Full Thesis
Full Thesis
Full Thesis
A dissertation submitted to
JIPMER
In partial fulfilment of the requirements for the award of degree
M.Sc. Nursing- Psychiatric Nursing
BY
Mr. SRINIVASAN C
Reg. no. 121877D05
July 2020
जवाहरलालस्नातकोत्तरआयर्ु ानश न ा थान
वज्ञ िक्ष स नस
ाएवअ ध स्
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL
EDUCATION & RESEARCH
(स्वास््यएवपररवारकल्याणमत्रालय,भारतसरकारके
अधीनराष्ट्रीयमहत्वकासस्थान)
(An Institution of National Importance under Ministry of Health & Family welfare)
भारतसरकार / GOVERNMENT OF INDIA, धन्वतरर नगर, पदच्चेरी /
DHANVANTARI NAGAR, PUDUCHERRY- 605 006
Website: www.jipmer.edu.in Email: [email protected]
Phone: 0413 – 2296002, 2296022 Phone : 0413 – 2279357, 2297161/56
Fax: 0413 – 2272067- 2272735 Fax : 0413 – 2279357
BONAFIDE CERTIFICATE
This to certify that the project entitled “Psychiatric morbidity among patients
attending the Integrated Counseling and Testing Center (ICTC) facility of a
tertiary care hospital in South India” is a bonafide record of work done by
Mr. SRINIVASAN C under our guidance and supervision in the College of Nursing,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Puducherry during the period of her postgraduate study for the degree of M.Sc.
(Nursing) in Psychiatric Nursing from August 2018 to July 2020.
Nursing Guide:
Dr. Padmavathi Nagarajan,
Assistant Professor,
College of Nursing, JIPMER
Co-Guides:
Dr. Vikas Menon, Dr. Rakesh Singh,
Additional Professor, Additional Professor,
Department Of Psychiatry, JIPMER Department of Microbiology, JIPMER
This study represents the independent work conducted by me and has not
previously formed the basis for the award of any degree, diploma,
Mr. SRINIVASAN C
Place: Puducherry
Date:
ACKNOWLEDGMENT
I thank God Almighty for the bountiful graces bestowed upon us and for his
enlightenment at every step which gave us the support to complete this study.
gratitude to Dr, Rakesh Aggarwal, Director, JIPMER of the institution for allowing
Dr. R. Raveendran, Dean (Research), JIPMER for allowing me to conduct the study.
(N), Ph.D.(N), Professor cum Principal (Ag) for her remarkable support throughout
the study.
Nagarajan, M.Sc. (N) Ph.D. (N), Assistant Professor, College of Nursing, JIPMER,
Dr. Rakesh Singh, Additional Professor, Department of Microbiology and Dr. Vikas
data.
I convey my gratitude to Dr. David V. Sheehan, M.D., M.B.A, Professor of
use my research tool and Mr. Dhinagaran A, ICTC counselor for given support
And my sincere thanks to all our teachers and non-teaching staff for their
timely support and cooperation. A word of appreciation to our seniors, friends, and
I also express my thanks to all the participants in the study and I am greatly
the study.
The completion of this thesis will mean a lot to them, particularly ‘seeing more of
me’. So I dedicate this project to my loving family, without whose love, affection and
I also place on record, my sense of gratitude to one and all, who directly or
Mr. SRINIVASAN C
ABSTRACT
Introduction
The burden of mental disorders is expected to rise significantly over the next
20 years. Psychiatric symptoms are becoming increasingly evident in infected with
HIV people. It is estimated up to 70% of people with HIV suffer from an acute
psychiatric condition, and people undergoing HIV testing also have distress due to the
stigma and the fear associated with the disease. So, early screening of psychiatric
illness helps to manage the symptom effectively. The purpose of the study is to assess
the psychiatric illness among patients undergoing HIV testing in the Integrated
Counselling and Testing Centre (ICTC) facility, JIPMER.
Methodology
Results
The study showed that out of 384 patients, 91 (24%) had the psychiatric
illness, the distribution remained single psychiatric morbidity of 62 (68%) and rest
had at least two psychiatric co-morbidity, I also revealed that there was no significant
association between selected socio-demographical variables and psychiatric morbidity
among patients utilizing ICTC center.
Conclusion
PAGE
CHAPTERS CONTENT
NO.
I INTRODUCTION 1-9
SYMBOLS ABBREVIATIONS
INTRODUCTION
physical, social, and mental well-being and not only the absence of disease. Stigma
and discrimination are the major drawbacks of mental health care in world wide.
However, globally 450 million people suffer from a mental or behavioral disturbance.
One in four families has at least one person with a mental disorder. Neuropsychiatric
disorders like depression, schizophrenia, and bipolar disorder, alcohol use disorder are
the one out of six leading causes of disability causing the problem worldwide.1
More than 80% of mental disorders are residing in low and middle- income
nations, with substance abuse disorders and mental illness performing since an
important cause of disease burdening approximately 16.6% and 8.8% of the total
substance use
1
was 22.44%, Schizophrenia, and other psychotic disorders were 0.42 %, Mood and
are neuropsychiatric problems 13 % and internal injury 3.3%, and HIV/AIDS and
other problems were 6%. Comorbidity results in lower adherence to medical therapy,
an increase in disability and mortality, and increasing the health care costs.6
HIV infection is one of the important global public health problems, more than
37.9 million peoples are living with HIV infection so far worldwide. However,
may lead to long and healthy living for patients with HIV infection and it was
estimated that
21.40 lakh people living with HIV infection in India (by NACO, 2017).7
infected with HIV. It is estimated that up to 70% of people with HIV suffer from an
acute psychiatric condition related to HIV infection at some point during their
ailment.8
will not help in identifying the flowing HIV infected population. So, the National
AIDS control organization of India has established the Integrated Counselling &
The need for ICTC is early diagnosis and treatment of disease, mostly who all
are risk populations like sex workers and homosexual practice peoples and who have
multiple sexual partners. Those people were referred to ICTC for diagnosis.
1.1 Need for the study
In many public health clinics in India, HIV testing has become an increasingly
routine practice. The higher level of anxiety, depression, and distress was commonly
observed in HIV test- seekers, more among repeat test-seekers. Screening for AIDS
anxiety at ICTC and providing appropriate intervention might help the quality of life
and empower them to practice safer behavior of the individual who attends the ICTC
center.9
Mental health disorders, particularly mood change have been shown to negatively
treatment.11
The testing for HIV infection may cause a significant amount of distress
because of the fear of the fatality of the disease as well as the stigma associated with
the diagnosis. Comorbid mental illness and substance abuse are also found to be at
higher levels among HIV infected individuals in comparison with the general
population.12
interventional approach. So, early screening of psychiatric illness among HIV test
seekers may support better case management, appropriate clinical care, slowing the
disease progression and building quality of life. Since there is a paucity of the data in
this area, the proposed study is expected to portray the reality of the situation in a
meaningful way. The ICTC facility of JIPMER hospital is catering services to a wide
population from all over South India, the present study would add to the literature on
the current prevalence of the psychiatric morbidity among patients attending the ICTC
facility of JIPMER.
In this study, the investigator intended to find out the psychiatric morbidity to
suicidal ideation, manic episode, bipolar disorder, panic disorder, phobic disorder,
social anxiety disorder, post-traumatic stress disorder, alcohol use disorder, other
1.4 Objectives
Primary objective:
Secondary objectives:
and the psychiatric morbidity among individuals who are attending the
Psychiatric morbidity:
causes impairment in occupational and social functioning during the time of attending
ICTC:
Integrated Counselling and Testing Center is a place where the person who is
at risk for HIV infection is counseled and tested for HIV infection, of his/her own free
1.6 Delimitations.
The data collection was limited to the patients attending the Integrated
The study was carried out to identify the prevalence of psychiatric morbidity
among patients attending the ICTC facility of JIPMER hospital. Based on the results,
those participants who were found to have some psychiatric illness were referred to
each individual.
The patients who are all coming for HIV testing have distress due to perceived stigma
Stressors
Neuman in 1995 defined stressors as “stimuli that produce tension and have
more potential for causing instability”. The system always has to deal with one or the
other stressor at any point in time. Here the researcher has identified that the major
stressor affecting the individual as a whole was patients attending the ICTC center for
HIV testing that contributed to the social stigma, fear about physical symptoms, and
prognosis of illness the impact of it within and around the client system.
According to Neuman’s theory, it describes a solid circle that that refers to the stability
of the individual (Neuman 1995). Any stressor can invade the normal line of defense.
In this study, the stressors that invaded the normal line of defense can be identified as
It is the outer and initial response of an individual towards the stressors which
act as a protective buffer that alters over some time. If the individual can maintain a
well build a flexible line of defense, that can result in the strengthening of his system.
In this study the role of study to acknowledge the psychiatric disorder in patients
attending ICTC center by devoid the risk of threats to the client by a poor prognosis,
Lines of resistance
For the study participants, prompt and early screening of psychiatric illness
Level of interventions
These are actions that help an individual out to regain their state of wellness
available resources and the degree of stressor the client experiences. Through the
study, the researchers have identified the patients attending ICTC center also having a
psychiatric illness, so early screening and referral improving the patient’s quality of
life.
Primary prevention
This mode of intervention is carried out when any stressor is identified by the
client system. The rectification of these stressors helps to strengthen the line of
defense of an individual.
The study was focused on identifying psychiatric illness patients who are attending
Secondary prevention
Secondary prevention results when the stressor has already affected the client
by breaking the line of defense and the individual has initiated symptoms. It focuses
on the early detection of psychiatric disorders and referral and prompt treatment to it.
Tertiary prevention
This mode refers to the adjustment of the client to attain stability through the
focusing on bringing back the stable system, after identification of psychiatric illness
treats the psychiatric illness will reduce the isolation behavior and good treatment
Secondary Prevention
Degree of
Early treatment reaction Basic
like Antipsychotic Structure
energy
& psychological source
Stressors
intervention
Reduction of symptoms Reaction Comorbidities like
through appropriate Anxiety physical disorders
clinical intervention Psychological distress Poor
Increase the risk treatment adherence
of behavior due to lake of family
alteration and social supports
Financial problem and
fear of rejection in
Tertiary prevention family and society
Rehabilitation of Psychological support
patient and family
Improve social and
occupational
function Intervention
Prevention of
complication Early screening of
and remission psychiatric disorders
Health education
Intra
Inter Personal
factors Extra
9
Fig.1.Conceptual framework – Betty Neumans system model (1970)
CHAPTER II
REVIEW OF LITERATURE
The researcher conducted an extensive literature review for the present study.
untreated at primary care facilities because of poor screening routines and the scarcity
of resources.13
mental disorders can result in significant social and economic burden for families,
friends and superiors. Several reasons have been suggested for the inadequate
Kessler et al reported that the lifetime prevalence rate of mental disorders was
morbidity in HIV positive subjects using the general health questionnaire (score 28.0,
p=.093) and structure clinical interview for DSM-IV. The study result showed that
adjustment disorders 7%, anxiety disorder 1 %, and substance use disorders 17%.16
10
Similarly, Ghuloum et al estimated in a Qatari population attending a primary
among 4351 adults, the South African Stress and Health Study (SASH) Herman et al.
The SASH study had shown that approximately 30.3% of the sample has been
diagnosed with a psychiatric disorder in their life that has gone untreated. The SASH
further showed that 16.5% of the sample has experienced common mental disorders
over twelve months, but only 25% of the adults were treated for this condition.18
diagnosed with common mental disorders. The authors found that depression was the
psychiatric disorders among primary care patients (n = 976). These authors found that
depression was the most prevalent disorder (20.6%) followed by generalized anxiety
among HIV/AIDS patients. Results showed that there was no statistically significant
association between the overall psychiatric morbidity and social determinants such as
assess the prevalence of the major depressive disorder. The study results showed that
among the general population. The study result showed that 26.2% of the women and
between 18 and 40. In this study, it was found that 31.4% of the sample met the
interview questionnaire.24
Similarly Olley et al. also reported that using the MINI, the prevalence of
MDD was 34.9% among HIV-infected individuals. The authors found that 6 months
25
later, 26% of their sample met the diagnostic criteria for depression.
The MINI was utilized among people with HIV/AIDS to assess the prevalence
Studies Depression (CES-D) scale was utilized to determine the levels of depression
among 160 people living with HIV and receiving ART treatment. The results
indicated that 58.75% of the sample met the criteria for depression. Furthermore,
more females (61.3%) than males (58.1%s) and transgender persons (50%) were
depressed.27
Prevalence of generalized anxiety disorder (GAD)
HIV infected individuals used SCID. The study result showed that a lower rate of
was 13.3%. 30
dependence was assessed among TB and HIV-positive men and women making use
of the MINI. The study reported that the prevalence of alcohol dependence of 27.2%
among men was higher than for women, with a rate of 3.9%.31
living with HIV. The study revealed that high prevalence rate of clinically significant
distress is a cause for concern as it may harm the quality of life of HIV-positive
individuals.32
Fear and stigma associated with HIV testing
knowledge about HIV counseling and testing among couples attending HIV
counseling and testing center. The structured interview showed that fear of positive
HIV test results strongly as the most significant barrier to couple HIV counseling and
testing.33
students to asses the fear of stigmatization as a barrier for HIV counseling and testing
through a focus group interview. Results showed that participants had a different level
of knowledge about HIV/AIDS and the main barriers for testing were fear of being
countries. Results indicated that the fear of consequences of testing positive -mainly
worries related to discrimination and rejection - also hindered HIV testing. Finally,
individuals appear more likely to test for HIV when they perceive more benefits from
testing.35
revealed that people who believe it is important not to stigmatize PLHA do.
Individuals maintain correct and incorrect knowledge about the transmission of HIV
simultaneously, but even those who know that HIV is not transmitted through casual
contact continue to have doubts and behave as if it is. People expressed both
symptoms among persons undergoing for HIV test using the mean scores of 45.78
Anxiety Inventory and 15.8 (SD=12.4) on the Beck Depression Inventory. Out of 485
Seema et al conducted a study among 150 HIV test seekers to assess the
anxiety, depression, and distress using the hospital anxiety depression scale. This
Study showed that repeat test seekers exhibited significant distress (AOR: 2.5; 95%
CI: 1.2–5.3; p = 0.017) and depression (AOR: 2.9; 95% CL: 1.4-6.1: p=0.004).
Education levels influenced the level anxiety (p = 0.033; 0.008). The repeat test seeker
who was HIV positive they had more anxious (p=0.035) and depressed (p=0.037).9
Ashraf et al concluded after a structured clinical interview with 485 HIV test
disorders were major depressive disorder 14.2%, alcohol use disorder (19.8%),
generalized anxiety disorder (5.0%), posttraumatic stress disorder (4.9%), and also
suggested that integration of screening and referral improving HIV test seeker mental
health care.38
among people coming for HIV testing. The result showed that prevalence of common
mental disorder was 5.3%, hazardous alcohol use disorder 12.8% and around a one-
fourth of people scored below the educational norm on two cognitive tests of delayed
HIV testing, HIV-related fears, perceived risk, and preventive behaviors, the study
result showed that any depressive disorder 4.9%, anxiety disorder 8.1%, posttraumatic
disorders 5.8% and the perceived risk of HIV infection was significantly higher
disorder, and also revealed there were no associations between depression, anxiety,
and substance abuse disorders and appropriate forms of behavior change toward HIV
risk reduction.40
Illness in the United States. Through the surveys from 21,785 respondents; 15 %
percent reported at least one mental illness. Of these, 2.6% had schizophrenia
spectrum disorder, 8.5% had bipolar disorder, and 88.9% had symptoms of depression
and/or anxiety. Overall, 36.9% of adults reported ever having had an HIV test.41
Perry et al assessed the severity of psychiatric symptoms after one year among
HIV testing individuals (328) by Hamilton Rating Scale for Depression, Beck
The final result showed that mean scores on all measures of psychiatric symptoms
were lower at follow-up among both 106 HIV-positive and 222 HIV- negative adults.
One year after HIV testing, 121 (37%) of the 328 subjects had scores associated with
114), being female (N = 46), and history of injection drug use (N = 32) and
heterosexual risk factors (N = 60) as compared to males having sex with males (N =
236).42
Chauhan et al assessed the psychiatric morbidity among asymptomatic
patients and compared them with seronegative control. The study concluded that
METHODOLOGY
This chapter deals with the methodology adopted for this study to assess the
hospital and its association selected socio- demographical variables. This chapter
deals with the research approach, research design setting, population, sample and
sampling technique, duration of the study, tool and technique, data collection
Research design
Cross sectional descriptive survey design
Research setting
Integrated Counselling and Testing Center (ICTC), JIPMER.
Population
Patients utilizing the ICTC facility of JIPMER.
Data collection
Assessment of socio-demographic data and M.I.N.I. plus neuro- interview questionnaires
a. Independent variables
Socio-demographic variables
b. Outcome variables
questionnaires.
hospital with a bed strength of 2114 and has various specialty departments. One of the
Integrated Counselling and Testing Center (ICTC) facility isdoing an excellent service
in South India. More than 150 individuals are utilizing the ICTC facility every day.
3.5 Population
Target population
The population selected for the study was patients who are utilizing the
Accessible population
o Patients who all are utilizing ICTC centre either voluntary or refered
The sample consisted of 384 patients utilizing ICTC facility care in JIPMER
The sample size was estimated using the formula for estimating a single
morbidity is 50% and the sample size was estimated at a 5% level of significance and
Inclusion criteria
o Patients who all are utilizing ICTC centre either voluntary or refered
Exclusion criteria
3.10.2. M.I.N.I
fills the gaps between short screening instruments and detailed diagnostic
main criteria of the disorder were asked. The remaining questions of each
into the screening questions corresponding to the next module for further
interviewing. Only symptoms occurring during the time frame indicated were
considered in the scoring of the responses. The rating for each question was
done at the right hand- side of each question by entering the codes as Yes or
No.
3.12 Content Validity
The tool used in the study is a standardized tool that has been used in many
previous studies in the Indian and Western countries. The tool was translated into
Tamil and its validity and reliability were established. A study conducted by Sheehan,
et.al on development and validity assessment, shows that tool has good validity for
3.13 Reliability
The M.I.N.I. was designed as a brief structured interview for the major
psychiatric disorders in DSM-5 and ICD-10. Validation and reliability studies have
been done comparing the M.I.N.I. to the SCID-P for DSM-III-R and the CIDI (a
these studies showed that the M.I.N.I. has similar reliability and validity properties,
but can be administered in a much shorter period (mean 18.7 ± 11.6 minutes, median
15 minutes) than the above-referenced instruments. Clinicians can use it, after a brief
training session. This tool has been previously used successfully in other studies
and Institute Ethics Committee (IEC) before starting the study. The investigator
introduced himself to the study participants and explained the study in their local
language and informed consent was obtained. Privacy was provided during the data
collection and confidentiality was maintained throughout the study. The participants
had the freedom to withdraw from the study without assigning any reason.
3.15 Pilot study
A Pilot study was conducted to check the feasibility of the tools used in the
administered to 10 patients utilizing the ICTC facility of, JIPMER. The tools were
found to be feasible.
Participants were recruited at the time of attending the ICTC for pre-test
referrals) or those formally referred for testing by doctors from other general medical
departments. Individuals whose purpose for attending the ICTC was to undertake pre-
test counseling and HIV blood tests were eligible to take part. Other inclusion criteria
were fluency in Tamil or English and a lower age limit of 18 years. Upon entering the
ICTC, attendees were approached by personally and informed about the study. If they
were interested in participating in the study, written informed consent was obtained
from participants and privacy was provided. After baseline demographical data
morbidity. The study was approved by the Nursing Research Monitoring Committee
and the Institutional Ethical Committee. Data was collected between the periods of
The collected data was organized and scored after which, the analysis was
done with SPSS version 23. The distribution of categorical variables such as gender,
socio-
demographical characteristics were expressed as frequency and percentages. The
continuous variables such as age etc. were expressed as mean with standard deviation
or median with range. The comparison of the psychiatric morbidity between different
subgroups was carried out by using chi-square test and Fisher's exact test. All
statistical analysis was carried out at 5% level of significance and P < 0.05 was
This chapter deals with the analysis and interpretation of the data collected.
Both descriptive and inferential statistics were used to analyze the data. The findings
Section II: Psychiatric morbidity among patients utilizing the ICTC facility of
variables.
SECTION 1: DESCRIPTION OF SAMPLE CHARACTERISTICS
(N=384)
Student 35 (9.1)
Yes 13 (3.4)
Family history of psychiatric
No 371 (96.6)
illness
The distribution of the socio-demographic variables among patients attending
the Integrated Counselling and Testing Center (ICTC) facility of a tertiary care
hospital in south India is shown in table 1. The majority of the subjects 254 (66.1%)
were males,
13 (33.9%) were females. Regarding educational status 246 (64.1%) had formal
education. Coming to marital status most of them 287 (74.7%) was married.
Regarding the employment status 275 (71.6%) subjects were employed but 235
revealed that 371 (96.6%) participants had no family history of any psychiatric
disorders; 202 (52.6%) of the participant’s income was less than 3000 rupees.
SECTION II: PSYCHIATRIC MORBIDITY AMONG PATIENTS
(N-384)
Figure 2. Out of 384 participants, 91 (24%) subjects were having psychiatric illness
and 293 (76%) participants did not have any psychiatric illness.
SECTION III: PSYCHIATRIC CO-MORBIDITIES AMONG PATIENTS
(N-384)
Suicidality 31 8.0
Counselling and Testing Center (ICTC) facility has been listed in Table 2. Out of 384
(8.0 %) and panic disorder 26 (6.8%); ADS 15 (3.9%) & 1 (0.3%) was found in OCD,
70 60
60
50
50
40
40
30
30
20 20
10 10
0 0
Single co-morbidityMultiple co-morbidity
Frequency Percentage %
of JIPMER hospital-(N-384)
ICTC facility is shown in the bar diagram. Out of 384 patients, the distribution of
single psychiatric morbidity of 62 (68%) and rest had at least two psychiatric co-
attending the ICTC facility is shown in Table 3. Results of the above table showed
DISCUSSION
In this study, the mean age of subjects was 40 years and ranged between 18-60
years. Similarly, a study conducted by Ashraf et al also founded that HIV testing
subjects mean age was 39 years.38 One study reported that HIV test seekers mean age
was 28.7 years and followed by a Kenyan (Pauline et al) study which shows that
patients attending the comprehensive care clinic mean age was 37.3 years.9, 21
The
national mental health survey reported that the age group between 40 to 49 years was
We found that 91(24 %) of our sample of patients attending ICTC facility met
the criteria for at least one of the mental disorders that we assessed, with the non-
psychiatric morbidity found among the samples was major depressive disorder 64
disorder 15 (3.9%), posttraumatic stress disorder 12 (3.0%). In this study the observed
prevalence rate of psychiatric morbidity among the sample was higher than expected
given what is known about the prevalence of psychiatric morbidity among the general
population of India. For example, a national mental health survey study investigating
Interview among the general population found that the prevalence of current mental
morbidity was 10.6%. Alcohol use disorder was 4.7%, while rates for Depressive
Disorder, PTSD and Phobic anxiety disorders were 2.7%, 0.2%, and 1.9%
respectively.5
our participants received an HIV test. In the study reports, in a minimum number of
Psychological literature has assumed that HIV positive result may cause the
psychological treatment is indicated following receipt of HIV positive test result. 47, 48
In a study among South African HIV infected persons, 34.9% had major
depression while 21.5% had dysthymic disorder as assessed by the MINI International
Psychiatric Interview.51 In a study conducted with 465 patients enrolled in HIV care
and treatment services in a major South African city ( mean age of the sample was 33
years, 75% were female, 74.4% were unemployed), the prevalence of depression as
assessed by the MINI was 14%.47 Indian study also showed that Psychiatric morbidity
irrespective of HIV status.52 The above studies recruited samples after they had
diagnosed with HIV and thus it was indeterminable whether these mental health
problems were precipitated due to HIV diagnosis or if they were already evident
before receiving an HIV positive test result. Our study helped to evaluate the
depression was a validation of PHQ against the MINI as a gold standard conducted by
cholera et al. the study showed that depression was assessed by PHQ only 1% had
very severe depression, 5% had severe depression, 18% had moderate depression and
32% of the study sample reported no depression. On the MINI 11.8% met the criteria
for a current major depressive episode.53 In this study, the results showed that MINI
similar study showed that patients with HIV infection had a lower prevalence rate of
disorder.
The second objective of the study was to find out the association between the
This study results showed that there was no association between selected
socio- demographical variables and psychiatric morbidity among patients utilizing the
ICTC center, similarly, Seema et al also reported that there was no association
between depression and anxiety among HIV test seeker age, marital status,
differences between males and females in the prevalence estimates among the
disorders assessed, except generalized anxiety disorder.35 Kenyan study showed that
there was
no statistically significant association between the overall psychiatric morbidity and
social determinants such as gender, marital status, level of education, and occupation
or employment.46
Psychiatric comorbidities
single psychiatric morbidity and the remaining had at least two psychiatric
the general population and HIV positive person. Patients attending HIV primary care
clinic in South Africa were found to have a high prevalence of distress; the authors
identified 52% of their participants as having significant depression and 65.6% had a
Given our finding of non-trivial rates of mental disorders among this sample, it
may be argued that patients attending the ICTC facility should be the focus of targeted
was not clear that screening instruments were able to accurately identify individuals
who met the diagnostic criteria for mental disorders under routine care. 55 Given the
logistical, financial and capacity limitations in the Indian public health system, it may
Hence, ensuring that staff working in HIV testing sites can recognize individuals in
need of a psychiatric referral and are informed about appropriate psychiatric referral
pathways.
Limitations of the study
no follow-up.
context of HIV and mental health research, is rare. Second, participants were before
rather than following HIV testing, which also unique in terms of the existing body of
research.
CHAPTER VI
AND RECOMMENDATIONS
6.1 Summary
The purpose of the present study was to assess the psychiatric morbidity in
patients attending the ICTC center, and its association with the selected socio-
The conceptual framework of the current research was based on the Betty
Neuman systems model. The instruments used for the data collection consists of the
Participants were selected after obtaining informed consent. A total number of 384
participants from the patients attending the ICTC facilities were selected and
(Chi-square test and Fisher's exact test) were used to analyze the data. The findings
Out of 384 samples, attending the ICTC facility, 91 (24%) subjects had
(68%) and rest had at least two psychiatric co-morbidity (depression with suicidal
behavior, ADS with depression, anxiety and substance use disorder), it also revealed
variables and the psychiatric morbidity among patients utilizing ICTC center.
Demographic characteristics
The subjects were selected based on the age ranging from 18 to 60 years. All
384 participants were between the given age group, and the average mean age was
patients with psychiatric morbidity 40.74 years and the remaining people had an
average mean age was 37.98 years. The prevalence of psychiatric morbidity among
287 (74.7%) of the subjects were married and 275 (71.6%) had employed.
Concerning the monthly income of the individual, the majority had a monthly income
6.2 Conclusion
About one fifth had psychiatric morbidity among patients attending the ICTC
facility. Out of one-fifth of psychiatric morbidity, 30% (29) had multiple co-
morbidity.
The findings of the study are supported by the literature and have strong support
from other studies conducted in India and worldwide. The same methodology of
assessment
is widely supported by many studies and thus can be generalizable to common men in
community settings. The present study also suggests that it could be useful to
introduce screening psychiatric morbidity among patients attending the ICTC facility.
Early screening of psychiatric morbidity among patients utilizing the ICTC center
may help identify and treat the illness at an early stage. The screening tool used in this
study was found to be useful in identifying the psychiatric symptoms and easy to
of alcoholic patients for cognitive impairment, motivational state, and violence. The
nurses should be taught to give health education regarding the ill effects of HIV
associated with HIV infection and screening of HIV in rural areas and provide health
education regarding the HIV infection and psychological problems for reducing the
Nursing service:
Nurses can easily identify their risk behavior for the client’s depression,
methods and referral to psychiatric counseling and treatment units. Ongoing health
teaching and assessment of health risk levels can help patients to retrieve their
normal life.
Community health nurses also can screen the psychiatric disorder from HIV infected
people and refer to psychiatric care that may improve the patient's quality of life.
Nursing administration
programs for improving the knowledge level of nurses in the screening of HIV/AIDS
patients living with HIV infection. They should be given health education regarding
prevalence of HIV infection in patients with a psychiatric disorder. They can screen
psychiatric patients earlier which will improve the quality of care and prevention of
3. A comparative study can be conducted among patients with risk behavior and
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Date
1) Gender
3) Marital status
4) Level of education:
6) Occupation:
8) Monthly income
a) Yes b) No
I
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3. taJ (tULq;fspy;):…………………..
4. jpUkz epiy
(m) jpUkzkhfhjth; (M) jpUkzkhdth;
(c) tpjit
5. fytp epiy
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7. njhopy;
(m) Kiwahd (m) Njh;r;rp ngw;w njhopy; (M) rhjhuzkhd njhopy;
(,) fy;tpgapy;gth;
8. khj tUkhzk;
(m) 3000 mjpfk; (M) 3000 Fiwthd
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APPENDIX II
NURSING RESEARCH MONITORING COMMITTEE CERTIFICATE
APPENDIX III
APPENDIX IV
PLAGIARISM VERIFICATION CERTIFICATE
APPENDIX V
PERMISSION LETTER FOR RESEARCH TOOL
APPENDIX VI
CONSENTFORMS (ENGLISH/ TAMIL)
Dear participants,
patients utilizing the Integrated Counselling and Testing Center (ICTC) facility and
general population of tertiary care hospital in South India and those who do not’. The
Psychiatric morbidity among patients attending the Integrated Counselling and Testing
Student Researcher:
Srinivasan C
M.Sc. Psychiatric Nursing I year,
Mob No: 9944910092
Email ID: [email protected]
Guide:
You have been enrolled in this study since you have came to ICTC for undergoing
some test. Here, you will be counselled regarding the purpose of the test. I will be asking
you some details such as age, education status, occupation and income, I will be
assessing you whether you are having any psychological/mental disturbance. If you
found to have some symptome related to any unusual evidence, you will be referred to
the psychiatric clinic for further management.
One-time interview for each patient. It may take 30-45 minutes for you to
respond.
The benefits to be expected from the research to the participant or to others and the
post-trial responsibilities of the investigator.
Since the study involves only interview and question. You can feel free to
express you concerns and please let us know if you feel uncomfortable.
We ensure that the personal information obtained from you will remain
confidential throughout the study period and up to three years of publication. If the
results are published in a journal, your name and other details will not be disclosed. The
study records will be kept confidential for a period of three years.
Since this is a descriptive study, we do not except any injury to you. But in the
event of foreseen or unforeseen research related injury, free treatment will be provided as
per JIPMER guidelines.
No reimbursement will be given in this study. Since, you came for your treatment
purpose only.
You are eligible for compensation in the event of any unforeseen study related
risk or injury as per JIPMER guidelines
Freedom to withdraw from the study at any time during the study period without
the loss of benefits that the participant would otherwise be entitled
You will have freedom to withdraw from the study at any time during the study
period without assigning any reason and without loss of benefits that you would
otherwise be entitled. Withdrawal will not affect standard medical care provided from
JIPMER
Possible current and future uses of the biological material to be generated from the
research and if the material is likely to be used for secondary purposes or would be
shared with others, this should be mentioned.
Possible current and future uses of the data to be generated from the research and if
the data is likely to be used for secondary purposes or would be shared with others,
this should be mentioned.
Yes. Data to be generated and the result will be used as secondary data by future
researchers for their study without disclosure of your identity.
Thank you taking time to read this information sheet. If you have any study
related queries you contact.
Student Researcher:
Srinivasan C
M.Sc. Psychiatric Nursing I year,
Mob No: 9944910092
Email ID: [email protected]
Guide:
Date:
Place:
XC
INFORMED CONSENT DOCUMENT (ICD) PART-2
Participant’s name:
Address:
The details of the study have been provided to me in writing and explained to me in
my own language. I confirm that I have understood the above study and had the
opportunity to ask questions. I confirm that I have understood about the compensation
and the risks and benefits involved in this research. I understand that my participation in
the study is voluntary and that I am free to withdraw at any time without giving any
reason, and without my routine medical care in this hospital being affected. I understand
that confidentiality of my identity will be maintained during the research period, after its
completion as well as during publication of the results. Only investigator, ethics
committee, institutional or regulatory authorities may have access to my information
when required.
I have been given a copy of information sheet giving details of the study. I volunteer to
participate in the above-mentioned study.
(I also consent/ do not consent to use of my stored biological samples or related data for
future scientific purposes, if applicable)
(I also consent / do not consent to be contacted over telephone for study purposes/
knowing the results – if applicable)
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