Among the various psychiatric disorders, schizophrenia is considered to be associated with high level of stigma. The stigmatizing experience is not only limited to the patients but is also experienced by their close relatives. This article reviews the conceptual issues in understanding stigma, mainly in relation to schizophrenia. Further, this article reviews the existing literature in terms of extent and correlates of stigma experienced by patients with schizophrenia and their close relatives. Stigma experienced by the patients can be categorized as public stigma and personal stigma. The personal stigma is further understood as perceived stigma, experienced stigma, and self-stigma. Stigma experienced by caregivers of patients with mental illness is called associative or courtesy stigma and affiliate stigma. A number of tools have been developed for assessment of stigma among patients with mental illnesses and their close relatives. Depending on the type of instrument used to assess stigma, the prevalence of stigma among patients with schizophrenia varied from 6% to 87%. Much of the literature on stigma in the patients with schizophrenia is from developed countries. There is limited literature from India and majority from Southern and Central part of the country. Stigma associated with schizophrenia is highly prevalent across regions and varies according to different sociodemographic and clinical correlates. The experience of stigma among patients of schizophrenia is influenced by the type and severity of psychopathology, insight, coping, causal beliefs, depression, social support, self-esteem, self-efficacy, and self-directness. Stigma influences medication compliance, quality of life, and social functioning. Research is scanty with regard to stigma perceived by caregivers of patients with schizophrenia. Besides the caregiver variables, different patient variables uniquely modify the stigma experienced by the caregivers. Different interventions may reduce the stigma experienced by patients and their caregivers. Studies evaluating stigma experienced by patients with schizophrenia and their caregivers suggest that stigma is highly prevalent among patients and their relatives. Data on correlates of stigma are limited. There is a need for further research on stigma for a better understanding of the concept so as to find ways to reduce it and prevent its adverse consequences.

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Background: Internet has become an essential part of our daily life, especially among adolescents and youth. It is mainly used for education, entertainment, social networking, and information sharing. Its excessive use among health care providers is becoming a major concern. Aims: The aim of our study was to estimate the prevalence, understand the pattern, and to determine the association between psychopathology and internet addiction among health profession undergraduates. Materials and Methods: A cross-sectional study was conducted among 846 students of various faculties from Deemed University. Students were assessed with semi-structured data, Internet Addiction Test and Mental Health Inventory, after giving them brief instructions. Students were classified into normal students and addicted students for comparison. Results: The total prevalence of internet addiction was 19.85%, with moderate and severe addiction being 19.5% and 0.4%, respectively. Internet addiction was associated with gender, computer ownership, preferred time of internet use, login status, and mode of internet access (P < 0.05). It was also associated with anxiety, depression, loss of emotional/behavioral control, emotional ties, life satisfaction, psychological distress, and lower psychological well-being (P < 0.05). Conclusion: Significant association was found between psychopathology and internet addiction. Male gender, login status, emotional ties, and psychological distress were found to be important predictors of internet addiction among students. Hence, these parameters should be taken into consideration while promoting awareness of problematic internet use and educating students regarding healthy internet use.

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Background: The study was undertaken as there is very less literature related to sources of influence for sexual knowledge and attitude toward sex and sexual behaviors of youth in India. Aim: The objectives of the study were to explore sexual knowledge, attitudes, behaviors and the sources of influence and also to examine the relationship between sexual knowledge, attitude and behaviors in the youth. Method: The sample was selected from colleges using purposive sampling method and from the community using snowball method (n = 300). The tools used were sociodemographic data sheet, Sexual Knowledge and Attitude Questionnaire (SKAQ-II) and Sexual Behavior and Sources of Influence (SBSI) scale. Results: Descriptive statistics and correlation was done to analyze the data. The youth had poor sexual knowledge; there was positive relationship between sexual knowledge and attitudes. Sexual behaviors through media and with self or others were found to be low. Internet was found to be the major source for gathering information and was considered the most reliable source. Conclusion: Indian college youth continue to have poor sexual knowledge. Internet is a major source of information and is considered as the most reliable one among youth. More knowledge about sex is associated with liberal attitude toward sex.

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Families of Indian patients with mental illnesses have always been involved in their care. Such involvement arises both from choice as well as the compulsion of being a part of an inadequately resourced mental health system. Regardless, families have had to pay a heavy price for undertaking the task of providing care. An extensive body of Indian research on caregiver burden in a number of mental illnesses shows that providing care for a relative with mental illness is associated with considerable distress and burden for the family caregiver. However, much of this research has not made the shift from the somewhat outmoded concept of caregiver burden to the currently prevalent practice of considering the caregiving experience in its totality. Moreover, most of the research is not driven by contemporary theories of caregiving such as the stress coping model. Indian psychiatry has also had a long tradition of supporting family caregivers while they provide care for their ill members. Nevertheless, the Indian evidence for the efficacy of formal family-based interventions remains inadequate and lacks methodological precision. Finally, day-to-day practice in clinical settings does not seem to have made use of the ample body of research evidence in this area to help families in distress. Despite all these problems, progress is being made in the area of family caregiving for mental illness in India. Despite all these problems, slow but steady progress is being made in the area of family caregiving for mental illness in India. It can be hoped that some day in the near future, this progress would translate into mental health professionals forging a true partnership with families providing care for those with mental illnesses.

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The coronavirus disease 2019 (COVID-19) pandemic has emerged as a significant and global public health crisis. Besides the rising number of cases and fatalities, the outbreak has also affected economies, employment, and policies alike. As billions are being isolated at their homes to contain the infection, the uncertainty gives rise to mass hysteria and panic. Amid this, there has been a hidden epidemic of “information” that makes COVID-19 stand out as a “digital infodemic” from the earlier outbreaks. Misinformation and fake news are invariable accompaniments to this “information pollution” which can add to the anxiety, fear, uncertainty, and agitation and lead to faulty treatments, noncompliance to precautionary measures, prejudice, and stigma. Research shows that distress and panic during pandemics can propagate and promote misinformation in various ways along with increased digital screen time and unhealthy use of technology. In that context, media is considered to be a “double-edged sword” and can either add to the misinformation burden or aid in the awareness and health communication during such a biological crisis. Lessons from past outbreaks portray media, especially social media, as a useful tool to promote health literacy and control the outbreak. This article looks at the impact of information during COVID-19, the psychology behind spread of misinformation, and finally, a balanced view of the role of media in such disasters, proposing ways for its healthy integration into public and social health.

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Aims: To develop a Hindi translated version of the Internalized Stigma of Mental Illness (ISMI) Scale and evaluate its psychometric properties (test–retest validity, internal consistency, split half reliability, and cross-language equivalence), convergent validity and factor structure. Methodology: The study included 161 patients with severe mental disorders. Thirty-one patients were asked to complete the Hindi version of the ISMI Scale twice within a gap of 4–7 days. Another thirty patients were asked to complete the ISMI Hindi version followed by the English version after 4–7 days. Remaining hundred patients completed the Hindi version of ISMI Scale and Explanatory Model Interview Catalog (EMIC) Stigma Scale was administered by the interviewer at the same assessment. Results: Hindi version of ISMI Scale was found to have a good internal consistency (Cronbach's alpha was 0.863), split-half reliability (Spearman–Brown coefficient-0.661; Guttmann's split-half coefficient-0.645), test–retest reliability and cross-language equivalence for all the items and various domains with almost all the correlations and intraclass coefficients significant atP≤ 0.001, and convergent validity in the form of significant correlations with EMIC Stigma Scale. Factor analysis of the scale yielded five factors, which had significant overlap with the five domains of the scale described by the developer of the scale. Conclusions: The present study suggests that Hindi version of ISMI Scale developed as a part of this study has good psychometric properties.

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Background/Objectives: Eating disorders are rarely encountered in the Indian subcontinent. Surprisingly, there is sparse literature related to eating attitude distortions and body dissatisfaction in the Indian population. The objective of this study was to explore the eating attitudes and body shape concerns in medical students, with the objectives of determining any gender differences on eating attitudes and body shape concerns, and any predictors of psychological morbidity using demographic and psychosocial parameters. Materials and Methods: Sample comprised medical undergraduate students from all years (I-V) pursuing MBBS course at Government Medical College and Hospital, Sector 32, Chandigarh. It was a prospective, cross-sectional study. Instruments used were socioclinical sheet, acculturation index (AI), eating attitudes test-26 (Hindi version), and body shape questionnaire (BSQ) (Hindi version). Following written informed consent, all the questionnaires were administered in a group setting to each MBBS batch. Statistical analysis was carried out with Statistical Package for the Social Sciences (SPSS) version 17.0 using descriptive analysis (frequency, percentage, mean), univariate analysis (Chi-square, t-test), Pearson's correlational analysis, and binary logistic regression (backward). Results: A total of 250 medical students from 5 batches with mean age of 20.15 +/- 1.32 (18-28) years. And 55% (n = 137) were males and 45% (n = 113) were females. On gender comparison, males were more likely to be Hindu and have higher body weight (actual and ideal); females had significantly higher scores on dieting subscale of eating attitudes test-26 and BSQ (total score). On AI, there were no gender differences on family domain variables, with significantly less females reporting pure Western preference for social/peer domain variables. Correlation and logistic regression analysis showed high score on BSQ (median divide) as the only statistically significant predictor of eating (disorder) morbidity, whereas high score on AI (median divide) approached significance (P = 0.062). Conclusion: High score on BSQ is the mediating (proximate) risk factor for eating (disorder) morbidity. Influence of other/distal risk factors (especially AI) may be mediated through it.

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Psychiatric disorders cause significant burden to individuals and society across the world, accounting for nearly 13% of the global burden of disease. Eighty percent of people with mental disorders now live in low and middle-income countries. With one million deaths per year, suicide is the major reason for years of life lost due to mental illness. Estimates suggest that the burden due to mental illness is likely to increase over next decade and appropriate interventions are need of the hour. We discuss this increasing burden as a consequence of (1) lack of resources, (2) low budget for mental health in lower and middle income countries, and (3) under-utilization of services and stigma attached to mental illnesses.

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The biopsychosocial (BPS) approach proposed by Engel four decades ago was regarded as one of the most important developments in medicine and psychiatry in the late 20^th century. Unlike the biomedical model, the BPS approach posits that biological, psychological, and social factors play a significant role in disease causation and treatment. This approach brought about a new way of conceptualizing mental health difficulties and engendered changes within research, medical teaching and practice. Global mental health (GMH) is a relatively new area of study and practice that seek to bridge inequities and inequality in mental healthcare services provision for people worldwide. The significance of the BPS approach for understanding mental health difficulties is being debated in the context of GMH initiatives. This paper critically evaluates strengths and weaknesses of the BPS approach to mental health difficulties and explores its relevance to GMH initiatives.

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Background/Objectives: Caregivers of persons with schizophrenia experience more stress due to the nature of the symptoms as well as the prolonged duration of illness. The current study is an attempt to understand the subjective components of burden, distress, and social support in caregivers of patients with schizophrenia in Indian context and its linkage with their sociodemographic profile and patient's illness profile. Methodology: Thirty-two caregivers of patients with schizophrenia from a psychiatric inpatient facility of a multidisciplinary hospital were studied using descriptive research design. Results: The result shows that negative symptoms of patients, subdomains of burden (burden on well-being, marital burden, burden on relations, and burden due to perceived severity) were the predictors of subjective burden. Burden on well-being and respondent's age were predictors of psychological distress. Conclusion: Inclusive treatment services would enhance the quality of life of the caregivers and would help them in ensuring long-term care for the patients with schizophrenia.

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Background: Although there is abundant literature on stigma and its correlates in patients with severe mental illnesses such as schizophrenia and bipolar disorder, data on stigma experienced by patients with first-episode depression (FED) are limited. Aims and Objectives: To estimate internalized stigma perceived by patients with FED and to assess the relationship of stigma with sociodemographic and clinical variables. Methodology: This cross-sectional study included 107 patients with FED with duration of illness of at least 1 month, currently not meeting the criteria of syndromal depression (as assessed on Hamilton depression rating scale score ≤ 7). These patients were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma and Participation Scale for restriction of activities. Results: About two-fifths of patients (41.1%) reported stigma as per the total ISMIS score. In terms of various domains of stigma, stereotype endorsement (54.2%) was reported by the highest proportion of patients and this was followed by alienation (47.7%) and discrimination experience (38.3%). About half of the study sample (49.5%) reported restriction in participation with one-third of the sample reporting having severe or extreme restriction. Younger age, longer duration of depressive episode, and presence of comorbid physical illness were found to be strongly associated with higher level of stigma. Higher level of participation restriction was associated with higher level of stigma in the domains of alienation (P ≤ 0.001) and social withdrawal (P ≤ 0.004). Conclusions: The present study suggests that internalized stigma/self-stigma is highly prevalent among patients with FED. Accordingly, there is a need to develop stigma mitigation programs addressing these patients at the earliest to improve their treatment outcome.

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Background: The experience of aging is unique to every individual because of the individual differences in personalities, varying social support network, and differing cultures to which one belongs. Quality of life (QOL) of senior citizens is greatly influenced by their previous lifestyle, culture, education, health care beliefs, family strengths, and integration into the communities. Aims: To assess the sociodemographic profile, QOL, and to compare the QOL of senior citizens in rural and urban areas. Methodology: Data were collected from 830 rural senior citizens and 120 urban senior citizens through multistage random sampling technique. The tools used in this study were sociodemographic data sheet and WHO QOL-BREF-26. Results: Majority of senior citizens belonged to the age group 65–75 years in rural (65.3%) and urban (65%) areas and majority were females (rural 61.4% and urban 66.7%). A major percentage (44.7%) of senior citizens in rural areas lived with their spouses and children, whereas 40% of them in urban areas lived with their children and 40% with their spouse and children. Majority of study subjects in rural (90.6%) and urban areas (97.5%) were not involved in any social activities. The senior citizens in urban areas showed better QOL than the senior citizens in rural areas. This was statistically significant in the overall perception of QOL, the overall perception of health, physical health, psychological health, and environment (P < 0.05). Conclusion: This study showed that QOL was poorer among senior citizens in rural areas. In India, the population of senior citizens is greater in rural areas where the health care facilities are minimal. Hence, policies and programs related to senior citizens should be launched in rural areas without neglecting the needs of urban senior citizens. Training of voluntary workers, health care professionals, and family members on the care of senior citizens should be implemented. QOL of senior citizens could be enhanced only with the support of family members.

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Background: Deliberate self-harm (DSH) is a major public health concern. Gender differences in suicide methods are a controversial realm with various regional and cultural variations. This study compared and assessed the methods used in DSH attempters as undertaken by men and women, and investigated the possible role of gender and other clinical variables in the selection of suicide method. Materials and Methods: Two hundred subjects fulfilling the inclusion and exclusion criteria were recruited in the study. The sociodemographic details were recorded in the semi-structured pro forma. Detailed assessment of psychiatric morbidity and DSH was done by clinical interview and validated by Mini International Neuropsychiatric Interview-Plus 5.0 and Beck Suicide Intent Scale. Data were analyzed using SAS version 9.2 and SPSS version 17.0. The sample was disaggregated by gender to compare the known correlates of suicide risk on the two most common methods of suicide – poison consumption and drug overdose using multivariate analyses. Results: The analysis revealed that majority of the attempters were in the age group of 11–40 years (91%). Females (63%) outnumbered males (37%); poisoning was the most common type of method (50.5%), followed by drug overdose (35%). There were no statistical differences between the two genders with respect to other sociodemographic variables. Males from urban/semi-urban background (odds ratio [OR] = 4.059) and females living alone (OR = 5.723) had high odds ratio of attempting suicide by poison consumption. Females from urban/semi-urban background (P = 0.0514) and male subjects from nuclear families had an increased odds ratio (OR = 4.482) to attempt suicide by drug overdose. There were no statistical differences when the two genders were compared for other variables such as intentionality, lethality, impulsivity, and number of attempts. Conclusions: It appears that gender differences among DSH attempters appear less pronounced in the Indian setting compared to the worldwide literature on the subject. Nevertheless, the unique, gender-specific characteristics pertaining to DSH attempters in our population emphasize the need for gender-specific interventions in future clinical treatment.

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Background: Resilience building interventions are gaining popularity, and the same needs to be enforced. However, considering the effectiveness of a programme after a need assessment, understanding the extent of resilience and the related construct of perceived social support (PSS) becomes imperative. Hence, this study aimed at assessing the resilience and PSS among school-going adolescents. Objectives: The objectives of the study were to assess the Perceived Stress, PSS, to understand the gender differences in level of PSS and resilience among school going adolescents in Mangaluru city of Southern India. Materials and Methods: A cross- sectional descriptive research design was used. School-going adolescents from grades 8^–10^th of the four schools of Mangaluru city were selected through convenient sampling (n = 206). Data were collected through self-administered scales. Descriptive statistics and t-test were applied. Results: The mean age of the study sample was 14.10 (±0.896) years. Adolescents had mild level of perceived stress, high PSS, and moderate resilience. Significant difference was noted between boys and girls in the global PSS and PSS from friends and significant others and resilience. Conclusions: The moderate resilience highlights the scope for resilience building programmes in schools of Mangaluru. Furthermore, the gender differences in the measured competencies indicate the need to develop gender-specific intervention packages.

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Background: Previous research on caregiver burden in Nigeria has focused mainly on caregivers of patients with mental disorders. None of these studies compared the level of burden among the caregivers of patients with chronic mental disorders with caregivers of those with chronic medical illnesses. Furthermore, previous studies on caregiver burden in Nigeria did not examine the relationship between caregiver burden and coping style. Objectives: The objective of the study was to compare the level of burden and the coping styles used by the caregivers of patients with major mental disorders with that of caregivers of patients with hypertension, and also to determine any relationship between the caregiver burden and coping style. Methods: Four hundred caregivers were recruited from the psychiatry and cardiology clinics of a tertiary hospital. Psychiatric diagnosis was confirmed with the MINI-International Neuropsychiatric Interview (MINI). Caregivers completed a semistructured sociodemographic questionnaire, the Zarit Burden Interview, and the Coping Orientation to Problems Experienced Inventory. Results: There was a statistically significant difference in the level of burden experienced by the caregivers of patients with major mental disorders and hypertension. Overall, both groups of caregivers adopted similar coping styles except in the use of denial coping style, which was used significantly by caregivers of patients with major mental disorders. There was no significant relationship between the caregiver burden and coping style. Conclusions: This study found that caregivers of patients with major mental illnesses experienced a considerable burden than caregivers of patients with hypertension and also found that both groups of caregivers made use of similar coping styles.

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Background and Aims: The cost-of-treatment studies can help to make informed decisions while planning health-care services. This study is aimed to assess direct costs of outpatient treatment of four common chronic severe mental illnesses in a tertiary care hospital in South India. Methods: The patients with ICD-10 diagnoses of schizophrenia, unspecified nonorganic psychosis, bipolar disorder, and recurrent depression were recruited by purposive sampling from a government teaching hospital in South India. The total cost-of-treatment to the patient and the hospital was computed for each disorder as a percentage of the per-capita income of an individual patient. Results: The study comprised a total of 140 patients. The average monthly total cost-of-treatment was Indian Rupees (INR) 770 (95% confidence interval of 725 to 815), or approximately US$ 12.8. The monthly total cost-of-treatment was INR 720 for schizophrenia, INR 750 for unspecified nonorganic psychosis, INR 830 for bipolar disorder, and INR 790 for recurrent depression, with no significant differences between groups. On an average, 22.8% of total cost-of-treatment was borne by the patient, and the rest by the hospital. The patients spent a median of 12% of their per-capita income on treatment related to direct costs. Conclusions: Despite substantial government subsidies, patients do incur some expenses in treatment of chronic psychiatric illnesses. The attempts to reduce treatment and travel costs can facilitate psychiatric care to larger number of individuals.

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Caregiving of persons with mental illness is challenging as sometimes it is demanding and at other times, it is fulfilling to caregivers. In India, family members are the caregivers for persons with mental illness as there are extremely limited alternative facilities and family members are preferred for caring. The changing social milieu in India such as urbanization and nuclear family is placing significant burden on family members. This article will discuss about the emotional dimensions of caregiving, importance of care receivers, utilizing the caregiving situations to address prevention of mental disorders, promotion of mental health, and fight stigma of mental disorders. In India, majority of the research is on the burden of caregiving on family members and there is less or no research on caregiving in different communities, population groups, and develop programs to make caregiving a positive experience on caregivers and caregiving. In India, there is a need to develop systems of sharing of skills, support, and supervision to caregivers in providing care to the individuals with chronic illnesses. This can minimize the stress of caregiving and maximize the positive feelings of caregiving.

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Stigma has been described as a mark of disgrace associated with a particular person, quality, or a circumstance. Persons with either psychiatric illness or substance use disorders, their family members, caregivers, as well as health professionals engaged in the management of these persons are subject to stigma. Interestingly, there is a high prevalence of substance use disorders among persons with psychiatric disorders and vice versa. However, only a limited literature has focused on stigma in the context of co-occurrence of psychiatric disorders and substance use disorders. The current review is aimed at the presentation of various aspects of stigma in the context of dual diagnosis of psychiatric disorders and substance use disorders. Findings on the published literature on stigma in the context of psychiatric disorders and substance use disorders have been examined separately to develop an understanding into the relevance and implication of addressing stigma in the context of dual diagnosis.

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The World Health Organization is in the process of publishing the 11^th edition of international Classification of Diseases and Related Health Problems (ICD-11). This article discusses the rationale behind the creation of the new “Obsessive-Compulsive and Related Disorders (OCRD)” section in the ICD-11 chapter on Mental and Behavioral Disorders and compares it with the ICD-10 and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new section on OCRD was introduced in ICD-11 after a review of the relevant literature that has accumulated since the publication of ICD-10 in 1990. The proposed OCRD section includes obsessive-compulsive disorder (OCD), body dysmorphic disorder, olfactory reference disorder, hypochondriasis, hoarding disorder, trichotillomania, and skin-picking disorder. Tourette syndrome is also cross-referenced in OCRD. These disorders are grouped together on the basis of considerations of diagnostic validity and clinical utility. The ICD-11 OCRD section is somewhat similar to the DSM-5 OCRD section, reflecting efforts to harmonize the two major classificatory systems. Clustering together disorders related to OCD may encourage clinicians in diverse settings worldwide to identify these disorders early and offer timely interventions.

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Background: The World Health Organization Quality of Life–BREF (WHOQOL-BREF) is a well-validated, cross-cultural, generic instrument to measure the quality of life, which is available in many languages. Objective: It was intended to translate and validate the WHOQOL-BREF in Odia, an Indian language. Materials and Methods: WHOQOL translation methodology was adopted that included forward and backward translation and contribution from bi- and monolingual individuals. A sample of adult patients attending psychiatric unit and their caregivers without mental illness completed the questionnaire. Psychometric properties of the Odia version including reliability, validity, and item's correlation with their assigned domains were assessed. Results: A total of 150 individuals were included in the study, comprising 91 patients and 59 caregivers as healthy controls. Validity as measured by known group's comparison produced significant result in all the four domains (physical health, psychological health, social relationships, and environment), overall quality of life and health. There was significant correlation of the questionnaire items with their original assigned domain scores. The internal consistency reliability was acceptable; Cronbach's alpha value for the whole scale was 0.81 and that for individual domains were physical health: 0.71, psychological health: 0.70, social relationships: 0.65, and environmental health: 0.71. Conclusion: The study presents the preliminary findings on the psychometric properties of the Odia version of WHOQOL-BREF and suggests that it has acceptable reliability and validity for use in clinical settings involving patients with mental illness.

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Transgender people in India, commonly known as the Hijras, who claim to be neither male nor female, are socially excluded in Indian society. The uniqueness of Hijras lies not only in their existence beyond social structure but also in Indian society's historical acceptance of that position. This study aims to understand the sociocultural exclusion of Hijras, depending on their gender identity disorder and their paradox sexual appearance. An exploratory cum descriptive research design with a nonrandom purposive sampling including the snowball technique was adopted, to collect information from 51 Hijras at Kharagpur town from the state of West Bengal, India. The study shows that although Hijras have a sort of sanctioned and visible place in Hindu society, but in the contemporary Indian context, it is the gender nonconformity of the Hijra that has a major impact besides lack of a gender recognition, sexual expression, employment, decent housing, subsidized health-care services, and as well as the violence they suffer, especially when they choose to take up formal works. Therefore, Hijras are controversial and minacious community in Indian society and their existence disrupts essential ideas about sex or gender. They need to be recognized as having a space on society's gender continuum. Vertical interventions of rights are greatly needed to address the unique needs of this marginalized group and recognizing them as equal citizens of India.

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Background: Suicide is a major public health concern in India. There is limited information regarding views about suicide and suicidality in the community. Aims: It was intended to study the suicidal cognitions and behavior in a sample of adults in India along with views about suicide. Methodology: It was a cross-sectional, questionnaire-based, anonymous survey conducted in four tertiary level medical centers. The subjects included patients and their attendants and health professionals in the organizations. The questionnaire included items on suicidal cognitions, suicide attempt history, current and past physical and mental illness, stress, views on suicide and the interventions along with information on the sociodemographic variables. Results: A considerable proportions of participants reported lifetime suicidal cognitions: Life not worth living, 44.2%; death wish, 26.9%; suicidal ideas, 24.6%; made suicidal plans, 12.4%; and 7.1% had a history of suicide attempt. These cognitions were significantly associated with suicide attempt. There was a general awareness of risks and supportive measures. The finding that 29.7% of participants might consider suicide for themselves in certain circumstances suggested the degree of acceptability of suicide in the community. Contrasting views were also present where suicide was considered as a sin by 66.2%, but 10.4% felt that their religion allows it in certain situations. The majority of participants felt that suicide is preventable. Conclusions: Suicidal thought and behaviors were common in the community. The results suggest that there is still a need for public education increasing awareness about the risks, support systems available in the local community and timely help-seeking that may improve the scope for suicide prevention.

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Background: Teachers can be trained in early identification of possible mental illness and referral which is well-established in the west and lacking in India. Hence, we attempt to study the knowledge and attitudes of secondary school teachers toward mental illness and probable gender differences in these measures. Materials and Methods: Five hundred and twenty teachers from English medium schools of Ahmedabad city were assessed by a self-reported, predesigned and pretested 25 item questionnaire, the first 15 of which assessed their knowledge about mental illnesses and the remaining 10 pertained to negative attitudes. Results: 79.4% of teachers were 45 years or less, 77.5% were female teachers and 86.9% were married. 76% of teachers scored <7 out of 15 which points toward majority of them having inadequate knowledge. 63.6% scored 5 or more on the negative attitudes questionnaire, which points toward high prevalence of negative attitudes. Females had comparatively more knowledge than males about symptoms and management of mental illness, although there was no significant gender difference in the attitude toward mental illnesses. Conclusion: The knowledge of teachers about mental illness is insufficient, and they hold a lot of stigma against mentally ill as demonstrated by their low score in attitude.

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Telepsychiatry, the use of information and communication technologies to provide psychiatric services from a distance, has matured as a mode of service delivery and has expanded its reach since its inception. Telepsychiatry promotes equality of access to high-quality specialized care for underserved users. It enables, empowers and brings about high levels of satisfaction among users. Telepsychiatry can deliver a broad array of clinical services and support several other nonclinical activities. Accumulated evidence demonstrates that clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among patients of all ages, ethnicities, cultures, and diagnostic groups across diverse clinical settings. However, negative attitudes, concerns about the quality of the evidence, doubts about cost-effectiveness, technological vagaries, uncertainty regarding the doctor–patient alliance, and a number of legal, ethical and regulatory hurdles continue to hinder the widespread implementation of telepsychiatric services. A particularly disappointing aspect has been the lack of development of telepsychiatric services in developing countries, where they are required the most because of the large mental-health gap in care with the more traditional forms of services. Problems of costs, lack of infrastructure and connectivity, shortage of trained personnel, sociocultural differences, limited data on effectiveness, and lack of institutional support are the principal challenges to the wider adoption of telepsychiatry in these resource-constrained countries. It is evident that much more effort by all stakeholders, innovative solutions, and hybrid models of care are required before telepsychiatry is able to fulfil its true potential and bring about the promised change in mental health outcomes in the developing world.

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