Sujata Satapathy

Review of Randomized Controlled Trials on Psychological Interventions in Child Sexual Abuse: Current Status and Emerging Needs in the Indian Context.

Child sexual abuse (CSA) is a critical, psychologically traumatic and sometimes life-threatening incident often associated with sequel of adverse physical, behavioral, and mental health consequences. Factors such as developmental age of the child, severity of abuse, closeness to the perpetrator, availability of medico-legal-social support network and family care, gender stereotypes in the community complicate the psychological trauma. Although the research on the effects of CSA as well as psychological intervention to reduce the victimization and promote the mental health of the child is in its infancy stage in India, the global research in the past three decades has progressed much ahead. A search was performed using MEDLINE, PubMed, PsycINFO, and Google Scholar from 1984 to 2015 and only 17 randomized controlled trials (RCTs) out of 96 potentially relevant studies were included. While nonspecific therapies covering a wide variety of outcome variables were prominent till 1999s, the trend changed to specific and focused forms of trauma-focused therapies in next one-and-half decades. Novel approaches to psychological interventions have also been witnessed. One intervention (non-RCT) study on effects on general counseling has been reported from India.

An Adolescent with Bestiality Behaviour: Psychological Evaluation and Community Health Concerns.

Bestiality is a serious but less commonly reported form of animal cruelty occurring in a society. It is a punishable sexual offence in India. Bestiality has received little attention in recent psychiatric literature, and even though case reports have been published, an elaborate psychological assessment is often missing. This case report of 18 year old male presented here highlighted the importance of psychological assessment to emphasize on its implications for the further risk assessment of the person, family psycho-education and non-pharmacological intervention for bestialists. The overall assessment suggested of absence of any brain dysfunction and active psychopathology, average intelligence (IQ) and intact cognitive functioning. The findings portrayed physical and sexual inadequacies, emotional and sexual immaturity, difficulty in emotional attachment, internalized hostility, voyeuristic tendencies and infantile social behaviour, excitement seeker, inability to delay gratification of impulses, lacks empathy, poor self-discipline, less conscientiousness and less sensitive to criticism. The report also emphasized the role of child sexual abuse on sexual behavior later life. The importance of including the topic within the community health/sexual and reproductive health education programmes was highlighted.

Intervening with the Process of Recovery from a Traumatic Life Event: Case Study of a Child Victim of a School Fire Disaster in India

Abstract The case analysis is based on a school fire tragedy in India, which resulted in 93 deaths and 21 grievously injured children. The case discussed here was a part of a larger study undertaken mainly to identify harmful psychological reactions and associated behaviour having long-term psychiatric implications, and to assess the suitability and appropriateness of a 10-day home-based psychosocial intervention programme. The intervention was undertaken three and half months after the incident to ensure that the major treatment of injuries was done. Different play therapy methods were applied to facilitate the ventilation of thoughts and emotions in the child. Post traumatic stress symptoms were measured with a subset of 8 items from the Impact of Events Scale (Horowitz, Wilner & Alvarez, 1979; validated by Dyregrov & Yule, 1995). Results showed remarkable reduction in the exhibition of psychosomatic symptoms, especially stress and anxiety symptoms, in the post intervention assessment. The mean score on the IES scale was also less. Parents, neighbours and relatives corroborated the behavioural change observed by the team. Reduced anxiety, apprehension, and shyness also validated the intervention. The findings highlighted the need for and significance of providing mental health care services and developing need-based psychosocial intervention programmes for children encountering such severe disasters.

Non-pharmacological Interventions for Pediatric Cancer Patients: A Comparative Review and Emerging Needs in India

ContextEvidence-based research on psycho-oncology in last three decades lays emphasis upon the critical role of psychological services for better illness adjustment, improved quality of life, reduced distress and cognitive problems among the rapidly increasing pediatric cancer population.JustificationThis review aims to summarize the evidence-based psychological interventions in childhood cancer over the two decades and addresses the wide gap that existed between intervention studies worldwide and India, thus highlighting the need for research and appropriate services.Evidence acquisitionWe searched electronic databases such as MedLine, PubMed, PsycINFO, and Google Scholar. Key search terms were pediatric cancer, psycho-oncology, children with cancer + psychological intervention, or multimodal treatment, psychotherapy, cognitive training, behavioral, social skills+ feasibility study, pilot, randomized controlled trial, case study, systematic reviews.Results28 full papers published between 1996 to 2016, including survivors and under-treatment children below 18 years, were reviewed. Various types of key interventions were psychosocial, physical, cognitive behavioral, cognitive, music art therapy and play therapy. Generally, intervention settings were either hospital or home, and were designed to promote psychological well-being. Psychological interventions were more in customised formats in these studies. A generic intervention module was not available for replication.ConclusionDevelopment of culture-specific generic intervention module and using the same in randomized control studies with larger effect size are needed in India for larger coverage of patients.

Nonpharmacological interventions for children with attention deficit hyperactivity disorder in India: A comprehensive and comparative research update

The nonpharmacological treatments for children with attention deficit hyperactivity disorder (ADHD) have witnessed a sea change from a rudimentary and haphazard psychosocial to cognitive interventions to social and behavioral skills to body oriented interventions to more sophisticated neurocognitive interventions. As the objective of each treatment varied, the method or procedure of each treatment also differed across studies. Indian research although not very rigorous, did witness changes emphasizing on exploring interventions in reducing symptoms and improving overall behavior. The research literature between 2005 and 2015 was searched using PubMed, Google Scholar, IndMED, MedIND, ResearchGate, and other indexed databases. Results of 110 studies were organized into five broad categories of themes of interventions such as psychosocial, body-focused, cognitive/neuro-cognitive, and cognitive behavioral. Effects of ADHD on cognitive, academic, and behavioral outcomes were also highlighted before the themes of intervention to establish linkage with discussion. However, a limited number (n = 9) of reported Indian studies focusing either on the impact of ADHD on the function of children or on interventions were found, suggesting a huge gap between global and Indian research in the area of children with ADHD. It also highlights the need for development and efficacy testing of indigenous intervention program in different areas of intervention for research and clinical practice.

A short geriatric assessment tool for the older person with cancer in India-Development and psychometric validation

INTRODUCTION With rise in incidence and prevalence of cancers in the ageing population, the need for an age sensitive comprehensive assessment measure has been felt. Comprehensive Geriatric Assessment (CGA) is often difficult to implement due to time and logistic constraints. A brief assessment tool encompassing the specific domains of the CGA would be a better way to assess older adults with cancer. These tools exist but have not necessarily been culturally adapted. The main aim of the study was to develop a culturally relevant short geriatric assessment tool and explore its psychometric properties. METHODOLOGY An initial item pool was formed after review of the literature and study of the existing scales. This draft tool was then pre and pilot tested to finalize the items and check the feasibility of application. The final tool was validated by exploratory factor analysis on a sample of 100 older patients with cancer. RESULTS After pre and pilot study on fifteen and thirty older patients with cancer respectively, this tool consisting of a total of 38 items spread over eight domains was developed and validated on a sample of 100 subjects. Due to co-linearity, three items were deleted after exploratory factor analysis, bringing the final item number to35. The Cronbachs alpha was 0.93 and the intra-class correlation co-efficient (ICC) was 0.94. Thus, the final tool had 13 questions with sub-parts (35 items in total). The time taken to administer the tool was around 25 min. CONCLUSION The tool developed is valid and reliable and can be used for the initial assessment and further care planning of older Indian patients with cancer.

Development of a multi-dimensional scale to measure trauma associated with child sexual abuse (MSCSA) and its ramifying impacts on children: A pilot study

BACKGROUND With the rising incidence of CSA in India and absence of culturally competent tool to assess the impact of trauma, there is a dire need for development of a comprehensive scale to assess the impact of trauma on children. Thus, the present study aims to develop a multi-dimensional CSA tool for children aged between 7 and 13 years. METHOD Qualitative research method of FGD/Key Interviews with 4 group participants (Parents, counsellors, mental health and medical professionals) and in-depth interview with children having history of CSA was conducted along with item pooling from existing scales. Scale domain and sub-constructs were identified through thematic analysis of the qualitative data and statements extracted through item pooling. Face and content validity was obtained followed by the administration of the scale on pilot sample of 30 children meeting selection criteria of the study. RESULTS 6 domains of the multi-dimensional impact of trauma was identified (i.e. Behavioral, Emotional, Cognition, Biological, Psychopathology and Social Functioning) which was constructed in the form of 85 scale statements across 6 domains and 48 sub-constructs on a 3-point Likert scale of response in both Hindi as well as English language. The scale was found to be having high reliability and average inter-item and inter-domain correlation. Modification of scale items based on pilot study findings and expert feedback analysis done to obtain a final scale containing 78 items. DISCUSSION Discussion done primarily in terms of scales psychometric properties, its clinical & research implications, especially focusing on cultural competency of the scale.

Tools to assess psychological trauma & its correlates in child sexual abuse: A review & current needs in Asia.

Absence of visible physical symptoms and limited capacity to express trauma directly, pose significant challenges in assessment of its exact nature of trauma and its correlates in child sexual abuse. There are numerous assessment tools however, deciding upon the appropriateness is often challenging in Asian socio-cultural and health care set up. A review would provide a ready reference to the practioner regarding the exact clinically utility of the tools and also would guide them in the direction of culture specific modifications. Computerized databases namely Medline, PsycINFO, Health and Psychosocial Instruments, and Social Sciences Citation Index were used. 52 scales were obtained and analysed in terms of scale characteristics, reference to theory and DSM, and cultural competency. Despite of a wide variety of methods, and newer instruments, many of the traditionally used techniques of childs internal thinking and emotional assessment appear outdated while reviewing the recent theories of CSA related psychological trauma. An integrated format, incroporating child-parent-clinicain rating, with multiple domain speciafic items and verbal and non-verbal tasks, is the current need in the Asian region.