Anindya Das - Academia.edu (original) (raw)
Papers by Anindya Das
Introduction Family caregivers with schizophrenia struggle with psychological, social, and othe... more Introduction
Family caregivers with schizophrenia struggle with psychological, social, and other challenges due to stigma, lack of adequate information, and maladaptive coping strategies. We aimed to explore the experiences of caregivers of persons with schizophrenia (PwS) to comprehend the emotional challenges and other burdens and coping strategies utilized.
Methods
We subscribed to a phenomenological approach and interviewed nine caregivers in-depth. Audio-recorded interviews were transcribed and translated from Hindi to English. Thematic analysis was performed using the seven-step Colaizzi's method. ATLAS.ti.22 was used for the analysis of the data.
Results
Five themes emerged from the data: 1) general understanding of schizophrenia, 2) emotional burden, 3) Disruption in personal and socio-occupational life, 4) challenges in caregiving, and 5) coping strategies. Caregiving adversely affected the quality of life socially and financially. Schizophrenia stigmatized families, trapped them in their homes, and left them no choice but to get support from informal networks. Also, caregivers experienced a lack of healthcare facilities in the vicinity and reported a substandard level of formal care.
Conclusion
Giving care to PwS entails financial, social, emotional, and physical burden. Feelings of frustration, helplessness, uncertainty, and loss are common. Transformation of personal, professional, and social life are usual consequence of caregiving. Generally, caregivers cope through addictions or spiritual means. Significant perceived requirements include a lack of knowledge about the condition and how to manage it as well as inadequate support services. Emotional and financial support and community support services near home may ease the burden of caregiving for PwS.
We systematically reviewed empirical studies of psychotherapy with Indian clients. We defined psy... more We systematically reviewed empirical studies of psychotherapy with Indian clients. We defined psychotherapy as an intervention aimed at treating mental disorders using “talk,” which, in a professional medical setting, along with the therapeutic relationship, acquires medicinal value. Besides manual searches in three leading Indian psychiatry journals, we conducted digital searches in PubMed, Google Scholar, and Scopus databases. We found that the commonly practiced evidence-based psychotherapy in India follows the cognitive-behavioral model. Our findings suggest several replication studies which claimed to have used the well-established western models of cognitive behavioural paradigm but have mostly focused on basic behavioural techniques in their protocol. A few innovations were observed, and several essential errors were noted. Innovations include contextual modifications to address the difficulties and challenges faced in service delivery, while errors include deviations from protocol without adequate rationale.
Journal of Cross-Cultural Gerontology, 2023
Background and Objectives With the aging of Indians and the cultural context of family care, fai... more Background and Objectives
With the aging of Indians and the cultural context of family care, faith-based ashrams are a possible middle way for older adult care for strained families. Religiosity is multidimensional, but it is unclear how its different dimensions relate to coping. This exploratory study investigates the profile of residents living in a faith-based ashram of Haridwar, a pilgrimage town in Northern India. Additionally, it examines religiosity and coping in this population, and the correlates of positive coping response (PCR).
Methodology
Preliminary field survey helped zero in on a single consenting ashram. We included 95 older adult participants (≥ 60 years) residing for more than six months. Relevant dimensions were captured with a survey interview form to record sociodemographics, BriefCOPE, and Duke University Religion Index. The sample was representative of the institutionalized older-adult population considering the overlap of sociodemographics (age, gender, and marital status). We conducted linear regression to examine possible predictors of PCR.
Results
Most older adults were Hindus, higher educated, married, and lived with their spouses. The participants were highly religious. Coping through religion was most common, followed by active coping. On linear regression, a significant model emerged [F (13, 63) = 3.411, p < .001), where age, education, and organizational religious activity were significant predictors of PCR. However, other sociodemographic (sex, marital status, economics, family contact) and dimensions of religiosity (non-organizational religious activity and intrinsic religiosity) variables failed to predict PCR.
Conclusion
Lesser age, higher education, and involvement in the public practice of religiosity are essential contributors to PCR in older adults. How different aspects of religiosity influence coping and lend meaning to dealing with stress, needs further exploration.
Indian Journal of Psychological Medicine, Mar 9, 2022
Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performan... more Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performance and encourage accountability, besides allowing judicious health system decision making. 3 While choosing a measure that eventually contributes to a composite index, a few crucial elements that need consideration are defining priority areas, avoiding positively correlated measures (as it may lead to "double counting)," 3 and data that are robust and part of a routine process. Health outcome measures such as under-five mortality rate or suicide rate are dependent not only on the health service system but also on an extraneous complex of social, cultural, environmental, and political factors. For example, the suicide rate is also determined by employment and livelihood issues, religious beliefs, gender, socioeconomic status, ruralurban differences, etc. 4 However, health systems, too, are part of the latter complex. In contrast, inputs and process indicators are contingent on the functioning of the health service system 1 and are sensitive to change.
Eastern Journal of Psychiatry , 2018
Farmers’ suicide in India has become a controversial issue, with political repercussions along wi... more Farmers’ suicide in India has become a controversial issue, with political repercussions along with attendant huge loan waiver and vote bank politics. As an academic task it begs the question is farmers’ suicide really a cause of concern? And we think so, but with a nuanced understanding. Rather than broad generalization of it being a countrywide problem and keeping in view the niceties, we turn to extant literature that has tried to dwell into the causes for this phenomenon. We use an interdisciplinary lens to review selected literature and analyse this. Concluding from this analysis we suggest a multilevel approach that is both pragmatic and useful to understand farmers’ suicide and theoretically mature to think about suicides in general. The commentary does not propose solutions, though this may be implicit, the larger aim is to theorise about factors for suicide in general. Keywords: farmers’ suicide, agrarian distress, India, multilevel framework
Indian Journal of Psychological Medicine, 2018
Indian Journal of Psychiatry, 2019
On‐consultation training The training primarily focuses on how to briefly evaluate for psychiatri... more On‐consultation training The training primarily focuses on how to briefly evaluate for psychiatric signs and symptoms and come up with a prescription devoting on an average 5–10 min for each patient. Thus, the focus is primarily pharmacological management as the authors themselves submit. Moreover expecting something more from the PCDs would be lavish. My personal participation with this training has also made it evident that nonavailability of drugs then turn into a major hurdle in the treatment of patients. Considering the PCDs practice in less resourced locales, even private pharmacies do not stock psychotropics. Thus, training in pharmacological management should go hand in hand with ensuring availability of drugs under the DMHP.
Journal of Geriatric Mental Health, 2020
Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event... more Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event research. The use of PSLES in the elderly has been rather mechanistic, without giving due emphasis on the unique experiences of the elderly, particularly within the context of contemporary social change of family values in India. This research aimed to critically appraise the relevance of PSLES in the elderly. Methodology: The research was part of a larger project on stress, coping, and religiosity in (faith bases) ashram-dwelling elderly. A single consenting ashram for the elderly (for aged > 60 years) consented to the study. Participants were included if they had stayed for more than 6 months and had no impairment that compromised understanding of the research. We used the PSLES (a checklist method) for evaluating life events. We supplemented our exploration with open-ended interviews to evaluate the relevance and salience attributed to these life-events. Results: Ninety-four elderly participated (response rate was 70.15') with a mean (standard deviation) age of 74.56 (7.39) years, equally represented by either gender, with a mean duration of ashram stay of 10.85 years. Most frequent events reported were death in the family, going on a trip/pilgrimage, personal illness, and changes in biological functions. Discussion: PSLES was developed for adult Indians, and its use in the elderly may need modification due to qualitatively and quantitatively varying life events, such as the importance of nonegocentric stress (loss of job of one's child) versus egocentric stress (own hospitalization) or change of salience of events (e.g., lack of son versus daughter). Conclusion: To improve the relevance of PSLES for life-event research and capture the unique experiences of the elderly, suggested modifications are necessary.
Community Mental Health Journal, 2021
Within the ambit of the National Mental Health Program, the Government of India has mandated long... more Within the ambit of the National Mental Health Program, the Government of India has mandated long-acting risperidone, a patented molecule of Janssen Pharmaceutica. We contest that the healthcare system of India is ill-equipped (due to its weak infrastructure) to monitor side effects, regulate the use, and ensure informed consent. The process of including patented Risperdal Consta into the Indian formulary has lacked transparency and suggests undo favor towards Janssen. Janssen Pharmaceutica is known for its aggressive marketing strategy resulting in off-label use of oral risperidone in the US. Moreover, the lax regulatory structure for pharmaceutical dispensing in India coupled with Janssen's aggressive marketing is a potential cause of concern. We are critical of the decision to include a costly and patented molecule in a publicly financed health program otherwise sourced by generic drugs.
Perspectives in Psychiatric Care, 2021
PURPOSE This study examined therapeutic milieu interventions on self-esteem, socio-occupational f... more PURPOSE This study examined therapeutic milieu interventions on self-esteem, socio-occupational functioning, and depressive symptoms among inpatients with depressive disorders. METHODS A pretest-posttest nonequivalent control group quasi-experimental design was adopted. Sixty participants with depression who got admitted to the general hospital psychiatric ward were assigned to a control (Treatment as Usual) group and an experimental (therapeutic milieu intervention) group nonrandomly using a convenience sampling technique. We evaluated the following outcome measures: self-esteem, socio-occupational functioning, and depressive symptoms for both groups at baseline, 4th, 8th, and 12th weeks. RESULTS Therapeutic milieu interventions improved self-esteem, socio-occupational functioning, and reduced depressive symptoms. The findings provided initial evidence for practice. IMPLICATIONS Psychiatric nurses can implement simple, milieu therapy interventions in any setting, which will enhance the clinical outcomes and socio-occupational functioning of depressive patients.
Journal of Cleft Lip Palate and Craniofacial Anomalies, 2020
Introduction: Cleft lip and palate are a common but significantly disfiguring congenital anomaly ... more Introduction: Cleft lip and palate are a common but significantly disfiguring congenital anomaly affecting children. Besides the multiple problems they pose regarding the child's feeding, speech, and hearing, being visible, they cause a major social stigma. Different degrees of parental guilt and shame are frequently encountered, primarily due to the perceived cause of the birth defect. Aims: This study aims to define parental perceptions associated with a child of cleft lip or palate and their social significance. Materials and Methods: A detailed questionnaire was structured based on a previous study by Weatherly-White (2004). A sample of 64 families was selected by total enumerative sampling technique over a period of one year. Tools were translated into Hindi (local language) and validated. Parents not willing to participate or unable to understand Hindi or English were excluded from the study. The data were collected using questionnaire and semi-structured interviews. Ethical clearance was obtained and consent was taken from parents for participation in the study. Results: Parents of 63 patients were interviewed and the results were tabulated. Conclusion: The study identified many cultural and societal attitudes that deeply affect the way that communities treat children with clefts and other facial deformities. The results interestingly almost mirror the last study similar to this, almost 20 years ago. It is surprising to note the beliefs and perceptions about clefts have remained largely unchanged.
Lung India : official organ of Indian Chest Society
Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations incl... more Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations including psychiatric comorbidities most commonly being depression and/or anxiety. Studies regarding the association of these psychiatric comorbidities in terms of symptom scores, spirometric variables, and hospitalizations among patients of COPD are lacking, especially in India. One hundred and twenty-eight patients of COPD attending the Outpatient Department of AIIMS Rishikesh, and fulfilling inclusion criteria were screened by Hospital Anxiety and Depression Scale, and those who scored above the cutoff underwent psychiatric evaluation using the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research for confirmation of their diagnosis. All patients were then evaluated by physician-administered questionnaire for symptom scores by Modified Medical Research Council Scale (mMRC) for dyspnea, Hindi-validated Clinical COPD Questionnaire (CCQ), and for functional...
Epilepsy & Behavior, 2016
This piece describes a very simple, economical yet innovative use of mobile technology in aiding ... more This piece describes a very simple, economical yet innovative use of mobile technology in aiding clinical history taking in a specific situation, i.e. “transient episodic behavioural disturbances” (particularly complex patterns of seizures, non-epileptic attack disorder, and sleep associated behavioural disturbances). Using video recording function present in (even low cost) mobile phones, video samples of such episodic attacks is reported to be a helpful aid to clinical history taking in a busy clinical consultation facility, a practice that has helped me on many occasions.
Indian journal of medical ethics
The Indian journal of medical research, 2012
Sir, It was astounding to read the article in the daily ‘The Times of India’ dated August 19, 201... more Sir, It was astounding to read the article in the daily ‘The Times of India’ dated August 19, 2011 on a medical postgraduate seat sold out for Rs. 1.7 crore1. Though it was not something new, keeping in mind the recent trend towards privatization of medical education in India. For a scholarly take on the phenomenon, I would make note of some historical turning points and discuss the implications arising thereof. Firstly there has been a slow yet consistent change in the economic policies of India post 1990s marked by the shift of provision of social services from government sources to the non-government (for-profit and not for-profit) sector under the name of neo-liberal policies. This included the privatization of higher educational services (such as medical education). The logic being (presumably) low social returns on expenditure in higher education2,3 and preservation of limited resources for the more important task of financing primary and secondary education4. Moreover, the impetus to private medical education was to offset the short supply of medical professionals. To facilitate establishment of private medical colleges the government from time to time provided land to private players for free or at discounted rates5, relaxed norms for the requirement of minimal land area6 and exempted tax for importing high end medical equipment. The second turning point was the Honourable Supreme Court's (SC) judgment on the TMA Pai Foundation & others vs. State of Karnataka case7 and other related judgments followed by ‘The Private Professional Educational Institutions (Regulation of Admission and Fixation of Fee) Bill, 2005’ allowing maximum autonomy to the private medical institutes with respect to admission procedure (including control over entrance tests)8, fee structure, and abolishing of State quotas9. It allowed up to 50 per cent seats to be reserved under the management category while only 15 per cent for general category to be filled on an all-India basis. The said bill's ambiguity over allowable profits (termed ‘reasonable surplus’), fair and transparent admission procedure under the ‘management category’ without any legal/administrative tool for the State to oversee, control and intervene had allowed scope for manipulation by private colleges10. In addition, sting operations by media group have unearthed the practice of capitation fees despite SC judgments illegalizing it11. The third turning point was the revelations made by the arrest of President of Medical Council of India (MCI) Ketan Desai on charges of corruption. This also resulted in the dissolution of MCI in 2010. Though Desai was removed from the said position (on charges of misuse of office) earlier in 200112,13, he regained his presidentship in 2009. In 2010, Desai and three others were caught red handed in a bribery case related to MCI recognition of a private medical college14. This need for (re-)recognition from the MCI in the face of many private medical colleges lacking the minimum standards has sown the seed for corruption. As many would agree, such practices have now been prevalent for a long time, thus to assume a single person to be at the root of the problem would be erroneous. In addition, such corruption is partly augmented by the involvement of certain politicians in the management of various medical colleges13. The fourth turning point has been the amorphous and disjointed changes in the consciousness of the young Indian medical professionals on the issue of medical practice and medical specialization. In present times (super-) specialization in medical discipline is becoming an essential requirement in the opinion of young medical graduates. Partly this may be due to the trend in (bio-) medical sciences towards increased dependence on technology, and partly this is determined by the medical market (in the case of Indian graduates the private practice and corporate hospital arena, the migration to first world nations or the concentration of government provided advanced medical facilities in urban influential areas). The importance of research and teaching which is the essence of postgraduate medical training has entirely been usurped by the market of specialized clinical practice. At the same time private healthcare is ailing under the pressure of unhealthy competition resulting in irrational prescription practices and unwarranted diagnostics15 which may be socially wasteful and personally burdensome. The establishment of private higher education in India was a commitment towards market economy and an outcome of the shortfall of public resources for funding. The expansion though, took place due to collusion between powerful politicians and the government apparatus in-charge of control of its standards. In the aftermath what can be seen is confusion not only in the ideological commitment of the Indian polity and in the regulatory understanding of Indian judiciary but also in the values of merit among the Indian middle class.…
International Journal of Occupational Safety and Ergonomics, 2013
Objective. We examined the personality correlates of accident-proneness of auto-rickshaw drivers ... more Objective. We examined the personality correlates of accident-proneness of auto-rickshaw drivers in the Indian city of Ranchi. Methods. This was a cross-sectional study in which 50 male drivers aged 18-50 years, selected randomly from a list of licensed auto-rickshaw drivers in Ranchi, were assessed with a Hindi version of Cattell's 16 Personality Factors (16-PF) Questionnaire. Results. There was a significantly higher frequency of breaking rules, crossing speed limits, substance use and a trend towards a higher frequency of carrying extra persons (i.e., more than recommended) in accident-prone drivers. There was significant negative correlation of accident-proneness with 16-PF factors such as reasoning, rule consciousness, apprehension and emotional stability. Conclusion. Personality characteristics with lower scores of reasoning, rule consciousness, apprehension and emotional stability are common in commercial auto-rickshaw drivers with high accident-proneness.
Asian Journal of Psychiatry, 2013
Asian Journal of Psychiatry, 2014
India, among the low-and middle-income countries, in the 1980s, made an early attempt at formulat... more India, among the low-and middle-income countries, in the 1980s, made an early attempt at formulating a mental health program. India's National Mental Health Program (NMHP) intended to attend to the mental health needs of all her citizens. Some aspects of this program bear significant resemblance to what recent experts in global mental health (GMH) have been proposing. The paper uses India as a country-level example to review and critically analyze the contextual background culminating in the formulation of the NMHP. Literature searches from two bibliographic databases (PubMed and Google Scholar) with supplementary searches and manual search from Indian Journal of Psychiatry were made relating to the context of formulation of India's NMHP. The search helped isolate 12 peer reviewed journal articles, three chapters from books, and one policy group approach paper. This literature has been synthesized to enumerate the various contextual factors. The present analysis identifies two vital factors relevant for international health, viz. the primary health care movement and the changing concepts of institutional care/de-institutionalization in mental health. This then puts in perspective the opportunities allowed and challenges produced, for NMHP, by subsequent changes in public health services in India. The lessons for GMH movement are then pointed out.
Indian Journal of Psychological Medicine, 2022
Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performan... more Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performance and encourage accountability, besides allowing judicious health system decision making. 3 While choosing a measure that eventually contributes to a composite index, a few crucial elements that need consideration are defining priority areas, avoiding positively correlated measures (as it may lead to "double counting)," 3 and data that are robust and part of a routine process. Health outcome measures such as under-five mortality rate or suicide rate are dependent not only on the health service system but also on an extraneous complex of social, cultural, environmental, and political factors. For example, the suicide rate is also determined by employment and livelihood issues, religious beliefs, gender, socioeconomic status, ruralurban differences, etc. 4 However, health systems, too, are part of the latter complex. In contrast, inputs and process indicators are contingent on the functioning of the health service system 1 and are sensitive to change.
Bengal Journal of Psychiatry
Worldwide research has provided evidence of premature death in people with mental illness (as com... more Worldwide research has provided evidence of premature death in people with mental illness (as compared to the general population). Moreover, in recent decades, the mortality gap between the preceding two groups has not shown any decline even in countries with the most accessible/responsive health systems. This essay considers mortality to be influenced by a multiplicity of factors, many of which, in addition, influence the rate of occurrence and recovery from mental illnesses. The essay examines these factors and analyses them through the lens of structural discrimination (defined as institutional and social structures that perpetuate norms, practices and behavior that deny opportunities/rights to others, often members of a minority). The implications for India in this regard are also reflected upon.
Introduction Family caregivers with schizophrenia struggle with psychological, social, and othe... more Introduction
Family caregivers with schizophrenia struggle with psychological, social, and other challenges due to stigma, lack of adequate information, and maladaptive coping strategies. We aimed to explore the experiences of caregivers of persons with schizophrenia (PwS) to comprehend the emotional challenges and other burdens and coping strategies utilized.
Methods
We subscribed to a phenomenological approach and interviewed nine caregivers in-depth. Audio-recorded interviews were transcribed and translated from Hindi to English. Thematic analysis was performed using the seven-step Colaizzi's method. ATLAS.ti.22 was used for the analysis of the data.
Results
Five themes emerged from the data: 1) general understanding of schizophrenia, 2) emotional burden, 3) Disruption in personal and socio-occupational life, 4) challenges in caregiving, and 5) coping strategies. Caregiving adversely affected the quality of life socially and financially. Schizophrenia stigmatized families, trapped them in their homes, and left them no choice but to get support from informal networks. Also, caregivers experienced a lack of healthcare facilities in the vicinity and reported a substandard level of formal care.
Conclusion
Giving care to PwS entails financial, social, emotional, and physical burden. Feelings of frustration, helplessness, uncertainty, and loss are common. Transformation of personal, professional, and social life are usual consequence of caregiving. Generally, caregivers cope through addictions or spiritual means. Significant perceived requirements include a lack of knowledge about the condition and how to manage it as well as inadequate support services. Emotional and financial support and community support services near home may ease the burden of caregiving for PwS.
We systematically reviewed empirical studies of psychotherapy with Indian clients. We defined psy... more We systematically reviewed empirical studies of psychotherapy with Indian clients. We defined psychotherapy as an intervention aimed at treating mental disorders using “talk,” which, in a professional medical setting, along with the therapeutic relationship, acquires medicinal value. Besides manual searches in three leading Indian psychiatry journals, we conducted digital searches in PubMed, Google Scholar, and Scopus databases. We found that the commonly practiced evidence-based psychotherapy in India follows the cognitive-behavioral model. Our findings suggest several replication studies which claimed to have used the well-established western models of cognitive behavioural paradigm but have mostly focused on basic behavioural techniques in their protocol. A few innovations were observed, and several essential errors were noted. Innovations include contextual modifications to address the difficulties and challenges faced in service delivery, while errors include deviations from protocol without adequate rationale.
Journal of Cross-Cultural Gerontology, 2023
Background and Objectives With the aging of Indians and the cultural context of family care, fai... more Background and Objectives
With the aging of Indians and the cultural context of family care, faith-based ashrams are a possible middle way for older adult care for strained families. Religiosity is multidimensional, but it is unclear how its different dimensions relate to coping. This exploratory study investigates the profile of residents living in a faith-based ashram of Haridwar, a pilgrimage town in Northern India. Additionally, it examines religiosity and coping in this population, and the correlates of positive coping response (PCR).
Methodology
Preliminary field survey helped zero in on a single consenting ashram. We included 95 older adult participants (≥ 60 years) residing for more than six months. Relevant dimensions were captured with a survey interview form to record sociodemographics, BriefCOPE, and Duke University Religion Index. The sample was representative of the institutionalized older-adult population considering the overlap of sociodemographics (age, gender, and marital status). We conducted linear regression to examine possible predictors of PCR.
Results
Most older adults were Hindus, higher educated, married, and lived with their spouses. The participants were highly religious. Coping through religion was most common, followed by active coping. On linear regression, a significant model emerged [F (13, 63) = 3.411, p < .001), where age, education, and organizational religious activity were significant predictors of PCR. However, other sociodemographic (sex, marital status, economics, family contact) and dimensions of religiosity (non-organizational religious activity and intrinsic religiosity) variables failed to predict PCR.
Conclusion
Lesser age, higher education, and involvement in the public practice of religiosity are essential contributors to PCR in older adults. How different aspects of religiosity influence coping and lend meaning to dealing with stress, needs further exploration.
Indian Journal of Psychological Medicine, Mar 9, 2022
Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performan... more Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performance and encourage accountability, besides allowing judicious health system decision making. 3 While choosing a measure that eventually contributes to a composite index, a few crucial elements that need consideration are defining priority areas, avoiding positively correlated measures (as it may lead to "double counting)," 3 and data that are robust and part of a routine process. Health outcome measures such as under-five mortality rate or suicide rate are dependent not only on the health service system but also on an extraneous complex of social, cultural, environmental, and political factors. For example, the suicide rate is also determined by employment and livelihood issues, religious beliefs, gender, socioeconomic status, ruralurban differences, etc. 4 However, health systems, too, are part of the latter complex. In contrast, inputs and process indicators are contingent on the functioning of the health service system 1 and are sensitive to change.
Eastern Journal of Psychiatry , 2018
Farmers’ suicide in India has become a controversial issue, with political repercussions along wi... more Farmers’ suicide in India has become a controversial issue, with political repercussions along with attendant huge loan waiver and vote bank politics. As an academic task it begs the question is farmers’ suicide really a cause of concern? And we think so, but with a nuanced understanding. Rather than broad generalization of it being a countrywide problem and keeping in view the niceties, we turn to extant literature that has tried to dwell into the causes for this phenomenon. We use an interdisciplinary lens to review selected literature and analyse this. Concluding from this analysis we suggest a multilevel approach that is both pragmatic and useful to understand farmers’ suicide and theoretically mature to think about suicides in general. The commentary does not propose solutions, though this may be implicit, the larger aim is to theorise about factors for suicide in general. Keywords: farmers’ suicide, agrarian distress, India, multilevel framework
Indian Journal of Psychological Medicine, 2018
Indian Journal of Psychiatry, 2019
On‐consultation training The training primarily focuses on how to briefly evaluate for psychiatri... more On‐consultation training The training primarily focuses on how to briefly evaluate for psychiatric signs and symptoms and come up with a prescription devoting on an average 5–10 min for each patient. Thus, the focus is primarily pharmacological management as the authors themselves submit. Moreover expecting something more from the PCDs would be lavish. My personal participation with this training has also made it evident that nonavailability of drugs then turn into a major hurdle in the treatment of patients. Considering the PCDs practice in less resourced locales, even private pharmacies do not stock psychotropics. Thus, training in pharmacological management should go hand in hand with ensuring availability of drugs under the DMHP.
Journal of Geriatric Mental Health, 2020
Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event... more Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event research. The use of PSLES in the elderly has been rather mechanistic, without giving due emphasis on the unique experiences of the elderly, particularly within the context of contemporary social change of family values in India. This research aimed to critically appraise the relevance of PSLES in the elderly. Methodology: The research was part of a larger project on stress, coping, and religiosity in (faith bases) ashram-dwelling elderly. A single consenting ashram for the elderly (for aged > 60 years) consented to the study. Participants were included if they had stayed for more than 6 months and had no impairment that compromised understanding of the research. We used the PSLES (a checklist method) for evaluating life events. We supplemented our exploration with open-ended interviews to evaluate the relevance and salience attributed to these life-events. Results: Ninety-four elderly participated (response rate was 70.15') with a mean (standard deviation) age of 74.56 (7.39) years, equally represented by either gender, with a mean duration of ashram stay of 10.85 years. Most frequent events reported were death in the family, going on a trip/pilgrimage, personal illness, and changes in biological functions. Discussion: PSLES was developed for adult Indians, and its use in the elderly may need modification due to qualitatively and quantitatively varying life events, such as the importance of nonegocentric stress (loss of job of one's child) versus egocentric stress (own hospitalization) or change of salience of events (e.g., lack of son versus daughter). Conclusion: To improve the relevance of PSLES for life-event research and capture the unique experiences of the elderly, suggested modifications are necessary.
Community Mental Health Journal, 2021
Within the ambit of the National Mental Health Program, the Government of India has mandated long... more Within the ambit of the National Mental Health Program, the Government of India has mandated long-acting risperidone, a patented molecule of Janssen Pharmaceutica. We contest that the healthcare system of India is ill-equipped (due to its weak infrastructure) to monitor side effects, regulate the use, and ensure informed consent. The process of including patented Risperdal Consta into the Indian formulary has lacked transparency and suggests undo favor towards Janssen. Janssen Pharmaceutica is known for its aggressive marketing strategy resulting in off-label use of oral risperidone in the US. Moreover, the lax regulatory structure for pharmaceutical dispensing in India coupled with Janssen's aggressive marketing is a potential cause of concern. We are critical of the decision to include a costly and patented molecule in a publicly financed health program otherwise sourced by generic drugs.
Perspectives in Psychiatric Care, 2021
PURPOSE This study examined therapeutic milieu interventions on self-esteem, socio-occupational f... more PURPOSE This study examined therapeutic milieu interventions on self-esteem, socio-occupational functioning, and depressive symptoms among inpatients with depressive disorders. METHODS A pretest-posttest nonequivalent control group quasi-experimental design was adopted. Sixty participants with depression who got admitted to the general hospital psychiatric ward were assigned to a control (Treatment as Usual) group and an experimental (therapeutic milieu intervention) group nonrandomly using a convenience sampling technique. We evaluated the following outcome measures: self-esteem, socio-occupational functioning, and depressive symptoms for both groups at baseline, 4th, 8th, and 12th weeks. RESULTS Therapeutic milieu interventions improved self-esteem, socio-occupational functioning, and reduced depressive symptoms. The findings provided initial evidence for practice. IMPLICATIONS Psychiatric nurses can implement simple, milieu therapy interventions in any setting, which will enhance the clinical outcomes and socio-occupational functioning of depressive patients.
Journal of Cleft Lip Palate and Craniofacial Anomalies, 2020
Introduction: Cleft lip and palate are a common but significantly disfiguring congenital anomaly ... more Introduction: Cleft lip and palate are a common but significantly disfiguring congenital anomaly affecting children. Besides the multiple problems they pose regarding the child's feeding, speech, and hearing, being visible, they cause a major social stigma. Different degrees of parental guilt and shame are frequently encountered, primarily due to the perceived cause of the birth defect. Aims: This study aims to define parental perceptions associated with a child of cleft lip or palate and their social significance. Materials and Methods: A detailed questionnaire was structured based on a previous study by Weatherly-White (2004). A sample of 64 families was selected by total enumerative sampling technique over a period of one year. Tools were translated into Hindi (local language) and validated. Parents not willing to participate or unable to understand Hindi or English were excluded from the study. The data were collected using questionnaire and semi-structured interviews. Ethical clearance was obtained and consent was taken from parents for participation in the study. Results: Parents of 63 patients were interviewed and the results were tabulated. Conclusion: The study identified many cultural and societal attitudes that deeply affect the way that communities treat children with clefts and other facial deformities. The results interestingly almost mirror the last study similar to this, almost 20 years ago. It is surprising to note the beliefs and perceptions about clefts have remained largely unchanged.
Lung India : official organ of Indian Chest Society
Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations incl... more Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations including psychiatric comorbidities most commonly being depression and/or anxiety. Studies regarding the association of these psychiatric comorbidities in terms of symptom scores, spirometric variables, and hospitalizations among patients of COPD are lacking, especially in India. One hundred and twenty-eight patients of COPD attending the Outpatient Department of AIIMS Rishikesh, and fulfilling inclusion criteria were screened by Hospital Anxiety and Depression Scale, and those who scored above the cutoff underwent psychiatric evaluation using the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research for confirmation of their diagnosis. All patients were then evaluated by physician-administered questionnaire for symptom scores by Modified Medical Research Council Scale (mMRC) for dyspnea, Hindi-validated Clinical COPD Questionnaire (CCQ), and for functional...
Epilepsy & Behavior, 2016
This piece describes a very simple, economical yet innovative use of mobile technology in aiding ... more This piece describes a very simple, economical yet innovative use of mobile technology in aiding clinical history taking in a specific situation, i.e. “transient episodic behavioural disturbances” (particularly complex patterns of seizures, non-epileptic attack disorder, and sleep associated behavioural disturbances). Using video recording function present in (even low cost) mobile phones, video samples of such episodic attacks is reported to be a helpful aid to clinical history taking in a busy clinical consultation facility, a practice that has helped me on many occasions.
Indian journal of medical ethics
The Indian journal of medical research, 2012
Sir, It was astounding to read the article in the daily ‘The Times of India’ dated August 19, 201... more Sir, It was astounding to read the article in the daily ‘The Times of India’ dated August 19, 2011 on a medical postgraduate seat sold out for Rs. 1.7 crore1. Though it was not something new, keeping in mind the recent trend towards privatization of medical education in India. For a scholarly take on the phenomenon, I would make note of some historical turning points and discuss the implications arising thereof. Firstly there has been a slow yet consistent change in the economic policies of India post 1990s marked by the shift of provision of social services from government sources to the non-government (for-profit and not for-profit) sector under the name of neo-liberal policies. This included the privatization of higher educational services (such as medical education). The logic being (presumably) low social returns on expenditure in higher education2,3 and preservation of limited resources for the more important task of financing primary and secondary education4. Moreover, the impetus to private medical education was to offset the short supply of medical professionals. To facilitate establishment of private medical colleges the government from time to time provided land to private players for free or at discounted rates5, relaxed norms for the requirement of minimal land area6 and exempted tax for importing high end medical equipment. The second turning point was the Honourable Supreme Court's (SC) judgment on the TMA Pai Foundation & others vs. State of Karnataka case7 and other related judgments followed by ‘The Private Professional Educational Institutions (Regulation of Admission and Fixation of Fee) Bill, 2005’ allowing maximum autonomy to the private medical institutes with respect to admission procedure (including control over entrance tests)8, fee structure, and abolishing of State quotas9. It allowed up to 50 per cent seats to be reserved under the management category while only 15 per cent for general category to be filled on an all-India basis. The said bill's ambiguity over allowable profits (termed ‘reasonable surplus’), fair and transparent admission procedure under the ‘management category’ without any legal/administrative tool for the State to oversee, control and intervene had allowed scope for manipulation by private colleges10. In addition, sting operations by media group have unearthed the practice of capitation fees despite SC judgments illegalizing it11. The third turning point was the revelations made by the arrest of President of Medical Council of India (MCI) Ketan Desai on charges of corruption. This also resulted in the dissolution of MCI in 2010. Though Desai was removed from the said position (on charges of misuse of office) earlier in 200112,13, he regained his presidentship in 2009. In 2010, Desai and three others were caught red handed in a bribery case related to MCI recognition of a private medical college14. This need for (re-)recognition from the MCI in the face of many private medical colleges lacking the minimum standards has sown the seed for corruption. As many would agree, such practices have now been prevalent for a long time, thus to assume a single person to be at the root of the problem would be erroneous. In addition, such corruption is partly augmented by the involvement of certain politicians in the management of various medical colleges13. The fourth turning point has been the amorphous and disjointed changes in the consciousness of the young Indian medical professionals on the issue of medical practice and medical specialization. In present times (super-) specialization in medical discipline is becoming an essential requirement in the opinion of young medical graduates. Partly this may be due to the trend in (bio-) medical sciences towards increased dependence on technology, and partly this is determined by the medical market (in the case of Indian graduates the private practice and corporate hospital arena, the migration to first world nations or the concentration of government provided advanced medical facilities in urban influential areas). The importance of research and teaching which is the essence of postgraduate medical training has entirely been usurped by the market of specialized clinical practice. At the same time private healthcare is ailing under the pressure of unhealthy competition resulting in irrational prescription practices and unwarranted diagnostics15 which may be socially wasteful and personally burdensome. The establishment of private higher education in India was a commitment towards market economy and an outcome of the shortfall of public resources for funding. The expansion though, took place due to collusion between powerful politicians and the government apparatus in-charge of control of its standards. In the aftermath what can be seen is confusion not only in the ideological commitment of the Indian polity and in the regulatory understanding of Indian judiciary but also in the values of merit among the Indian middle class.…
International Journal of Occupational Safety and Ergonomics, 2013
Objective. We examined the personality correlates of accident-proneness of auto-rickshaw drivers ... more Objective. We examined the personality correlates of accident-proneness of auto-rickshaw drivers in the Indian city of Ranchi. Methods. This was a cross-sectional study in which 50 male drivers aged 18-50 years, selected randomly from a list of licensed auto-rickshaw drivers in Ranchi, were assessed with a Hindi version of Cattell's 16 Personality Factors (16-PF) Questionnaire. Results. There was a significantly higher frequency of breaking rules, crossing speed limits, substance use and a trend towards a higher frequency of carrying extra persons (i.e., more than recommended) in accident-prone drivers. There was significant negative correlation of accident-proneness with 16-PF factors such as reasoning, rule consciousness, apprehension and emotional stability. Conclusion. Personality characteristics with lower scores of reasoning, rule consciousness, apprehension and emotional stability are common in commercial auto-rickshaw drivers with high accident-proneness.
Asian Journal of Psychiatry, 2013
Asian Journal of Psychiatry, 2014
India, among the low-and middle-income countries, in the 1980s, made an early attempt at formulat... more India, among the low-and middle-income countries, in the 1980s, made an early attempt at formulating a mental health program. India's National Mental Health Program (NMHP) intended to attend to the mental health needs of all her citizens. Some aspects of this program bear significant resemblance to what recent experts in global mental health (GMH) have been proposing. The paper uses India as a country-level example to review and critically analyze the contextual background culminating in the formulation of the NMHP. Literature searches from two bibliographic databases (PubMed and Google Scholar) with supplementary searches and manual search from Indian Journal of Psychiatry were made relating to the context of formulation of India's NMHP. The search helped isolate 12 peer reviewed journal articles, three chapters from books, and one policy group approach paper. This literature has been synthesized to enumerate the various contextual factors. The present analysis identifies two vital factors relevant for international health, viz. the primary health care movement and the changing concepts of institutional care/de-institutionalization in mental health. This then puts in perspective the opportunities allowed and challenges produced, for NMHP, by subsequent changes in public health services in India. The lessons for GMH movement are then pointed out.
Indian Journal of Psychological Medicine, 2022
Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performan... more Viewpoint Anindya Das 1 instrument for health systems has two primary purposes: improve performance and encourage accountability, besides allowing judicious health system decision making. 3 While choosing a measure that eventually contributes to a composite index, a few crucial elements that need consideration are defining priority areas, avoiding positively correlated measures (as it may lead to "double counting)," 3 and data that are robust and part of a routine process. Health outcome measures such as under-five mortality rate or suicide rate are dependent not only on the health service system but also on an extraneous complex of social, cultural, environmental, and political factors. For example, the suicide rate is also determined by employment and livelihood issues, religious beliefs, gender, socioeconomic status, ruralurban differences, etc. 4 However, health systems, too, are part of the latter complex. In contrast, inputs and process indicators are contingent on the functioning of the health service system 1 and are sensitive to change.
Bengal Journal of Psychiatry
Worldwide research has provided evidence of premature death in people with mental illness (as com... more Worldwide research has provided evidence of premature death in people with mental illness (as compared to the general population). Moreover, in recent decades, the mortality gap between the preceding two groups has not shown any decline even in countries with the most accessible/responsive health systems. This essay considers mortality to be influenced by a multiplicity of factors, many of which, in addition, influence the rate of occurrence and recovery from mental illnesses. The essay examines these factors and analyses them through the lens of structural discrimination (defined as institutional and social structures that perpetuate norms, practices and behavior that deny opportunities/rights to others, often members of a minority). The implications for India in this regard are also reflected upon.
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British Journal of Psychiatry, 2022
Indian Journal of Psychiatry, 2020
This piece describes a very simple, economical yet innovative use of mobile technology in aiding ... more This piece describes a very simple, economical yet innovative use of mobile technology in aiding clinical history taking in a specific situation, i.e. “transient episodic behavioural disturbances” (particularly complex patterns of seizures, non-epileptic attack disorder, and sleep associated behavioural disturbances). Using video recording function present in (even low cost) mobile phones, video samples of such episodic attacks is reported to be a helpful aid to clinical history taking in a busy clinical consultation facility, a practice that has helped me on many occasions.
Indian journal of psychological medicine, 2012
Journal of Clinical Psychopharmacology, 2007
The phenomena that define catatonia have been traditionally conceptualized as motor abnormalities... more The phenomena that define catatonia have been traditionally conceptualized as motor abnormalities that occur in association with changes in thought, mood, and vigilance. 1 The most common signs are mutism, posturing, negativism, staring, rigidity, and echo phenomena. In the ...
Journal of Clinical Psychopharmacology, 2007
An 18-year-old man having no contributory past or family history was brought to our clinic with h... more An 18-year-old man having no contributory past or family history was brought to our clinic with history suggestive of an International Classification of Diseases, 10th Revision, psychotic manic episode. He was drug naive, and no symptom suggestive of OCD was present. We ...
Australian and New Zealand Journal of Psychiatry, 2006
... Olanzapine-induced oculogyric crisis. Pushpal Desarkar,; Anindya Das,; Vinod K. Sinha. Articl... more ... Olanzapine-induced oculogyric crisis. Pushpal Desarkar,; Anindya Das,; Vinod K. Sinha. Article first published online: 20 MAR 2006. DOI: 10.1111/j.1440-1614.2006.01805.x. Issue. Australian and New Zealand Journal of Psychiatry. Volume 40, Issue 4, page 374, April 2006. ...
European Child & Adolescent Psychiatry, 2006
Over two thirds of people suffering from depression complain of pain with or without reporting ps... more Over two thirds of people suffering from depression complain of pain with or without reporting psychological symptoms. Physical symptoms are more prevalent among the women, the elderly, the poor, and in children population. Successful treatment of depression in children complicated by pain symptoms constitutes a great clinical challenge. Duloxetine has already emerged as a safe and effective treatment option for adult depressed patients with painful physical symptoms. However, no data exist in literature which suggests use of duloxetine in childhood and adolescent population for the same clinical indication. We report a case documenting successful use of duloxetine in a depressed girl child who also had severe pain and dissociative symptoms.
The Indian parliament recently passed its Mental Health Care Bill. Though it is more rights-based... more The Indian parliament recently passed its Mental Health Care Bill. Though it is more rights-based compared to the previous Mental Health Act, 1987 the post seeks to describe what is needed to be done next for the realization of the objectives of the Bill.