Psychological Medicine

Medical Council of India's New competency-based curriculum for medical graduates: A critical appraisal KS Jacob Indian Journal of Psychological Medicine 2019 41(3):203-209

The P value and statistical significance: Misunderstandings, explanations, challenges, and alternatives Chittaranjan Andrade Indian Journal of Psychological Medicine 2019 41(3):210-215 The calculation of a P value in research and especially the use of a threshold to declare the statistical significance of the P value have both been challenged in recent years. There are at least two important reasons for this challenge: research data contain much more meaning than is summarized in a P value and its statistical significance, and these two concepts are frequently misunderstood and consequently inappropriately interpreted. This article considers why 5% may be set as a reasonable cut-off for statistical significance, explains the correct interpretation of P < 0.05 and other values of P, examines arguments for and against the concept of statistical significance, and suggests other and better ways for analyzing data and for presenting, interpreting, and discussing the results.

Depression in children and adolescents: A review of Indian studies Sandeep Grover, V Venkatesh Raju, Akhilesh Sharma, Ruchita Shah Indian Journal of Psychological Medicine 2019 41(3):216-227 Background: Depression is a common mental disorder seen across all age groups, including children and adolescents. Depression is often associated with significant disability in children and adolescents. Aim: This review aims to evaluate the Indian research on depression in children and adolescents. Results: Available data suggest that the point prevalence of depression/affective disorders ranges from 1.2% to 21% in the clinic-based studies; 3%–68% in school-based studies and 0.1%–6.94% in community studies. There has been only one incidence study from India which estimated the incidence to be 1.6%. With respect to the risk factors for depression, studies have reported various education-related difficulties, relationship issues with parents or at home, family-related issues, economic difficulties, and other factors. A limited number of studies have evaluated the symptom profile, and the commonly reported symptoms include depressed mood, diminished interest in play activities, concentration difficulties, behavior problems in the form of anger and aggression, pessimism, decreased appetite, decreased sleep, anhedonia, and somatic symptoms. None of the studies from India has evaluated the efficacy/effectiveness of various antidepressants in children and adolescents with depression. Conclusion: There is a wide variation in the point prevalence reported across different studies, which is mainly due to methodological differences across studies. Limited data are available with respect to symptom profile and factors associated with depression in children and adolescents.

Children of parents with mental illness: The need for family focussed interventions in India Divya Ballal, Janardhana Navaneetham, Prabha S Chandra Indian Journal of Psychological Medicine 2019 41(3):228-234 Family interventions have been an integral part of mental healthcare in India for several decades. This paper highlights the need for an emerging change in the nature of family interventions in India—from generic interventions for heterogeneous caregiver groups to interventions addressing particular needs based on family stages and structures. It makes a case for recognizing the experiences and needs of one such group, that is, families affected by parental mental illness with children in their care and summarizes the current status of research on this topic in the Indian and global context. It presents implications for future research in India and discusses preliminary ideas for professionals working in adult mental health settings to address the needs of children and families affected by parental mental illness.

Interventions for childhood anxiety disorders – What works best from a child's perspective: A qualitative study Preeti Kandasamy, Satish Chandra Girimaji, Shekhar P Seshadri, Shoba Srinath, John Vijay Sagar Kommu Indian Journal of Psychological Medicine 2019 41(3):235-239 Background: Anxiety spectrum disorders are the most prevalent psychopathology among children and adolescents. Qualitative research in childhood anxiety disorders can provide valuable insights regarding interventions. The objectives of this study were to examine the child's perspectives on the subjective experience of concerns, the impact of the symptoms on socioacademic functioning, and the process of recovery with interventions. Methods: Children and adolescents aged 6–16 years, presenting with any subtype of anxiety spectrum disorder as per International Classification of Diseases and Related Health problems, 10th Revision (ICD-10) Diagnostic Criteria for Research, were included. Convenience sampling was used, and 30 children fulfilling inclusion and exclusion criteria were selected. An interview guide with simple questions to facilitate response was used, at the baseline and 12th week of follow-up, to generate a written narrative account of the experience of concerns, the impact of symptoms, and the treatment process. Children received treatment as usual, which included a workbook-based cognitive behavioral intervention. Results: Content analysis was done using 30 baseline and 20 follow-up narratives. Clustering of themes were done. Themes related to the recovery process reflected perceived improvement in academic performance and competence, apart from the improvement in symptoms. There were more themes in favor of cognitive interventions. Conclusion: Children's narratives highlight the importance of cognitive interventions for anxiety disorders.

Emotional and behavioral problems among left-behind children in Indonesia Raisatul Umami, Sherly S Turnip Indian Journal of Psychological Medicine 2019 41(3):240-245 Background: The number of migrant workers in Indonesia has been increasing over the years. Most of the migrant workers are females with children, creating a huge number of left-behind children (LBC). The issue of LBC has become important to discuss because LBC tends to experience more emotional and behavioral problems than non-LBC. The aim of this study was to assess and compare emotional and behavioral problems between LBC and non-LBC in Indonesia. This paper analyzes data from a project by the Community Mental Health Research Group from the Faculty of Psychology, Universitas Indonesia, held in 2015 − 2016. Materials and Methods: Participants were 629 adolescents: 359 LBC and 270 non-LBC. The data were acquired in a cross-sectional study conducted in rural Indonesia. Data on emotional and behavioral problems were assessed with Strength and Difficulties Questionnaire, while data related to risk factor variables were collected using multidimensional scale of perceived social support, the 6-item De Jong Gierveld Loneliness Scale, and Inventory of Parent and Peer Attachment. The data were analyzed with descriptive statistics and multiple regression analysis. Results: The prevalence of emotional and behavioral problems in LBC was 28.4% compared to 21% among non-LBC. Peer attachment, communication, social support, and loneliness were identified as factors that impact the emotional and behavioral problems among LBC. Conclusions: LBC has more emotional and behavioral problems than non-LBC. Comprehensive understanding of various protective and risk factors is needed to provide impactful interventions for LBC.

Neuro-Cognition in adolescents with dissociative disorder: A study from a Tertiary Care Center of North India Ayushi Dixit, Shweta Singh, Sujita K Kar, Amit Arya, Vivek Agarwal Indian Journal of Psychological Medicine 2019 41(3):246-251 Background: Dissociative disorder is a common neurotic disorder. Patients with dissociative disorder experience significant psychological distress and have deficits in various domains of neurocognitive functions. Objective: To assess the neurocognitive functioning of adolescents diagnosed with dissociative disorder and compare it with that of healthy controls. Materials and Methods: This is a cross-sectional observational study conducted on adolescents diagnosed with dissociative disorder, attending child and adolescent specialty clinic of a tertiary care hospital of North India from October 2016 to February 2017. Healthy control subjects were also recruited for comparison on study variables. Malin's Intelligence Scale for Indian children and standardized neuropsychological tools were administered for the assessment of intellectual functioning and neurocognitive functioning. Results: A total of 50 participants with dissociative disorder and 50 healthy controls completed the study. Participants of both the groups had an average level of intellectual functioning. Participants with dissociative disorder showed poorer performance on tasks of attention and executive functions. After the Bonferroni correction, deficits were detected in the domains of coding (P = 0.0012), maze (P = 0.0001), and mathematics (P = 0.0016). Conclusions: Adolescents with dissociative disorder have impaired neurocognitive functions in comparison to healthy controls.

Factors associated with treatment adherence in children with attention deficit hyperactivity disorder Parvin Safavi, Mehrdad Saberzadeh, Afsaneh Malekpour Tehrani Indian Journal of Psychological Medicine 2019 41(3):252-257 Background: Attention deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children. The aim of this study was to investigate factors related to treatment adherence in children with ADHD. Methods: This cross-sectional study was done in 118 children (aged 6–12 years) with ADHD who have been on medications for at least 6 months. The patients were selected based on the convenience sampling method from those who were referred to child psychiatry clinic. Medication Adherence Report Scale, Belief about Medicines Questionnaire specific version, and Children Symptom Inventory-4 were completed by parents and teachers. Findings: Medication adherence had significant negative correlation with inattention scores on teacher-report forms (r = -0.27, P= 0.003) and poor economic status (P = 0.03). There was a positive correlation between medication adherence and history of psychopharmacological treatment in the family (P = 0.01), and father's education level (P = 0.001). Treatment adherence had no significant correlation with age, gender, comorbid disorders, mother's education, family history of ADHD, medication side effects, or parental concerns and beliefs about the necessity of drug use. Conclusion: The factors found to have a correlation with adherence should be taken in to account by clinicians so that adherence can be improved in their patients.

Cognitive schemas among mental health professionals and other health professionals Saloni Dang, Pragya Sharma, Lokesh Singh Shekhawat Indian Journal of Psychological Medicine 2019 41(3):258-265 Objective: Research has demonstrated that dysfunctional cognitive schemas among mental health professionals (MHPs) may influence the ability to process clients' information in an unbiased manner, may be a substantial source of error in psychotherapeutic ratings, hinder accurate reporting of clients' cognitive schemas, and have a detrimental effect on therapeutic alliance. The present study compared cognitive schemas among MHPs and other health professionals (OHPs). Materials and Method: A sample of 128 professionals (64 MHPs and 64 OHPs) was chosen using a purposive sampling technique. The study used a cross-sectional observational research design. The Young Schema Questionnaire Short Form 3rd version was administered on the consenting participants. Results: OHPs had higher maladaptive schemas on the domains of abandonment and defectiveness. Overall, males had more maladaptive schemas in the domains of abandonment, mistrust, entitlement/superiority, admiration/recognition seeking, and emotional inhibition. Among MHPs, a weak positive correlation of years of experience with vulnerability to harm or illness was seen. Among other health professionals, a significant but weak positive correlation of age with admiration/recognition seeking was seen. Conclusion: This study highlights the presence of maladaptive schemas in health professionals and the need for incorporation of training modules to address these.

Adaptation and validation of parental behavioral scale for children with autism spectrum disorders to Kannada Karukayil Sivadas Gayathri, Shivani Tiwari Indian Journal of Psychological Medicine 2019 41(3):266-270 Background: Assessment of parenting behaviors in parents of children with autism is crucial in the assessment and treatment processes. Efficient tools and instruments with known psychometric properties are needed to assess parenting behaviors in parents of children with autism. Given the lack of such tools in the Indian context, there is a need to develop and/or adapt tools/scale to assess the parenting behaviors in regional languages. Aim of the Study: To adapt, translate and validate the Parental behavioral scale for Autism spectrum disorder (PBS-A) to Kannada. Materials and Methods: The original version of PBS-A was given to three healthcare professionals to examine the sociocultural suitability of items. The linguistic adaptation was performed through a forward-backward translation scheme. It was then administered on 50 parents of children with autism. Further, the psychometric properties of PBS-A Kannada version were examined, viz. acceptability, test-retest reliability and internal consistency. Results: Kannada version of PBS-A showed an excellent test-retest reliability (ICC = 0.993) and an overall high level of internal consistency (α = 0.93). The acceptability was found to be good among the Speech-language pathologists (SLP) ratings (k = 0.485). Conclusions: Kannada version of PBS-A is a valid and reliable scale that can be useful for assessing the parenting behavior.

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