NIMHANS

DEPARTMENTS

Department of

Epidemiology

PSHYCHIATRIC EPIDEMIOLOGY

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The contribution of the department in psychiatric epidemiology has been in the areas of – estimating the burden and impact of mental disorders, studies of risk behaviours, understanding service utilization patterns, role of complementary systems of medicine in managing mental disorders, translating research to programmes and policies, and providing technical inputs to individuals and organizations. Research activities have focused on substance abuse ( tobacco and alcohol) , suicide prevention, maternal mental health, service utilization and others.

Projects and Programmes

MENTAL, BEHAVIOURAL AND SUBSTANCE ABUSE DISORDERS: NATIONAL SCENARIO

The burden of mental, behavioral and substance abuse disorders are both due to the increasing numbers and to the significant disability resulting from disorders. The study undertaken for the National Macro-economics Commission of India estimated that 67 million were in need of mental health services for major mental disorders; an estimated 21 million and 10 million would require services for common mental disorders and alcohol dependency, respectively, during the year 2001. Extrapolations have been made to arrive at the burden of these mental, behavioral and substance abuse disorders in 2005, 2010 and 2015. These estimates have contributed to planning and enhancing service delivery.

SUBSTANCE ABUSE

Substance abuse is a growing epidemic in the Indian region with increasing numbers of tobacco and alcohol users. The areas of research has been on examining burden and impact, risk behaviors, comorbidity states, socioeconomic impact, existing programmes and policies and directions for future work in Indian region.

ALCOHOL USE and ABUSE

Alcohol abuse is a common public health problem with substantial impact on family and society. Work in this area in collaboration and partnership with Deaddiction services of NIMHANS has focused upon – (1) association of alcohol with injuries ( road traffic deaths and injuries, suicides, brain injuries and violence) , (2) alcohol as a risk behavior in communities, (3) alcohol overuse as a mental health problem and precursor to Non-communicable diseases ( stroke) , ( 4 ) socioeconomic impact of alcohol, and (5) policy issues regarding alcohol in different Indian states ( what has worked and what has not worked) . These activities have helped in setting an agenda for future research and policy directives for the Indian region. The department has supported WHO activities in this area for formulating integrated policies for prevention and control of Non-communicable diseases in South East Asia and global levels.

Tobacco use

The department undertook the Karnataka state component of the Global Youth Tobacco Survey - 2004 which examined the prevalence, emerging patterns and major factors influencing tobacco use among 13 – 15 year old children in urban, rural and transitional town of the State.. In addition, tobacco use as a contributory factor and as a co morbid condition has been examined with stroke, alcohol and others in few studies. The findings have been incorporated into the national "Tobacco Control policy report in India". The research findings have been incorporated into policy and programme frameworks of national and WHO activities for integrated approaches to prevention and control of Non-communicable diseases in south east Asia and global levels.

Health behaviours

"Behavioral risk factors" affects the health of the individual and are common contributors to many of the emerging non-communicable diseases and injuries. A long term approach which includes, "tracking the dynamic changes" in the presence or absence of such behavioral risk factors is fundamental to reduce the disease, disability and deaths. The Health Behavior Surveillance Study – Risk behavior studies – Social determinants of Health Study have contributed to a greater understanding of risk behaviors and to formulate programmes (Bangalore Healthy Urbanization project and integrated behavior surveillance). Mental health behaviors (indicating underlying depression, anxiety, suicidal tendencies), Major NCD risk behaviors ( tobacco, alcohol, unhealthy diet and physical inactivity) and injury related behaviors ( safety related behaviors of road safety and violence including suicides) are key determinants in the ongoing epidemiological transition. At present there is lack of an integrated approach or mechanism to measure these behaviors, develop and monitor interventions and including them under integrated approaches. Health promotion based on an understanding of health behaviors through coordinated – integrated – and targeted approaches is crucial for improving health of societies.

Suicides

Suicides resulted in death of more than 110,000 persons in India during 2004 as per official reports. It is also a major public health problem in other countries of South – East Asia region and is a social, economic, legal, psychosocial problem apart from mental health concerns. Epidemiological information on the suicidal phenomenon in India is not clearly known.

Epidemiology of suicides

The centre in collaboration with the department of psychiatry and several NGOs and hospitals in the city has completed number of descriptive and analytical studies. The findings clearly highlight the burden, risk factors, socio-economic impact and care related issues in the India region. A recently completed case control study has brought to the fore front a number of risk and protective factors indicated the causation of suicides. Surveillance continues on a regular basis with data pooling from government and other sources.

Risk factors for completed and attempted suicides

Several risk factors have been implicated in the causation of suicides around the world. A recent case control study done in collaboration with Bangalore City Police and 12 major hospitals has identified number of risk and protective factors contributing for suicidal deaths. Further studies are in progress in the areas of alcohol involvement and impact, role of domestic violence, economic issues, association with past suicidal attempts and role of several protective factors.

Intervention programmes for suicide prevention

The findings of research studies have been incorporated into series of capacity building workshops for health professionals, family physicians, NGOs, Women and Child development organizations, educational institutions, police personnel and media professionals. The workshops clearly identify the roles and responsibilities of different sectors in suicide prevention. An intersectoral workshop in 2004 with key stakeholders of earlier workshops resulted in the development of a suicide prevention action plan for the state of Karnataka. Recently, inputs have been provided for the National Suicide Prevention policy under the National Mental Health Programmes of the government of Indian by identifying specific components for intervention purposes.

The centre in collaboration with Medico Pastoral Association and Bangalore Rotary (East) facilitated the implementation of SAHAI – An exclusive suicide prevention helpline in the city of Bangalore. In 2006, collaboration with Christ College and Bangalore Rotary resulted in the development of SAHAI – II aimed at distress prevention among students. Both help lines are run by trained lay volunteers and has been helpful to people in crisis situations. Nearly 100 volunteers run both the help lines on a voluntary basis and have provided timely emotional support and referral services.