Prabha S. Chandra

Disclosure of HIV infection in South India: Patterns, reasons and reactions

The aim of this study was to examine aspects related to self-disclosure of their seropositive status among 68 persons (35 men and 33 women) infected with HIV. Data was collected through in-depth interviews to assess ways in which HIV-related disclosure took place and factors that influenced disclosure. The data was subjected to both qualitative and quantitative analysis. Voluntary disclosure was noted in 44 subjects (65%), while in other 24 (35%) subjects disclosure occurred without consent. Of those who disclosed, 78% of the subjects reported self-disclosure to family members, 7% to friends and 15% exclusively to health professionals. Expectations of emotional and material support from the family members were one of the commonly cited reasons for voluntary disclosure. Only half of the subjects disclosed complete and truthful information while in the rest, disclosure was partial or disguised as a less stigmatizing illness. Stigma, fear of discrimination, disgrace to family and self and futility were reported as the main reasons for non-disclosure. The majority of the subjects (73%) reported anticipation of negative societal reaction as the main concern following disclosure. In India, where HIV-related counselling services are still not freely available, there continue to be non-uniform practices related to confidentiality and disclosure. The findings of this study are important in identifying cultural factors related to disclosure in HIV infection and highlight the need to examine the varying patterns and concerns related to disclosure among HIV-infected individuals.

Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period

The perinatal period is associated with an increased risk of severe mental disorders. We summarise the evidence regarding the epidemiology, risk factors, and treatment of severe mental illness in relation to childbirth, focusing on bipolar disorder, affective psychosis, and schizophrenia. We discuss women with ongoing chronic conditions and those with the onset of new episodes of post-partum psychosis. Despite the importance of perinatal episodes, with suicide a leading cause of maternal death, few studies are available to guide the management of women with severe mental disorders in pregnancy and the post-partum period. However, general principles of management are discussed, including the need for an individual risk-benefit analysis for each woman.

Anxiety and depression among hiv-infected heterosexuals— a report from india

The aim of the study was to study factors related to anxiety, depression, and suicidal ideation among HIV-seropositive heterosexuals soon after being tested for their HIV status for the first time. Anxiety, depression, and suicidal ideation were assessed among 51 HIV-seropositive heterosexual men and women with various stages of HIV infection. All assessments were done between 4 and 6 weeks after revelation of positive serostatus. Psychosocial variables such as quality of family relationships and substance use and sociodemographic details such as gender, income, education, and residence were studied for their association with psychiatric morbidity. Illness details studied for their association with psychiatric morbidity included stage of HIV infection, spouses HIV status, presence of physical illness, and pain. Depression was present in 40% and anxiety in 36% of the sample. Serious suicidal intent was seen in 14%. Multiple regression analysis indicated that presence of pain, concurrent alcohol abuse, poor family relations, and presence of AIDS in the spouse were significant factors associated with depression, anxiety, and suicidal ideation.

Relationship of psychological morbidity and quality of life to illness-related disclosure among HIV-infected persons

OBJECTIVE The aim of this study was to examine the relationship between HIV-related disclosure and quality of life, anxiety and depression among HIV-infected subjects in South India. METHODOLOGY 68 subjects (35 men and 33 women) were assessed for quality of life and psychological morbidity using WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS). Details of disclosure were collected using a semistructured interview. RESULTS Certain disclosure-related variables appear to relate significantly with quality of life among HIV-infected persons. A positive outcome related to disclosure and extent to which a subject felt the need to disclose were significantly associated with higher scores on the total quality of life measure and in the social and environmental domains of the WHOQOL-BREF. No relationship was found between disclosure-related variables and psychological morbidity or other domains of quality of life. The type of disclosure (voluntary/without consent) did not appear to influence quality of life in this sample. CONCLUSION Disclosure-related variables may have an important influence on QOL in the context of HIV infection in India.

Women reporting intimate partner violence in India: Associations with PTSD and depressive symptoms

Intimate Partner Violence (IPV) is prevalent worldwide and often has mental health sequelae. The aims of this study were (a) to describe the prevalence and the nature of PTSD symptoms among Indian women reporting IPV, (b) to study the relationship between symptoms of PTSD and depression, and (c) to examine the relationship between sexual coercion and PTSD symptoms. Consecutive women (n = 105) presenting to an adult psychiatry outpatient unit of National Institute of Mental Health and Neuro Sciences in South India were recruited. These women were assessed for IPV, sexual coercion, PTSD symptoms, and depression. Fifty-nine women (56%) reported a history of IPV, of whom 41 (70%) also reported sexual coercion. Among women reporting IPV, seven (14%) exceeded cut-off scores for PTSD and twelve (20%) exceeded cut-off scores for sub-threshold PTSD. The majority of those reporting IPV exceeded cut-off scores for a depressive disorder. Compared to women without a history of IPV, women reporting IPV had higher scores on PTSD and depression. Severity of violence and sexual coercion correlated positively (r = 0.39) with PTSD severity. The findings highlight the importance of screening women for IPV and its sequelae, in mental health settings.

Delusions related to infant and their association with mother-infant interactions in postpartum psychotic disorders.

SummaryThe relationship between mother infant interactions and psychopathology in postpartum psychotic disorders has been recognised as being clinically important, however data in the field is sparse. The current study had two aims – firstly, to study the prevalence and nature of delusions towards the infant among mothers with postpartum onset severe mental illness and secondly, to study the association between delusional symptoms towards the infant and mother infant interactions. 108 consecutive women with onset of severe mental illness in the postpartum, who were admitted to an inpatient psychiatric unit in South India over a two-year period, were systematically assessed for presence of delusions related to the infant, using the Kannada version of the Birmingham Interview for Maternal Mental Health.Fifty-three percent of subjects reported delusions related to the infant, with 34% reporting more than one delusion. Mothers with infant related persecutory delusions were more likely to show affectionate behaviour and had normal competence and caring for baby’s basic needs; however, they were more likely to get disturbed and agitated if separated from the baby.Mothers who had delusions that the baby was a devil or ill fated or someone else’s baby, were more likely to have significant abusive incidents towards the baby.Overall, the mothers who had delusions related to the infant were seen to have more significant abusive incidents and were more likely to be considered unsafe in looking after the baby alone. The study emphasises the need for systematic clinical assessment of psychopathology in mothers with postpartum psychosis.

Infanticidal ideas and infanticidal behavior in Indian women with severe postpartum psychiatric disorders

Few studies have investigated maternal aggression toward infants among women with a severe mental illness that emerges in the postpartum period. In this prospective study of 50 Indian women admitted to a psychiatric hospital for severe mental illness occurring in the postpartum period, we examined the prevalence, pattern, and predictors of maternal aggression, infanticidal ideas, and infanticidal behavior. Nearly half (43%) of the mothers reported infanticidal ideas, 36% reported infanticidal behavior, and 34% reported both infanticidal ideas and behavior. Infanticidal ideas and behavior co-occurred frequently (r = .80). Infanticidal ideas were associated with depression in the mother, adverse maternal reaction to separation from the infant, and psychotic ideas toward the infant. Infanticidal behavior was associated with having a female infant, psychotic ideas toward the infant, and adverse maternal reaction to separation from the infant. Logistic regression analyses indicated that presence of depression and of psychotic ideas predicted infanticidal ideas, whereas presence of psychotic ideas toward the infant predicted infanticidal behavior.

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.

HIV risk behaviour among psychiatric inpatients: results from a hospital-wide screening study in southern India.

The study was carried out to investigate the prevalence and correlates of sexual risk behaviour among psychiatric inpatients in India. Consecutive inpatients (n = 618) were assessed using a structured interview and standardized measures. Women were more likely to be sexually active (50%) than men (36%), but equally likely (6% vs 5%) to engage in risky behaviour. Common risk behaviours included having a risky partner, having multiple partners, and exchanging money for sex. Being sexually active was associated with younger age, being married, being diagnosed with a disorder other than schizophrenia, and a history of drug use problems. Engaging in risky sexual behaviour was associated with being male, using tobacco and screening positive for either drug use or alcohol problems. Screening psychiatric patients for HIV risk behaviour can identify those who may benefit from risk reduction programmes.

Sociocultural aspects of menstrual attitudes and premenstrual experiences in India

Menstrual attitudes were studied in a group of 48 Indian women using the Menstrual Attitude Questionnaire, modified and adapted for Indian background. Attitudinal factors of menstruation being a natural, bothersome and debilitating event were studied, as also denial of the event and healthy/unhealthy attitudes. High rating was seen in menstruation being perceived as a natural event and least as a debilitating one. Older women considered menstruation as a natural event. Relating premenstrual experiences to attitudes, it was observed that distressful symptoms correlated significantly with debilitating and unhealthy attitudes. Similarly, premenstrual well-being correlated highly with naturalness attitudes, thereby suggesting that the personal experiences are likely to influence the menstrual attitudes.