M. Manjula

Suicidal risk and childhood adversity: a study of Indian college students.

BACKGROUND The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth. AIM The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students. METHOD A cross sectional study design was conducted with 436 undergraduate students in the age range of 18-25. Suicidal risk was assessed using Scale for Suicidal Ideation and Becks Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences. RESULTS Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting. CONCLUSION The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting.

Cognitive behavior therapy in the treatment of panic disorder

Background: Comprehensive cognitive behavior therapies have been proved to be more effective than behavioral interventions. However, the efficacy of CBT is not studied in the Indian context and also, the amount of change brought about by CBT is not known. Aims: This study aims to examine the efficacy of cognitive behavioral intervention (CBI) in the treatment of panic disorder. Our specific objectives were to assess the effectiveness of CBI in reducing symptom severity as well as cognitions related to panic and panic-related behaviors. Design: The study adopted a two-group comparison with pre- and postassessments design. Materials and Methods: The sample consisted of 30 patients sequentially allotted to the CBI (n = 15) and behavioral intervention (BI, n = 15) groups. Assessment was done using a semistructured interview schedule, panic disorder severity scale, Texas panic attack record form, Anxiety Sensitivity Index, Agoraphobic cognitions questionnaire, Behavioral avoidance checklist, and Panic appraisal inventory. The CBI group was provided with comprehensive cognitive behavior therapy and the BI group with psycho-education and applied relaxation. Results: CBI was found to be superior to BI in the reduction of panic symptoms, behavioral avoidance, safety behaviors, and cognitions. A large percentage of the CBI group patients met the criteria for clinically significant change with a large magnitude of change. Conclusion: Multicomponent CBI is superior to BI in terms of the amount of change it brings about with respect to panic symptoms, avoidance, safety behaviors, and cognitions.

Development of a school-based program for adolescents at-risk for depression in India: Results from a pilot study

A majority of adolescents in India, who are at risk for depression, do not receive treatment or receive it when the psychopathology has become entrenched and chronic. The present pilot study was an endeavor to assess the felt needs of adolescents vis-à-vis the difficulties and stressors experienced by them. For this purpose, 300 students across three schools were screened using standardized measures. Another objective of the study was to develop and test a school-based Coping Skills Program to address adolescents at-risk for depression. Schools were sequentially assigned to intervention or control conditions; students of index (n=13) and control (n=6) groups were assessed at baseline, post-intervention, and 3 months follow-up. At post-intervention for the index group, all outcomes measures except coping skills-including depressive symptoms, negative cognitions, academic stress, and social problem-solving-showed change in the expected direction, this difference assuming significance at follow-up. The program was rated positively by students using anonymous feedback and there was low to nil perceived stigmatization. Results are discussed in the context of need for such intervention programs in India, and future scope of research involving larger samples.

Growing up with a parent having schizophrenia: Experiences and resilience in the offsprings

Background: Parental mental illness has been found to have an impact on offsprings in their emotional, social, and behavioral aspects of life. Aims: To examine the experiences of offsprings of a parent having schizophrenia and to study their resilience. Materials and Methods: A sample of 45 adults with one parent diagnosed with schizophrenia was selected using purposive sampling. Subjects were assessed using socio-demographic data sheet, semi-structured interview schedule, and Connor–Davidson Resilience Scale. Results: The experiences perceived by them as different from children of healthy parents included negative experiences in social (49%) and emotional aspects (40%), lack of support from the parent who is ill (40%), and burden (66%) in various areas. Majority of the offsprings were satisfied with the parenting received (70%). About 60% of them reported medium resilience, and 24% and 15% reported high and low resilience, respectively. Majority of those with medium and high resilience had supportive relationship with other family members. Social support was the most frequently reported factor that helped them to cope with difficulties. Conclusions: Growing up with a parent having mental illness can have negative impact on offsprings. However, it can also have positive effects in terms of developing resilience in the presence of good support system.

SELF-CONCEPT IN ADULT CHILDREN OF SCHIZOPHRENIC PARENTS: AN EXPLORATORY STUDY

Background: Much of the work on children of schizophrenic parents has primarily focused on the risk of developing various kinds of psychiatric disorders, behavioural problems and cognitive vulnerability factors. There has been inadequate attention given to children without a clinical diagnosis and particularly the adult offspring of schizophrenic parents. It would be worthwhile to study the wellness or otherwise of these children, especially in terms of the self-concept of these individuals. Aim: To study the impact of parental mental illness on the self-concept of adult children. Method: Thirty subjects who had one parent diagnosed as suffering from schizophrenia formed the study group, and 30 subjects, matched on age and gender with the study group, formed the control group. Subjects were assessed using a socio-demographic and clinical data sheet and a self-concept scale. Results: The results showed that the study group had significantly poorer self-concept compared to the control group. The current clinical status of the parents had an impact on the family self-esteem of the children. Subjects who were above 10 years of age at the onset of the parental mental illness had a poorer self-concept, as compared to those who were below 10 years at the onset of illness in their parents. Conclusions: The results provide evidence for poor self-concept in adult children of schizophrenic parents compared to children of normal parents.

Subclinical depression in Urban Indian adolescents: prevalence, felt needs, and correlates

Background: Subclinical depression in adolescents constitutes a risk factor for future clinical depression and hence warrants examination. However, there is a paucity of research that documents subclinical depression among adolescents in India. Objectives: (a) To investigate the prevalence of subclinical depression in urban school-going adolescents; (b) to investigate the problems and felt needs of these adolescents; (c) to examine depression-related variables; and (d) to examine the relationships between socio-demographic and depression-related variables. Materials and Methods: Eight hundred adolescents (ages 13–18 years) of English-medium schools of Bangalore city were assessed using standardized self-report measures. Results: Academic difficulties were the most frequently reported problem, followed by interpersonal issues. Of the sample, 18% adolescents were identified as endorsing subclinical depression. Adolescents in the present study scored higher on measures of depression and negative cognitions than their Western counterparts. In addition, girls were found to be at higher risk for experiencing depressive symptoms and negative cognitions, lower social problem-solving skills, and more problematic interpersonal relationships as compared to boys. Conclusion: Identification of subclinical depression constitutes an important goal, as it places an adolescent at risk of considerable vulnerability and impairment.

Adolescent Depression Prevention Programs-A Review

In recent years, there has been an increasing focus on prevention of depression among adolescents. This review delineates and evaluates major depression prevention programs for adolescents developed and tested world-wide, according to the three major types, viz. universal, selective, and indicated. Overall, targeted prevention with selective and indicated programs seem to give better results with higher effect sizes than a universal approach. School-based cognitive-behavioural approach interventions have been found to significantly reduce depressive symptoms among adolescents, with some evidence that the intervention provides long-lasting effects. However, further research to ameliorate the understanding of the development and maintenance of depression is essential in order also to improve the effects of prevention and intervention

Filicide as a part of extended suicide: An experience of psychotherapy with the survivor

The tragedy of maternal filicide and extended suicides has occurred throughout history. Maternal filicide–suicide perpetrators most often suffer from depression, suicidality, or psychosis. Interventions in such cases are not commonly reported in the psychiatric settings, and the components of psychotherapeutic approach and its efficacy are also not known. Here we present a long-term therapy carried out with a 36-year-old married lady, with the complaints of low mood, suicidal ideation, severe guilt feelings, and depressive cognitions. There was positive family history of depression, past history of dysthymia, suicidal attempt, and severe marital discord. Therapy was carried out for a period of 9 months with follow-up for 4 years and addressed existential issues and grief with the components of existential therapy, grief therapy, narratives, religious beliefs, and interpersonal acceptance. The case highlights the need for blending of multiple approaches to meet the challenges such cases can pose.

Temporal Patterns of Change in Panic Disorder during Cognitive Behaviour Therapy: An Indian Study

BACKGROUND CBT has been proven to be effective in the treatment of panic disorder; however, attempts to study the process of change are limited. AIM The study evaluated the temporal patterns of change in the panic symptoms, cognitions, behaviours, and anxiety sensitivity in subjects with panic disorder being treated with CBT. METHOD Thirty subjects with panic disorder were allocated to two groups: Cognitive Behaviour Therapy (CBT, n = 15) and Behaviour Therapy (BT, n = 15). Assessments were carried out weekly for five consecutive weeks using the Semi-Structured Interview Schedule, the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire, and the Texas Panic Attack Record Form. The CBT group received comprehensive CBT and the BT group received psycho-education and Applied Relaxation. RESULTS Following intervention the change was continuous and gradual on all the variables in the CBT group and the scores reduced to a functional range after 4-5 weeks of therapy. Such a change was not evident in the BT group. Significant change was evident in cognitive domains following the introduction of the exposure and cognitive restructuring within the CBT group. Both cognitive and behavioural techniques contributed to the overall change. CONCLUSION CBT had an impact on the cognitive domains and significant changes were evident corresponding to the addition of cognitive restructuring and exposure techniques in the 3rd to 5th week. Both cognitive and behavioural components are therefore crucial for overall improvement to occur.