Vikram Patel - Academia.edu (original) (raw)
Papers by Vikram Patel
American Journal of Psychiatry, 2002
This study described the natural history of depression in mothers who recently gave birth in a lo... more This study described the natural history of depression in mothers who recently gave birth in a low-income country and to investigate the effect of risk factors, particularly related to infant gender bias, on the occurrence and outcome of depression. The authors studied a group of pregnant mothers recruited during their third trimester of pregnancy from a district hospital in Goa, India. The mothers were interviewed at recruitment, 6-8 weeks, and 6 months after childbirth. Interview data included presence of antenatal and postnatal depression, obstetric history, economic and demographic characteristics, and gender-based variables (preference for male infant, presence of marital violence). Depressive disorder was detected in 59 (23%) of the mothers at 6-8 weeks after childbirth; 78% of these patients had had clinically substantial psychological morbidity during the antenatal period. More than one-half of the patients remained ill at 6 months after delivery. Economic deprivation and poor marital relationships were important risk factors for the occurrence and chronicity of depression. The gender of the infant was a determinant of postnatal depression; it modified the effect of other risk factors, such as marital violence and hunger. Depressed mothers were more disabled and were more likely to use health services than nondepressed mothers. Maternal and infant health policies, a priority in low-income countries, must integrate maternal depression as a disorder of public health significance. Interventions should target mothers in the antenatal period and incorporate a strong gender-based component.
Social Science & Medicine, 2003
There is little qualitative research on depression in motherhood from non-Western societies. The ... more There is little qualitative research on depression in motherhood from non-Western societies. The objective of the study described in this paper was to use qualitative methods to investigate the cultural validity of the construct of post-natal depression (PND) and its social and cultural contexts. The study was nested in a cohort of mothers recruited to study the risk factors and outcome of PND in Goa, India. In-depth interviews were carried out with 39 mothers (19 of whom were found to be suffering from PND as defined by a cut-off score on the Edinburgh PND scale) and their husbands purposively recruited from the cohort. An illness narrative was conducted with mothers who were categorized as suffering from PND and their husbands to elicit their explanatory models. The two groups (PND and non-PND) of mothers were comparable in terms of socio-demographic characteristics. PND mothers had lower levels of practical help and emotional support. The symptoms reported by PND mothers were similar to those recorded in studies with women in other cultures suggesting a universal clinical presentation of PND. Causal attributions for the experience of depression focused on economic difficulties and poor marital relationship. All mothers expressed the need for more practical help and support during the period after childbirth; husbands in both groups were often disengaged from baby care or supporting the mother. The study provides validity for the construct of PND in an Indian setting, but also shows that the emotional distress is interpreted from the context of social adversity, poor marital relationships and cultural attitudes towards gender rather than a biomedical psychiatric category. Contrary to the assumption that socio-cultural contexts associated with childbirth in non-Western societies protect mothers from depression, factors unique to the culture such as gender preference and the low involvement of husbands in child-care are major causes of stress to mothers.
Lancet, 2008
The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is ... more The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally diff erent from acute care, relying on several features: opportunistic case fi nding for assessment of risk factors, detection of early disease, and identifi cation of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-eff ectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment.
British Journal of Psychiatry, 1922
Mental disorders are diseases that affect cognition, emotion, and behavioral control and substant... more Mental disorders are diseases that affect cognition, emotion, and behavioral control and substantially interfere both with the ability of children to learn and with the ability of adults to function in their families, at work, and in the broader society. Mental disorders tend to begin early in life and often run a chronic recurrent course. They are common in all
Psychological Medicine, 2000
There is now a considerable body of epidemiological evidence from developing countries and multil... more There is now a considerable body of epidemiological evidence from developing countries and multilateral agencies that so called common mental disorders are common and disabling (eg Murray & Lopez, 1996; Patel et al. 1998). The logical next step is to identify efficacious ...
British Journal of Psychiatry, 1998
This study examined the association of common mental disorders in primary health clinic attenders... more This study examined the association of common mental disorders in primary health clinic attenders with indicators of poverty and disability in Goa, India. Adult attenders (n = 303) in two primary health clinics were recruited. There were 141 (46.5%) cases of common mental disorder. The following were associated with common mental disorder: female gender; inability to buy food due to lack of money; and being in debt. Cases scored significantly higher on all measures of disability. Primary health clinic staff recognised a third of the morbidity but used multiple oral drugs, injectable vitamins and benzodiazepines to treat common mental disorders. Poverty is closely associated with common mental disorder which in turn is associated with deprivation and despair. Primary mental health care priorities in low-income countries need to shift from psychotic disorders which often need specialist care to common mental disorders. Health policy and development agencies need to acknowledge the intimate association of female gender and poverty with these disorders.
Social Science & Medicine, 1999
British Journal of Psychiatry, 1998
Little is known about the outcome of common mental disorders (CMD) in primary care attenders in l... more Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries. Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n = 199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness. The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation. A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.
British Journal of Psychiatry, 1997
Lancet, 2003
Common mental disorders are associated with substantial morbidity and disability in developing co... more Common mental disorders are associated with substantial morbidity and disability in developing countries, but there are no data for efficacy of treatment. We aimed to assess the efficacy and cost-effectiveness of antidepressant and psychological treatment for common mental disorders in general health-care settings. We did a randomised, placebo-controlled trial (double-blind for the antidepressant group) in general outpatient clinics in two district hospitals in Goa, India. Consecutive eligible adults who scored more than 15 on the Revised Clinical Interview Schedule (n=450) were randomly assigned to antidepressant (fluoxetine), placebo, or psychological treatment. Antidepressant or placebo was provided for up to 6 months. Up to six sessions of psychological treatment were provided by trained therapists. The primary outcome was psychiatric morbidity; secondary outcomes were disability and costs. Outcome measurements were done at 2, 6, and 12 months. Intention-to-treat analyses were done with linear regression. 80% of patients were reviewed; the number of drop-outs was similar in all three groups. Psychiatric outcome was significantly better with antidepressant than with placebo at 2 months (p=0.02; standardised effect size 0.3), but not over the 2-12 month period (p=0.10); antidepressants were significantly more cost effective than placebo in the short term and long term (p<0.05). Psychological treatment was not more effective than placebo for any outcome during either period. Affordable antidepressants such as fluoxetine should be the treatment of choice for common mental disorders in general health-care settings in India, since they are associated with improved clinical and economic outcomes, especially in the short term.
Lancet, 2007
Background Depression is an important public-health problem, and one of the leading causes of dis... more Background Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the eff ect of depression, alone or as a comorbidity, on overall health status.
American Journal of Psychiatry, 2002
This study described the natural history of depression in mothers who recently gave birth in a lo... more This study described the natural history of depression in mothers who recently gave birth in a low-income country and to investigate the effect of risk factors, particularly related to infant gender bias, on the occurrence and outcome of depression. The authors studied a group of pregnant mothers recruited during their third trimester of pregnancy from a district hospital in Goa, India. The mothers were interviewed at recruitment, 6-8 weeks, and 6 months after childbirth. Interview data included presence of antenatal and postnatal depression, obstetric history, economic and demographic characteristics, and gender-based variables (preference for male infant, presence of marital violence). Depressive disorder was detected in 59 (23%) of the mothers at 6-8 weeks after childbirth; 78% of these patients had had clinically substantial psychological morbidity during the antenatal period. More than one-half of the patients remained ill at 6 months after delivery. Economic deprivation and poor marital relationships were important risk factors for the occurrence and chronicity of depression. The gender of the infant was a determinant of postnatal depression; it modified the effect of other risk factors, such as marital violence and hunger. Depressed mothers were more disabled and were more likely to use health services than nondepressed mothers. Maternal and infant health policies, a priority in low-income countries, must integrate maternal depression as a disorder of public health significance. Interventions should target mothers in the antenatal period and incorporate a strong gender-based component.
Social Science & Medicine, 2003
There is little qualitative research on depression in motherhood from non-Western societies. The ... more There is little qualitative research on depression in motherhood from non-Western societies. The objective of the study described in this paper was to use qualitative methods to investigate the cultural validity of the construct of post-natal depression (PND) and its social and cultural contexts. The study was nested in a cohort of mothers recruited to study the risk factors and outcome of PND in Goa, India. In-depth interviews were carried out with 39 mothers (19 of whom were found to be suffering from PND as defined by a cut-off score on the Edinburgh PND scale) and their husbands purposively recruited from the cohort. An illness narrative was conducted with mothers who were categorized as suffering from PND and their husbands to elicit their explanatory models. The two groups (PND and non-PND) of mothers were comparable in terms of socio-demographic characteristics. PND mothers had lower levels of practical help and emotional support. The symptoms reported by PND mothers were similar to those recorded in studies with women in other cultures suggesting a universal clinical presentation of PND. Causal attributions for the experience of depression focused on economic difficulties and poor marital relationship. All mothers expressed the need for more practical help and support during the period after childbirth; husbands in both groups were often disengaged from baby care or supporting the mother. The study provides validity for the construct of PND in an Indian setting, but also shows that the emotional distress is interpreted from the context of social adversity, poor marital relationships and cultural attitudes towards gender rather than a biomedical psychiatric category. Contrary to the assumption that socio-cultural contexts associated with childbirth in non-Western societies protect mothers from depression, factors unique to the culture such as gender preference and the low involvement of husbands in child-care are major causes of stress to mothers.
Lancet, 2008
The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is ... more The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally diff erent from acute care, relying on several features: opportunistic case fi nding for assessment of risk factors, detection of early disease, and identifi cation of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-eff ectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment.
British Journal of Psychiatry, 1922
Mental disorders are diseases that affect cognition, emotion, and behavioral control and substant... more Mental disorders are diseases that affect cognition, emotion, and behavioral control and substantially interfere both with the ability of children to learn and with the ability of adults to function in their families, at work, and in the broader society. Mental disorders tend to begin early in life and often run a chronic recurrent course. They are common in all
Psychological Medicine, 2000
There is now a considerable body of epidemiological evidence from developing countries and multil... more There is now a considerable body of epidemiological evidence from developing countries and multilateral agencies that so called common mental disorders are common and disabling (eg Murray & Lopez, 1996; Patel et al. 1998). The logical next step is to identify efficacious ...
British Journal of Psychiatry, 1998
This study examined the association of common mental disorders in primary health clinic attenders... more This study examined the association of common mental disorders in primary health clinic attenders with indicators of poverty and disability in Goa, India. Adult attenders (n = 303) in two primary health clinics were recruited. There were 141 (46.5%) cases of common mental disorder. The following were associated with common mental disorder: female gender; inability to buy food due to lack of money; and being in debt. Cases scored significantly higher on all measures of disability. Primary health clinic staff recognised a third of the morbidity but used multiple oral drugs, injectable vitamins and benzodiazepines to treat common mental disorders. Poverty is closely associated with common mental disorder which in turn is associated with deprivation and despair. Primary mental health care priorities in low-income countries need to shift from psychotic disorders which often need specialist care to common mental disorders. Health policy and development agencies need to acknowledge the intimate association of female gender and poverty with these disorders.
Social Science & Medicine, 1999
British Journal of Psychiatry, 1998
Little is known about the outcome of common mental disorders (CMD) in primary care attenders in l... more Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries. Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n = 199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness. The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation. A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.
British Journal of Psychiatry, 1997
Lancet, 2003
Common mental disorders are associated with substantial morbidity and disability in developing co... more Common mental disorders are associated with substantial morbidity and disability in developing countries, but there are no data for efficacy of treatment. We aimed to assess the efficacy and cost-effectiveness of antidepressant and psychological treatment for common mental disorders in general health-care settings. We did a randomised, placebo-controlled trial (double-blind for the antidepressant group) in general outpatient clinics in two district hospitals in Goa, India. Consecutive eligible adults who scored more than 15 on the Revised Clinical Interview Schedule (n=450) were randomly assigned to antidepressant (fluoxetine), placebo, or psychological treatment. Antidepressant or placebo was provided for up to 6 months. Up to six sessions of psychological treatment were provided by trained therapists. The primary outcome was psychiatric morbidity; secondary outcomes were disability and costs. Outcome measurements were done at 2, 6, and 12 months. Intention-to-treat analyses were done with linear regression. 80% of patients were reviewed; the number of drop-outs was similar in all three groups. Psychiatric outcome was significantly better with antidepressant than with placebo at 2 months (p=0.02; standardised effect size 0.3), but not over the 2-12 month period (p=0.10); antidepressants were significantly more cost effective than placebo in the short term and long term (p<0.05). Psychological treatment was not more effective than placebo for any outcome during either period. Affordable antidepressants such as fluoxetine should be the treatment of choice for common mental disorders in general health-care settings in India, since they are associated with improved clinical and economic outcomes, especially in the short term.
Lancet, 2007
Background Depression is an important public-health problem, and one of the leading causes of dis... more Background Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the eff ect of depression, alone or as a comorbidity, on overall health status.