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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 9  |  Issue : 4  |  Page : 301-304

Combating depression in India, an experiential perspective and its implications in COVID-19 pandemic


1 Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
2 Department of Psychiatry, St John's Medical College, Bengaluru, Karnataka, India

Date of Submission05-Jul-2020
Date of Decision05-Jul-2020
Date of Acceptance20-Jul-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Dr. M Kishor
Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_158_20

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How to cite this article:
Kishor M, Chandran S. Combating depression in India, an experiential perspective and its implications in COVID-19 pandemic. Int J Health Allied Sci 2020;9:301-4

How to cite this URL:
Kishor M, Chandran S. Combating depression in India, an experiential perspective and its implications in COVID-19 pandemic. Int J Health Allied Sci [serial online] 2020 [cited 2020 Nov 23];9:301-4. Available from: https://www.ijhas.in/text.asp?2020/9/4/301/298112



According to the World Health Organization by 2030, depression will be the leading cause of global burden of diseases ahead of all health conditions.[1] Depression is an emerging global epidemic with over 350 million people affected.[2] Suicide is a major concern in depression and is also the leading cause of death in Indian youths.[3] India with a population of 1.35 billion and 0.4 psychiatrist/100,000 people has inadequate professionals to cater mental health services.[4] It should also be noted that not a single skill in psychiatry is mandatory part of licensing to become doctor under the undergraduate competency-based medical curriculum. This impairs Indian doctors' ability to manage common mental health problems such as depression at primary health centers which are the pillars of health-care services in India. Hence, to address this unique Indian scenario, we have to look at all possible ways and means to combat depression. When the plan of having a first national conference on “combat depression”in India began in 2018 under the aegis of Indian Psychiatric Society, it was set out with the following objectives described. The possible processes and approach to achieve those objectives have been mentioned in the first section of this article and its implication in COVID-19 pandemic has been discussed in later part.

To address the issue of combating depression at earliest phase of life and among the most vulnerable, it is important to focus on the school teachers and college lecturers who can play a key role in creating awareness about depression. There are more than 1.6 million schools, 60,000 colleges, 30 million schoolteachers, and four million lecturers in India.[5] Studies have reported that 20%–50% of students report depressive symptoms.[6] The focus was to develop and standardize a training module for schoolteachers and college lecturers to combat depression among students. That enables the teachers and lecturers in the prevention–identification–help-seeking process. To design the module in a meaningful manner, representative schoolteachers and lecturers were involved right from the beginning. There was also a separate module for schoolteachers and college lecturers. It was also planned to submit a proposal and network with the Ministry of Human Resources and University Grant Commission at the central and similar institutions at the state level government. The module prepared was used for exclusive workshop for teachers and lecturers during the conference with positive feedback.[7]

Addressing the issue of misdiagnosis or under treatment of patients with depression in India, training of medical practitioners is crucial. Studies indicate that more than 20% of patients presenting to doctors may have comorbid mental health condition.[8] Hence, it was decided to develop and standardize a module for training physicians and general practitioners on combating depression (identification–treatment–referral). There are more than a million doctors in India; hence, their training becomes important in combating depression. The module was presented at the local chapter of Physician Association of India and it was planned to be implemented with collaboration of Indian Medical Association.[9] Based on the feedback from physicians, a prototype mobile application-based awareness module that helps users was made available after the conference.[10]

As depression is considered common in women and women meet obstetricians and gynecologists at a vulnerable phase of their life, enhancing skills of obstetrics and gynecology (OBG) practitioners in combating depression are required. Nearly 10%–13% of women develop depression during pregnancy and postpartum period.[11] It is, thus, important to engage OBG professionals in India to develop and standardize a module for training OBG professionals on combating depression that enables them in identification–treatment–referral when needed. This module was incorporated with crucial input from senior OBG faculty and module was presented in an exclusive workshop for OBG professionals during the conference.[12] It was decided to network with OBG Society of India and thus making it a useful upgradation of OBG clinical services.

Similarly, pediatricians play an important role in the mental health of children in India. Studies suggest that nearly 18%–25% of those in the pediatric age group are found to be depressed.[13] Hence, it was decided to develop and standardize module for training pediatricians in combating depression in children (identification–treatment–referral). The module was prepared with input from pediatricians and presented as exclusive workshop for pediatricians at the conference.[14] Considering, the constructive feedback it was decided to network with Indian Academy of Pediatrics for wider dissemination of the module content.

Involvement of professionals from health and allied sciences cannot be undermined in combating depression in India. Psychologists and social workers can play an important role. There are more than 700 colleges offering under graduation and postgraduation in these disciplines in India. The number of professionals from these disciplines may be more than 10,000.[15] They can work for spreading the awareness, identification, and counseling people with depression. A mental health team involving psychologists and social workers was formed to look at designing a module for training the psychology and social work students at earliest in such skills that help in combating depression. The group conducted an exclusive workshop for students at the conference.[16]

Pharmacists account for 11.2% of India's health workforce.[17] There are more than one million pharmacists registered with pharmacy council of India.[18] They can play an important role in creating awareness about depression, antidepressant medications, and adherence to medication. Hence, a module for training pharmacists was planned with involvement of pharmacist and an exclusive workshop was conducted.[19] It is important to network with Pharmacy Council of India for further enhancement of such collaborations.

Similarly, in India, nursing profession play a key role in health-care services. There are more than two million nurses in India.[17] Their involvement can be invaluable in combating depression. Capacity building in identification, creating awareness, and management skills in hospital and community care is important for nurses. Hence, a module of training was planned with involvement of nurses working in government and private hospitals including faculty from school of nursing and college of nursing. An exclusive workshop for nursing professionals was conducted during the conference.[20] It was proposed to network with Nursing Council of India for further capacity building exercise.

Combating depression in vulnerable population such as engineering students and information technology (IT) professionals is also important for India. Studies indicate that 30%–40% of individuals in software industry are at risk of developing depression and 40% of suicide in India is in the age group below 30 years, and engineering students formed major subgroup according to National Crime Report Bureau 2014.[21],[22] There are more than 10 million people working in the Indian IT sector and 1.5 million engineering students graduate every year.[23] The profession has many risk factors for depression such as a highly competitive environment, erratic work schedules, impairing sleep and food habits, and increasing use of alcohol and tobacco use. Hence, there has to be training module for engineering profession, where faculty members from engineering institutions and representatives from IT industry are involved along with mental health professionals. Efforts along these lines were made during the conference and an exclusive workshop was conducted for IT professionals.[24] Based on the positive feedback, it was proposed to network with All India Council for Technical Education and National Association of Software and Services Companies for combating depression by awareness, early identification, risk reduction, and help seeking.

Interestingly combating depression in India also means that medical students and doctors are aware of depression. India has 529 medical colleges with more than 70,000 students passing out every year and more than 10,00,000 registered doctors.[25] Suicide among doctors is 2.5 times more than general population.[26] Hence, not only a training module for combating depression in medical students and doctors was proposed but also another for training the psychiatry faculty in imparting theoretical and clinical skills on art of teaching depression was proposed. Both the modules were presented as workshop for specific purpose during conference. The team also included medical students as they are stakeholders.[27],[28] It was planned to submit the module to Medical Council of India or the proposed National Medical Council for incorporation of module at various levels and also to network with Indian Medical Association.

Combating depression also incorporates emphasis on research in basic sciences to improve our understanding of depression. There has been interesting finding about micronutrients and minerals.[29] The conference also provided glimpse into advance research in the brain and a team was entrusted to look at possible areas of research.[30]

Depression has numerous socioeconomic–cultural determinants that play an important role beyond the biopsychological factors and it is necessary to consider them in combating depression.[31] The concern regarding glamorization of depression or medicalization of normal sadness as depression should be made aware for public and professionals. The modules presented at the conference incorporated this issues.[32]

Yoga in depression has shown numerous benefits but there are some limitations which are rarely discussed.[33] A presentation on benefits and limitation of yoga in depression was held at the conference.[34] An e-book on yoga in combating depression is being prepared by the experts in yoga and mental health to be made available free for the public.

Combating depression can only be successful if the community is involved at every stage in India and hence it was proposed to have audio video competition for public to create awareness. The emphasis was given to all segments such as 20 s audio clips, 20 s video clip, 1–2 min video clip, and short movie section of 5–10 min slot. To make it more inclusive, the audio-video clips could be made in English/Hindi or vernacular language (Kannada). This enhanced the reach of the goals in combating depression among the public. Some of the videos have already attracted thousands of viewers in YouTube platforms.[35] Community reach is also important through the street plays and theater that connect well with public and these have to be incorporated more often in Indian scenario, which the conference did. Involving nongovernmental organizations (NGO) is important in community and interestingly an NGO sponsored the conference to an extent. Press and media play an important role in community for dissemination of mental health issues, particularly so about depression and suicide, they have to be partnered at the earliest. The preconference programs involved journalists in a seminar on responsible reporting of suicide.

With availability of mobile phones, the e-books have wider reach in community. Hence, self-help e-book on combating depression for armed forces and police personnel, women, medical students, IT professionals, and geriatric population was also proposed and is considered for free circulation. A concept e-book for emergency medicine professionals was released and is already made available.[36]

It is important for India to have such national conference once in 4 years and enable all stake holders to come together and deliberate on addressing depression in India. The 2 days national conference ensured all stakeholders participation with delegate fee of Rs. 500 that included breakfast, lunch, and high tea on both days largely due to institutional sponsorship and expert speakers, who ensured that no additional cost is added expenditure of the conference. The future conferences can also be held in online platforms.

Combating depression in India during COVID-19 pandemic and its aftermath: COVID-19 pandemic is humanitarian disaster.[37] More than 500,000 people have died worldwide and nearly 20,000 in India due to COVID-19 infection.[38] The impact of disaster on the mental health is immense during the crisis and its aftermath. In India, from 1685 people aged 14–87 years surveyed during lockdown, more than 10% reported depression.[39] The number is likely to increase as the pandemic engulfs India, more importantly in the aftermath of pandemic. There is a need for additional resources to enable people to cope with psychological issues.[40] Unless every subsection of the society is considered and specific manpower is targeted like schoolteacher, lecturers, doctors, pharmacists, nursing professionals, engineers, and IT professionals as mentioned above in the tailored multidisciplinary manner, the pandemic will have devastating effect on millions even after disaster.

To conclude, combating depression in India should be the joint efforts of all and not just the mental health professionals. It involves a multidimensional approach to understand depression and varied strategy to combat depression in India. COVID-19 pandemic and its aftermath is a challenging time which reaffirms the need.

Acknowledgment

Our sincere gratitude to: (1) The JSS Medical College, JSSAHER, Mysuru, for providing financial support for the first national conference on combating depression. (2) Prof. T S Sathyanarayana Rao, Department of Psychiatry, JSSMC, JSSAHER, Mysuru for sponsoring all the cash prizes during the conference. (3) Minds united for health sciences and humanity Trust, Mysuru and Indian Psychiatric Society, Karnataka chapter, for sponsoring all public awareness program during the conference



 
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