social as well as community support. Identification also should look at the special populations such as women, children, elderly, and migrant population. Strategies involving psychological approaches and social interventions focusing at these factors and early intervention strategies for the first episode psychosis will reduce the psychiatric morbidity results in the prevention of mental health issues and related disability paving the way for prevention and positive mental health.

Material and social resources at old age from life course perspective: An overview of the United Kingdom Tulika Bhattacharyya Indian Journal of Social Psychiatry 2019 35(3):169-172 Material and Social resources throughout the life course has cumulative impact at old age. An individual utilizes these resources in varied ways to attain her/his goals. Even though material resources decline with aging, financial satisfaction increases with age. Older people will have a greater chance of having a family caregiver than their previous generations – in spite of the declining fertility – due to better chances of their caregiver's survival. The study concludes that new uncertainties and global risks threaten the well-being of the older people.

Sociodemographic profile, pattern of opioid use, and clinical profile in patients with opioid use disorders attending the de-addiction center of a tertiary care hospital in North India Bilal Ahmad Bhat, Shabir Ahmad Dar, Arshad Hussain Indian Journal of Social Psychiatry 2019 35(3):173-178 Background and Objectives: Opioids are the major drugs of potential harm and health consequences with more and more people getting involved in it especially from rural areas. One of the concerns with opioids is the injecting route used for their administration. The objective of this study was to assess the sociodemographic profile, pattern of opioid use, and clinical profile in patients with opioid use disorders. Methods: This was a cross-sectional descriptive study conducted among the opioid use disorder patients ≥10 years of age, diagnosed as per the Diagnostic and statistical manual of mental disorders-5 (DSM-5), who visited the drug de-addiction center for the treatment. A semi-structured pro forma was used to record sociodemographic profile. Opioid use disorder and psychiatric comorbidity were diagnosed as per the DSM-5 after a thorough clinical assessment. Results: A total of 74 patients were included in this study. The mean age of our patients was 27.55 years (standard deviation ± 7.26) with majority of patients (83.78%) between 20 and 40 years of age. Most of the patients were males (97.5%) from nuclear families (75.68%) and from rural background (62.16%). Majority of patients (48.65%) had started using opioids in 20–29 years age group with heroin as the most common opioid used in 62.16%. Majority of our patients (43.24%) were using intravenous route. Psychiatric comorbidity was present in 41.88% with attention-deficit hyperactivity disorder (24.32%) as the most common. Conclusion: Rural areas and students are increasingly involved in opioid use disorders. Heroin use has increased significantly when compared with previous study particularly through intravenous route.

Metabolic syndrome and its impact on functioning in participants with schizophrenia: A hospital-based cross-sectional study KN Nishanth, Rakesh Kumar Chadda, Mamta Sood, Ashutosh Biswas, R Lakshmy Indian Journal of Social Psychiatry 2019 35(3):179-182 Background: The prevalence of metabolic syndrome is shown to be high in patients with schizophrenia when compared to the general population. Metabolic syndrome can itself increase the morbidity and mortality in these patients who already have other risk factors. The aim of this study was to assess the prevalence of metabolic syndrome and its correlation with sociodemographic profile, with severity of schizophrenia and functionality in patients with schizophrenia. Materials and Methodology: A total of 100 patients with schizophrenia attending a tertiary care center were assessed for metabolic syndrome in this cross-sectional study. The severity of schizophrenia was assessed using positive and negative syndrome scale, and global assessment of functioning (GAF) and social and occupational functioning assessment scale (SOFAS) were used to assess functionality. Results: Mean age of the participants (n = 100) was 35.12 years (standard deviation = 10.7) with mean duration of schizophrenia being 8.3 years (standard error = 0.58). The prevalence of metabolic syndrome was 37%. Metabolic syndrome was more commonly seen in relatively older participants (P < 0.00), females (P = 0.002), homemakers (P = 0.006), with longer duration of schizophrenia (P = 0.013), and with longer duration of treatment (P = 0.027). The mean score of GAF and SOFAS in the participants with metabolic syndrome was low, suggesting poor functioning. Conclusion: Identification of metabolic syndrome needs to be further stressed as the functioning is impaired due to it.

Knowledge and attitude regarding declining sex ratio and female feticide among married females (15–49 years) residing in a village in Shahpur, Kangra, Himachal Pradesh Ankush Kaushal, Neeta Rana, Piyush Sharma, Akshay Minhas, Mitasha Singh Indian Journal of Social Psychiatry 2019 35(3):183-187 Background: Female feticide and sex selective abortion are common in today's scenario of two-child norm. Objective: The objective of the study is to assess the knowledge and attitude of married females residing in rural area of district Kangra, Himachal Pradesh, toward declining sex ratio and female feticide prevalent in the society. Methodology: This descriptive study was conducted on married females aged 15–49 years residing after their marriage in a village of health block Shahpur, Kangra. Of 350 households from the village, 106 were covered in the given time period. Systematic random sampling was used to select households. The youngest married female from the household who has recently given birth to a child was selected. A predesigned semi-structured questionnaire containing sociodemographic details of the family and knowledge and attitude questions was used. Results: One-third heard about declining female-to-male ratio. Killing of fetuses was known to 84% of female respondents. Only 24.5% were aware about law related to abortion and prenatal sex determination. The reason for decreasing sex ratio was quoted as preference for a male heir (62.3%). Around 60% of females have been harassed by a male and 48.1% have at least once felt not to have a female child. The attitude toward consequences of declining sex ratio was neutral among the females. Conclusion: The consequences of low sex ratio are liable to damage our social and economic fabric beyond repair. Solution needs to be tailored in the social context of country.

A Comparative study of half-orphan and double-orphan adolescents to explore the psychological well-being in orphanage of district Srinagar, Kashmir Tabasum Dilawar Malla, Ifshana Iliyas Rather, Nusrat Yousuf Indian Journal of Social Psychiatry 2019 35(3):188-192 Introduction: The impact of orphanhood on the mental health of adolescents is an inevitable phenomenon. This impact is raised when an adolescent loses both of his/her parents. Hence, the present study was aimed to compare the level of psychological well-being (PWB) and its dimensions (autonomy, environmental mastery, positive relations with others, purpose in life, personal growth, and self-acceptance) between half-orphans and double-orphans. Materials and Methods: The present study was conducted from June 2015 to June 2016 in selected orphanages of district Srinagar, Kashmir. The sample size consists of 115 adolescent orphans, and among those, 70 (61%) were half-orphans and 45 (39%) were double-orphans. Level of PWB was assessed using standardized scale – Ryff's PWB scale. t-test was used to compare the PWB and its dimensions between half-orphans and double-orphans. Results: Using t-test, it was found that there is significant difference between half-orphans and double-orphans only in case of positive relations with others (t = 2.034,P < 0.05) and self-acceptance (t = 2.325,P < 0.05) dimensions of PWB, while there is insignificant difference of autonomy (t = 0.126), environmental mastery (t = 1.013), personal growth (t = 0.377), purpose in life (t = 0.355) dimensions of PWB, and overall PWB (t = 1.788). Conclusion: Mean difference was found between half-orphans and double-orphans in every dimension while there was statistically significant difference between the two groups in only two dimensions (positive relationship with others and self-acceptance dimension of PWB) where half-orphans dominate. It is therefore recommended that the orphanages may have to consider the possibility of recruiting qualified counselors, psychiatric nurses, or child psychologists.

Attitude toward mental illness among adolescents: A hospital-based study Harleen Kaur, Sneha Sharma, Om Sai Ramesh Vallamkonda Indian Journal of Social Psychiatry 2019 35(3):193-200 Introduction: Stigma, prejudice, and discrimination toward mental illness continue to plague the society despite multiple advances in etiology and treatment. It deprives the persons with mental illness the right to a good quality of life, social support, and also has a direct effect on treatment seeking and compliance. Objective: The main objective of this study was to assess the attitude toward mental illness among adolescents, who might be an untapped human resource in care of persons with mental illness. Methodology: A cross-sectional comparative study of 70 adolescents aged 14–18 years was done. Attitude toward mental illness of adolescents having family members with severe mental illness was compared to adolescents having family members with chronic medical illness. Purposive sampling from a tertiary health-care center was done, and the “Attitude Scale for Mental Illness questionnaire” was administered. Sociodemographic data were collected using a standard pro forma. Results: Descriptive analysis showed an overall positive attitude on separatism, benevolence, and stigma subscale and a negative attitude toward stereotyping, restrictiveness, and pessimistic prediction. No significant difference was observed in the attitudes of adolescents from both the categories. Conclusion: Adolescents can form an important bridge in reducing the stigma surrounding mental illness.

Certifiable disability in schizophrenia and its correlates: A cross-sectional study Rakesh Byra Reddy, Kailash Sureshkumar, Srinivasan Balasubramania, OT Sabari Sridhar, Shabeeba Z Kailash Indian Journal of Social Psychiatry 2019 35(3):201-206 Background: Disability associated with schizophrenia has an impact on various domains of life. Patients with >40% disability are entitled for getting benefits from the government. The study aimed at assessing the certifiable disability, severity of the disability, and its correlates in patients with schizophrenia. Materials and Methods: Tertiary hospital-based cross-sectional study comprised of 63 patients with schizophrenia fulfilling the selection criteria. The data included sociodemographic and illness variables. Positive and Negative Syndrome Scale, Medication Adherence Rating Scale, and Glasgow Antipsychotic Side-effects Scale were used to assess the symptom severity, treatment adherence, and side effects, respectively. The Indian Disability Evaluation Assessment Scale (IDEAS) was used to evaluate the disability. Data were analyzed using the Statistical Package for Social Sciences software. Results: Majority of the patients (53.7%) had certifiable disability. About 46% of patients had mild level of disability, while 39.7% had moderate level of disability, 1.6% had severe level of disability, and 12.7% had profound disability. The disability was observed to be more in the work, social relationships, and communication domain of IDEAS. There was a strong positive correlation between symptom severity, antipsychotic side effects, and disability. The disability was greater in patients who had a poor medication adherence. Conclusion: Patients with schizophrenia have a significant certifiable disability in all domains of life. Symptomatology, antipsychotic side effects, and medication adherence are important predictors of disability. Preventive and rehabilitative measures should be taken for controlling these modifiable factors which would help in limiting disability. Suitable guidance should be given to avail the disability benefits.