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Poor psychological health is a serious public health concern, and determining factors thereof is of utmost importance to researchers and policymakers. This study examines sociodemographic, lifestyle and health factors associated with psychological health among adults from a semirural multi-ethnic population in Malaysia. Data were derived from a large-scale cross-sectional survey conducted in Malaysia. Psychological health was assessed by the psychological domain of the World Health Organization Quality of Life (WHOQOL). The relationships between the scores of psychological health and sociodemographic, lifestyle, and health factors were evaluated using Poisson regression, stratified by ethnic groups. Results showed that among Malays, income, education and being married were positively associated with psychological health outcomes, whereas age and being diagnosed with diabetes were correlated with undesirable psychological health. Chinese who had higher incomes, had higher education levels, were married, did not consume alcohol, and did not live with diabetes tended to have better psychological health than others. Indians and those of other ethnic groups with poor psychological health were more likely to have low incomes, be older, be less educated and have diabetes. Hypertension diagnosis was associated with poorer psychological health, particularly among the Malay and Indian/others ethnic groups. However, smoking was not associated with psychological health in all ethnic groups. In conclusion, there were differentiated roles of sociodemographic and health factors across ethnic groups in psychological health. Therefore, public health interventions directed toward improving quality of life among individuals of different ethnicities should pay attention to the roles of sociodemographic traits and health profiles.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Pregnant women are at increased risk for mental health issues such as anxiety and depression, influenced by multiple psychosocial factors. The current study aimed to develop and validate a proforma for screening psychosocial concerns in Indian pregnant women. This study used a mixed-methods design. In Phase 1, a detailed literature review and in-depth interviews with nine pregnant women at a private hospital in India were conducted, leading to the development of a preliminary draft of the proforma to understand the psychosocial concerns of pregnant women. In Phase 2, the proforma was validated by six subject matter experts in perinatal care. Content validation of the proforma was calculated using the item content validity index and the modified kappa (k*) statistic. Thematic analysis identified three major themes: Informed choice about pregnancy, navigating the journey of pregnancy, and social support. These themes and other major psychosocial risk factors, derived from an extensive literature review, guided the development of the screening proforma. All items in the screening proforma met the criteria for relevance and simplicity; however, two items required revision for clarity. After the necessary revisions, the final screening proforma consisted of eight domains and 20 items. Screening pregnant women using a psychosocial proforma during routine antenatal checkups facilitates timely referrals to mental health professionals, thereby promoting holistic, and culturally sensitive maternal care.
We aimed to study the prevalence of behavioral problems among school-going children, the factors affecting them, and to establish normative scores for the Strengths and Difficulties Questionnaire (SDQ) parent form. A cross-sectional questionnaire-based study was conducted among schoolchildren aged 6-11 years from two primary schools in South India. Parents of children included in the study were asked to fill out the Kannada/English version of the SDQ Parent Form. The SDQ parent report forms were filled by parents of 671 children, of which 49.8% (n = 334) were boys with a M: F ratio of 1:1.01. There was an equal distribution across different age groups. The comparison of scores between boys and girls showed no statistically significant difference in all scales except for the hyperactivity subscale, where the boys had a higher score with a median (IQR) of 4 (2,5) compared to the girls' score of 3 (1,4) (p = .001). Regarding age, although the total difficulties score, conduct problems score, hyperactivity score, and internalizing score were higher in the 9-11-year-old group than in the 6-8-year-old group, the p value was not significant. Children of fathers with higher educational status scored better in the peer problems and prosocial scores. The newer cut-off scores have been generated and are divided into four bands, similar to the 4-band categorization on the SDQ scoring site. Boys had higher scores on the hyperactivity subscale than girls. Normative data for Indian children aged 6-11 years have been generated and are similar to UK data.
Despite a high burden of psychological issues in low- and middle-income sub-Saharan countries, no national-level assessment exists for Senegal. To assess the prevalence and predictors of psychological issues, we analyzed the 2023 Senegal Demographic and Health Survey (DHS) data from 75,080 household members. The prevalence of psychological issues in Senegal was 5% (95% CI = 5.2-5.6). It was highest in the Matam region (8.7%) and lowest in the Saint-Louis region (3.5%). Female gender (adjusted odds ratios [aOR] = 1.11, 95% CI = 1.02-1.22), no education (aOR = 1.24, 95% CI = 1.11-1.36), singlehood (aOR = 1.64, 95% CI = 1.46-1.85), owned housing (aOR = 1.52, 95% CI = 1.26-1.84), rural residency (aOR = 1.18, 95% CI = 1.05-1.32), higher household size (aOR = 1.01, 95% CI = 1.01-1.02), indoor second-hand smoke (SHS) (aOR = 1.57, 95% CI = 1.43-1.73), and shock events (aOR = 1.61, 95% CI = 1.48-1.76) increased the likelihood of psychological issues. Access to video players (aOR = 0.22, 95% CI = 0.12-0.41), mobile phones (aOR = 0.77, 95% CI = 0.68-0.87), and the internet (aOR = 0.79, 95% CI = 0.66-0.96) reduced the likelihood of psychological issues. The burden of psychological issues is high in Senegal. Socio-demographic predictors suggest higher vulnerability among females, the uneducated, unmarried, and rural residents. Stressors such as shock events and indoor SHS increase the risk of psychological issues among household members. Access to recreational tools such as video players, mobiles, and the internet is beneficial in reducing psychological issues. Policy reforms prioritizing strategies to reduce psychological issues and integrating mental health services into healthcare delivery are discussed and recommended.
Patients with serious mental illness experiencing psychosis go through many challenges in their daily life activities. Despite the relevance of this issue, qualitative studies on this area from the Global South are scarce. This qualitative study aims to explore the impact of psychosis on functioning in patients with serious mental illness. Nine patients clinically diagnosed with serious mental illness, aged 18-60, identified through maximum variability sampling, were approached for written informed consent. Subsequently, they were invited for an in-person interview regarding the impact of psychosis on their daily activities and everyday functioning. Interviews were also conducted with seven primary caregivers and four healthcare professionals working in the field of mental health. The interviews were audio-recorded, transcribed, and thematically coded in Microsoft Word and Microsoft Excel. The data analysis was done using the Systematic Text Condensation (STC) strategy. Interviews were conducted until thematic saturation was achieved. The key themes are presented as: Influence of psychosis on functioning, personal narratives of living with psychosis, and personal anecdotes from mental health professionals on psychosis and functioning. The results highlight the multidimensional nature of psychotic experiences, which reach beyond clinical manifestations and lead to significant emotional distress, reduced self-worth, and a diminished sense of personal identity. This study brings out the need for holistic, patient-centered approaches that recognize the complex lived experiences of individuals experiencing psychosis, emphasizing the importance of comprehensive support systems that address functional, social, and psychological dimensions of mental illness.
Body image dissatisfaction (BID) is associated with compromised psychological well-being (PWB) and quality of life (QoL); however, the mechanisms underlying these associations remain underexplored in non-Western populations. This study tested whether psychological distress mediates the BID-PWB and BID-QoL relationships among college-going young adults in urban India, and examined gender differences across these pathways. A cross-sectional study was conducted with 225 participants (125 females, 100 males; M age = 19.87 years, SD = 1.95) from University of Delhi-affiliated institutions. BID, psychological distress, QoL, and PWB were assessed using validated self-report instruments. Structural equation modelling (SEM) with bootstrapped indirect effect analysis (2,000 resamples; 95% bias-corrected CIs) examined direct and mediated pathways. The final model demonstrated excellent fit (χ 2 [26, N = 225] = 34.99, p = .112; CFI = 0.99; TLI = 0.98; RMSEA = 0.04). BID dimensions-self-aggrandisement, body acceptance, and vitality-exerted significant indirect effects on QoL and PWB via psychological distress, with direct pathways non-significant after accounting for the mediator, indicating full mediation. Physical contact and sexual fulfilment showed additional direct associations with specific QoL and PWB indices. Contrary to prevailing assumptions, no gender differences emerged in psychological distress, suggesting BID-related psychological burden is equitably distributed across genders. BID compromises QoL and PWB primarily through psychological distress, identifying distress reduction as an efficient intervention target. These findings extend the body image literature into a collectivistic cultural context, suggesting that sociocultural factors attenuate gender-differential vulnerability patterns observed in Western samples. Culturally adapted, distress-focused interventions within college mental health frameworks are recommended; longitudinal research is needed to establish causal directionality.
Sexually transmitted infections (STIs) have emerged as significant public health concerns, imposing a substantial burden on both individuals and the healthcare system of the country. Additionally, STIs may also result in major extensive psychological consequences that profoundly affect individuals with STIs. Despite the government's implementation of different initiatives aimed at addressing STI-related challenges, these conditions are associated with shame and stigma which act as barriers to the effective utilisation of healthcare services. The purpose of the present study is to generate evidence on barriers and facilitators to service utilisation and management of STIs in India. Indian Council of Medical Research, New Delhi, is conducting a multi-centre study employing a mixed-method approach. The study involves different levels of healthcare systems, including both government and private healthcare facilities across seven sites in several states of India, including Maharashtra, Rajasthan, Punjab, Bihar, Uttar Pradesh and New Delhi. For the quantitative data, individuals seeking healthcare services related to STIs will be enrolled and assessed using a semi-structured pilot-tested questionnaire. In-depth interviews and focus group discussions will also be conducted with different stakeholders as per the standard guidelines of the qualitative method by the designated trained project staff. Descriptive and inferential statistics will be applied to the quantitative data, while the qualitative data will be analysed using a deductive approach with thematic content analysis. The study protocol has been approved by the ethics review committees of all the participating sites individually. The findings from this study will be published in peer-reviewed journals and disseminated through scientific conferences and meetings among policy-makers and government agencies. AIIMS/IEC/2024/609; AIIMS/Pat/IEC/2024/1205; F. 7/BIOETHICS/AIIMS-RBL/APPROEM/2021/1; KIMSDU/IEC/11/2022; LHMC/IEC/2024/11; IEC/02/EX/2024; PGI/IEC/2024EIC000373.
Nomophobia is a psychological condition characterized by an individual's fear of being disconnected from smartphone connectivity. Nomophobia Questionnaire (NMP-Q) is the most used self-reported measure to assess nomophobia across the globe. Therefore, the present study aimed to assess the factor structure, reliability, and validity of NMP-Q among Indian undergraduate college students. Using a cross-sectional design, our study employed an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), where data was collected from three centres across India. EFA was carried out to obtain factor structure and check the internal consistency among items. CFA was carried out to test the factor structure of NMP-Q. Convergent and discriminant validity were tested using bivariate correlation analysis. Exploratory factor analysis showed that the questionnaire has good internal consistency (Cronbach's alpha reliability coefficient= 0.952) with a three-factor pattern matrix. CFA explained three-factor structure which deemed to be the most tenable comprising of 20 items. NMP-Q fits good on almost all indices (CMIN/df= 3.01, CFI= 0.94, RMSEA=0.07, TLI=0.93, IFI=0.93) for the three-factor structure. Moderate to excellent associations were noted for the convergent (r=0.770) and divergent validity (r=-0.972) respectively. The NMP-Q demonstrated scores below 64 as no nomophobia; from 64-79 for mild nomophobia; 80-95 for moderate nomophobia and >95 indicated severe nomophobia for our population. The Nomophobia Questionnaire (NMP-Q) is a valid, accurate and reliable instrument that can measure nomophobia in the Indian youth population.
Opioid use disorder (OUD), particularly injection drug use (IDU), is on the rise and is associated with complications such as blood-borne infections, overdosing, and seizures, among others. Understanding factors distinguishing non-injecting opioid users (NIOU) and IDUs is essential for the development of effective prevention and management strategies. This study aimed to compare sociodemographic, clinical, and psychosocial factors between IDUs and NIOUs. A cross-sectional study was conducted at a tertiary care center in North India, including 100 opioid-dependent males (50 NIOUs and 50 IDUs). Sociodemographic, clinical, and psychosocial variables were assessed using structured interviews and validated instruments, including the Maudsley Addiction Profile, the severity of dependence scale (SDS), the high-risk behavior scale (HRBS), the sensation seeking scale (SSS), the Barratt Impulsiveness Scale (BIS), and the WHO-ASSIST. IDUs had significantly higher histories of alcohol use, duration of cannabis use, and family history of substance use, and significantly higher scores on HRBS, BIS, and the SSS (p < .05). WHO-ASSIST and SDS scores were comparable between the groups. IDUs had a substantially higher number of days of heroin use in the last month and days of conflicts with relatives (p < .05). Mean duration of the transition period from NIOU to IDU was 4 ± 3.3 years. Family history of drug use, higher sensation seeking, impulsivity, and risk-taking behavior were found to be important factors related to IDU. Interventions targeting these factors are essential for preventing the transition from NIOU to IDU.
BACKGROUND: Outcome measurement and economic evaluation in mental health are increasingly conducted in challenging contexts, including for young people, in low- and middle-income countries, and outside of the healthcare system. This study aimed to assess the feasibility, acceptability, and content validity of two key preference-based measures (the EQ-5D-Y-3L and CHU9D) in such a context in India. METHODOLOGY: Ten cognitive interviews with semi-structured follow-up discussions and 164 surveys were conducted with adolescents in Indian schools. Coding of the cognitive interviews and semi-structured follow-up discussions was conducted to identify completion challenges. The surveys contained both instruments and open-ended follow-up questions, and were analysed to further explore the feasibility, acceptability, and content validity of the instruments. RESULTS: Error rates were higher for the EQ-5D-Y-3L than for the CHU9D in the cognitive interviews, principally due to the ‘Having pain or discomfort’ item, and difficulty in reporting what occurred ‘today’. A lower proportion of adolescents completed the full EQ-5D-Y-3L instrument in the surveys. The CHU9D was the more preferred instrument by participants for reasons including having more relevant content, particularly regarding mental and psychological health, and more response options. However, some participants indicated neither instrument covered all important aspects of their quality-of-life, including social interactions, education, and material circumstances. CONCLUSIONS: Researchers might prioritise the CHU9D as an instrument for measuring quality-of-life in school-going Indian adolescents. However, the measure was not without limitations, and careful attention should be paid to understanding age- and country-specific factors that pose challenges to its usage in economic evaluations.
The decriminalization of suicide under Section 115 of the Mental Healthcare Act (MHCA), 2017 marked a paradigm shift in India, reframing suicide attempts as manifestations of severe stress requiring care rather than punishment. However, gaps in clinician awareness and ambiguity regarding medico-legal responsibilities may hinder effective implementation of the law in clinical settings. This study aimed to assess non-psychiatric clinicians' awareness and attitudes regarding the decriminalization of suicide under the MHCA, 2017, and to explore potential implementation gaps. A cross-sectional questionnaire-based study was conducted among 134 clinicians from non-psychiatric departments at a tertiary-care center in central India. A structured, self-administered questionnaire assessed sociodemographic characteristics, awareness of legal provisions related to decriminalization, and attitudes toward its impact on stigma, help-seeking, and clinical practice. Descriptive statistics were computed, and subgroup comparisons based on years of clinical experience (≤1 year vs. >1 year) were performed using the chi-square test. Most clinicians were aware that suicide has been decriminalized in India (76.1%) and that individuals attempting suicide are presumed to be under severe stress (84.3%). Nearly four-fifths (79.1%) recognized the government's obligation to provide care and rehabilitation. However, 80.6% believed that reporting suicide attempts to legal authorities remains mandatory, and only 51.5% were aware of professional immunity from civil or criminal liability. Attitudes toward decriminalization were largely positive: 55.2% agreed that it reduces stigma, 56.8% felt it encourages help-seeking, and 88.8% reported a greater likelihood of psychiatric referral following decriminalization. Subgroup analysis did not reveal significant differences across experience levels. Non-psychiatric clinicians demonstrated generally favorable awareness and supportive attitudes toward the decriminalization of suicide. However, persistent misconceptions regarding medico-legal obligations suggest an implementation gap. Targeted training, legal-literacy initiatives, and clear institutional protocols are needed to ensure consistent, rights-based care in alignment with the MHCA 2017.
This scoping review was conducted to comprehensively examine global research on support groups for neurotypical siblings of individuals with autism spectrum disorder (ASD). The study aimed to understand the psychosocial needs of neurotypical siblings, the available support, and the effectiveness of support groups in informing the development of an optimal support framework. We adhered to the PRISMA extension for scoping reviews (PRISMA-ScR) to systematically map existing knowledge and identify gaps. The selection criteria included studies published in English from 2010 to 2024, including peer-reviewed articles, dissertations, and theses. A systematic literature search was conducted across PubMed, Google Scholar, MS Copilot, CINAHL, Ovid, and Web of Science, following a systematic framework, using defined keywords. Data extraction and peer reviews were conducted using spreadsheet-based methods to ensure methodological rigor. The spreadsheet included the study's metadata (title, author, year, and journal name), population demographics (gender, age, and sibling order), methodology, and limitations. Of 662 screened studies, 12 met the inclusion criteria after review of titles, abstracts, and full texts. Most studies focused on the impact (n = 4), sibling relationship (n = 3), and varied intervention types. Support groups were found to be a feasible and acceptable intervention for neurotypical siblings, offering improved understanding of their sibling's condition, peer networks, safe self-expression spaces, better mental health, and coping skills. Findings support the development of tailored, evidence-based sibling support programs, recognizing these as a distinct domain in health and social care policy and funding.
The same dataset can be analysed in different justifiable ways to answer the same research question, potentially challenging the robustness of empirical science1-3. In this crowd initiative, we investigated the degree to which research findings in the social and behavioural sciences are contingent on analysts' choices. We examined a stratified random sample of 100 studies published between 2009 and 2018, in which, for one claim per study, at least five reanalysts independently reanalysed the original data. The statistical appropriateness of the reanalyses was assessed in peer evaluations, and the robustness indicators were inspected along a range of research characteristics and study designs. We found that 34% of the independent reanalyses yielded the same result (within a tolerance region of ±0.05 Cohen's d) as the original report; with a four times broader tolerance region, this indicator increased to 57%. Of the reanalyses conducted, 74% reached the same conclusion as the original investigation, 24% yielded no effects or inconclusive results and 2% reported the opposite effect. This exploratory study indicates that the common single-path analyses in social and behavioural research should not be simply assumed to be robust to alternative analyses4. Therefore, we recommend the development and use of practices to explore and communicate this neglected source of uncertainty.
This systematic review and meta-analysis examined whether gambling behavior is associated with neurocognitive deficits across executive function, decision-making, delay discounting, and reward sensitivity, and whether these deficits support the dual-process model of addiction. PubMed, Scopus, Embase, and Web of Science were searched on September 1, 2024. Observational studies including individuals with gambling behavior identified using Diagnostic and Statistical Manual of Mental Disorders (DSM)/International Classification of Diseases (ICD) criteria and/or standardized screening instruments were eligible. Risk of bias (ROB) was assessed using the Joanna Briggs Institute (JBI) checklist (cross-sectional studies). Random-effects meta-analyses using Hedges' g were conducted in R software, with heterogeneity, publication bias, leave-one-out sensitivity, subgroup, and meta-regression analyses. Of 12,488 records, 76 studies (n = 5362) met eligibility for the review, and 35 (n = 2822) were included in the meta-analysis. Across 15 random-effects meta-analyses (k = 02-12; n = 38-562; I 2 = 0%-94.1%), the largest deficits were observed in inhibitory control on the Stroop task (ST) under gambling (g = 1.91; p < .05) and neutral conditions (g = 1.83; p < .05), followed by delay discounting (area under the curve [AUC]: g = -1.07; p < .001; discounting parameter: g = 0.45; p < .01), cognitive flexibility on the probabilistic reversal learning test (g = -0.51; p < .05) and Intra/Extra-Dimensional Set Shift Task (g = 0.72; p < .001), and working memory on the Trail Making Test-B (TMT-B) (g = 0.59; p < .05). Decision-making impairments were partially supported by qualitative evidence, while no consistent deficits were observed in planning ability or reward sensitivity. Findings indicate impairments in controlled and automatic processes, partially supporting the dual-process model of gambling disorder; however, heterogeneity and task-specific effects warrant caution.
Substance use disorders (SUDs) persist as a critical public health concern across the globe, affecting individuals, families, and communities across diverse sociocultural contexts. Among various intervention strategies, family-based interventions have emerged as essential components in the holistic management and treatment of SUDs. This study systematically reviews the scientific literature published between 2012 and 2024 to evaluate the efficacy of family-based interventions in mitigating substance use and enhancing family functioning. Three databases, PubMed, Scopus, and Web of Science, were searched using a predefined strategy focused on the terms "SUD" and "family-based intervention." Eligible studies included randomized controlled trials (RCTs) involving individuals with SUDs that implemented family-based interventions aimed at reducing substance use and required the participation of at least one immediate family member. The Cochrane Risk of Bias 2.0 (RoB 2) tool is used to assess the methodological quality. A total of 3,864 records were identified, of which 15 trials met the inclusion criteria and were included in the final review. Findings indicate that family engagement in substance use treatment leads to favorable outcomes, including substance use reduction and improvements in family functioning, with 11 studies demonstrating significant positive effects of family-based interventions. This review suggests that involving family members in treatment reduces substance use and improves family functioning. However, further high-quality RCTs are necessary to strengthen these conclusions and provide more definitive evidence.
Alcohol dependence is prevalent, with significant morbidity and mortality linked to alcohol-induced delirium. A new but less studied strategy integrating personalized feedback intervention (PFI) with fear appeal has shown promise in modifying behavior. There is limited evidence to suggest that using patients' own videotaped recordings in a delirious state can reduce relapse and enhance abstinence. Our study evaluates the combined effect of both PFI and fear appeal on reducing alcohol use and prolonging abstinence. This study aims to evaluate the impact of PFI with fear appeal on alcohol consumption patterns in terms of duration of abstinence and amount of alcohol consumption in patients with delirium. This open-label randomized controlled trial will recruit 48 patients (purposive sampling) aged >18 years, any gender diagnosed with alcohol-induced delirium at AIIMS Bibinagar. Participants will be assessed for withdrawal severity and delirium using standardized tools. They will be randomly allocated (opaque sealed envelopes) to two groups: (a) PFI with fear appeal (Group 1) and (b) Treatment as usual (TAU, Group 2). Group 1 will receive TAU, along with PFI, and fear appeal, using a video recording of their own delirium symptoms. Intervention will focus on the harmful consequences of alcohol use, aiming to reduce consumption and increase abstinence duration. Group 2 will receive standard pharmacological treatment, along with motivational enhancement therapy (MET) or relapse prevention therapy (RPT). Outcomes will be measured through Timeline Follow Back (TLFB) for alcohol consumption and duration of abstinence, with follow-ups at 1 and 3 months.
Globally, mental health issues are becoming more prevalent, but stigma and obstacles to getting treatment are substantial. There is still a lack of community-based and region-specific research in India. This study examined patterns of mental health literacy (MHL) and help-seeking preferences among an urban non-clinical population in Ahmedabad, Gujarat, India. A community sample of 100 adults participated in semi-structured interviews and completed an adapted version of the General Help-Seeking Questionnaire (GHSQ). Qualitative manifest content analysis was used to analyze the interview results. Descriptive frequencies were used to map patterns of understanding and help-seeking preferences. Although the individuals were aware of the term "mental health," mental illness and abnormal behavior were the most prevalent conditions associated with mental health. The most common issues were anxiety and depression, and little knowledge of professional roles. The primary source of information about mental health was digital media. Even though the attitude toward seeking professional help was found to be positive, assistance was only considered as the last option for severe mental health issues such as schizophrenia and suicidal thoughts. Non-clinical concerns were mostly managed through informal support from trusted individuals or faith and motivation-based sources. Many participants also reported uncertainty about how to respond when others shared mental health concerns. The findings highlight a gap between awareness and appropriate help-seeking. Improving MHL must extend beyond awareness to strengthen understanding of professional roles, normalization of psychological help for non-clinical concerns, and promote community-level dialogue.
Transcranial alternating current stimulation (tACS) is a non-invasive technique that modulates brain oscillations and may help treat hallucinations when conventional treatments fail. This systematic review evaluated the efficacy of tACS in reducing hallucinations in psychiatric disorders. A systematic search of PubMed, Scopus, EMBASE, and clinical trial registries was conducted. Studies included adult psychiatric populations receiving tACS with hallucinations measured using standardized scales. Three randomized controlled trials (RCTs) were included in the meta-analysis, and five additional studies were synthesized qualitatively. Risk of bias was assessed using the Cochrane RoB 2 tool for RCTs, and the Joanna Briggs Institute tools for other designs, and certainty of evidence was assessed using GRADE.Meta-analysis of three RCTs (72 participants) showed no significant difference between tACS and sham treatment in reducing hallucinations post-intervention (SMD = -0.14, 95% CI = -0.61 to 0.32) or at study endpoint (SMD = 0.10, 95% CI = -0.41 to 0.61). Qualitative findings suggested potential benefits with gamma-frequency (40 Hz) tACS for auditory hallucinations in schizophrenia. Side effects were mild and infrequent. Overall risk of bias was moderate to high, and evidence certainty was low. Gamma-frequency tACS shows potential, but evidence remains inconclusive. Larger, well-designed trials are needed to determine its effectiveness for hallucinations in psychiatric disorders. Persistent auditory hallucinations pose treatment challenges in schizophrenia. Non-invasive brain stimulation such as TMS and tDCS has been found to offer some benefit for auditory hallucinations. However, the literature on the efficacy of tACS for auditory hallucinations has not been reviewed. This systematic review has synthesized all published studies and reported the pooled effect for efficacy and safety.
Binaural beats are used to reduce anxiety by presenting two sounds with steady intensities at different frequencies to each ear, resulting in a single tone midway between them, with an amplitude equal to the difference between them. We aimed to utilize this to reduce anxiety in alcohol withdrawal patients and assess its effectiveness. This study was done among 100 alcohol patients categorized as moderate and severe alcohol withdrawal by Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised (CIWA-Ar) score. The anxiety levels for both groups were assessed using the Hamilton Anxiety Rating Scale (HAM-A). Binaural Beats were played in their ears via headphones for 10 minutes, and their anxiety levels were assessed again. The data were analyzed using an independent sample t-test and regression analysis. Out of the 100 patients, 48 had moderate withdrawal, and 52 had severe withdrawal. Pre- and post-test HAM-A scores in moderate withdrawal showed no statistically significant difference (p = .17), whereas in severe withdrawal there was a significant reduction (p < .001). The patients with severe withdrawal had a reduction in anxiety with intervention when compared to moderate withdrawal. The rate of improvement in the severe and moderate withdrawal groups was 5.76% and 0.27%, respectively. Higher CIWA-Ar scores and pre-intervention HAM-A scores caused greater improvement in HAM-A post-intervention. Binaural beats technology could be a better add-on to conventional therapy to reduce anxiety, as evidenced by our patients' responses. This is the initial research on applying binaural beats in reducing anxiety among alcohol withdrawal patients. It reveals the potential of binaural beats as a new, nonintrusive, and effective strategy in reducing alcohol withdrawal anxiety. It can be implemented in our routine setup to improve patients' understanding of the illness, their drug compliance, and their cooperation with the initiation of therapy sessions like Motivational Enhancement Therapy and could help in minimizing the use and need for anxiolytic medications, thus making the treatment more cost-effective. Thus, it can be integrated as a part of psychiatric care, addiction treatment, and withdrawal management.