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Article: Barriers and facilitators to the implementation of mental health and psychosocial support programmes following natural disasters in developing countries: A systematic review.

Rowe, Olivia / Nadkarni, Abhijit

Global mental health (Cambridge, England)

2023 Volume 11, Page(s) e5

Abstract: Climate change is leading to more frequent and intense natural disasters, with developing countries particularly at risk. However, most research concerning mental health and natural disasters is based in high-income country settings. It is critically ... ...

Abstract	Climate change is leading to more frequent and intense natural disasters, with developing countries particularly at risk. However, most research concerning mental health and natural disasters is based in high-income country settings. It is critically important to provide a mental health response to such events, given the negative psychosocial impacts they elicit. The aim of this systematic review is to explore the barriers and facilitators to implementing mental health and psychosocial support (MHPSS) following natural disasters in developing countries. Eight databases were searched for relevant quantitative and qualitative studies from developing countries. Only studies reporting barriers and/or facilitators to delivering MHPSS in response to natural disasters in a low- or middle-income country were included and full texts were critically appraised using the McGill University Mixed Methods Appraisal Tool. Reported barriers and facilitators were extracted and analysed thematically. Thirty-seven studies were included in the review, reflecting a range of natural disaster settings and developing countries. Barriers to implementing MHPSS included cultural relevance, resources for mental health, accessibility, disaster specific factors and mental health stigma. Facilitators identified included social support, cultural relevance and task-sharing approaches. A number of practical approaches can be used to facilitate the implementation of MHPSS in developing country settings. However, more research is needed on MHPSS in the developing country natural disaster context, especially in Africa, and international policies and guidelines need to be re-evaluated using a decolonial lens.
Language	English
Publishing date	2023-12-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2806466-5
ISSN	2054-4251
ISSN	2054-4251
DOI	10.1017/gmh.2023.91
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Article ; Online: A systematic review of task-sharing interventions for substance use and substance use disorder in low- and middle-income countries.

Abba Hassan, Asma'u / Ibrahim, Abba M / Nadkarni, Abhijit

Drug and alcohol dependence

2024 Volume 256, Page(s) 111093

Abstract: Introduction: Substance use (SU) and substance use disorders (SUDs) are associated with adverse health and socio-economic consequences. Due to the shortage of specialist healthcare providers, people with SUDs in low- and middle-income countries (LMICs) ... ...

Abstract	Introduction: Substance use (SU) and substance use disorders (SUDs) are associated with adverse health and socio-economic consequences. Due to the shortage of specialist healthcare providers, people with SUDs in low- and middle-income countries (LMICs) have limited access to adequate treatment. Task-sharing with non-specialist health workers (NSHWs) has the potential to improve treatment accessibility for these individuals. This review synthesizes the evidence on the effectiveness of task-sharing interventions for SU and SUDs outcomes in LMICs. Methods: PsycINFO, MEDLINE, EMBASE, Global Health and CENTRAL databases were searched to identify eligible studies. Quality assessment was conducted using the Cochrane risk of bias (RoB2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was undertaken to analyze the data. Results: Nineteen RCTs and two quasi-experimental studies met the eligibility criteria, and the majority had a low risk of bias rating. NSHW-delivered interventions significantly impact SU and SUDs outcomes, particularly in reducing alcohol and other substance use, cessation of smoking, and use of opioids. Multiple sessions delivered via face-to-face interactions was the most utilized method for intervention delivery. There were variations in terms of components of the intervention across studies; however, the most common intervention strategies used were a) personalized feedback, b) psychoeducation, c) motivational enhancement, d) problem-solving, and e) coping skills. Conclusion: Our review highlights the growing interests in leveraging NSHWs to provide interventions to people with SU and SUDs in LMICs where access to treatment is limited. However, additional research is necessary to explore the effectiveness of these interventions and identify the specific active components linked to enhancing treatment outcomes on a broader scale.
MeSH term(s)	Humans ; Developing Countries ; Substance-Related Disorders/therapy ; Health Personnel ; Treatment Outcome
Language	English
Publishing date	2024-01-17
Publishing country	Ireland
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2024.111093
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Article: Increasing access to psychosocial interventions for alcohol use disorders: Home based interventions.

Nadkarni, Abhijit

Indian journal of psychiatry

2018 Volume 60, Issue Suppl 4, Page(s) S564–S570

Abstract: Alcohol use disorders (AUD) are a significant and growing public health problem in India. However, health services for AUD remain largely confined to large institutions and a significant proportion of people with AUD do not having access to help for ... ...

Abstract	Alcohol use disorders (AUD) are a significant and growing public health problem in India. However, health services for AUD remain largely confined to large institutions and a significant proportion of people with AUD do not having access to help for their alcohol related problems. One way of changing this status quo is making evidence based psychosocial interventions available in communities and closer to people's homes. There is extensive evidence supporting the effectiveness of a range of psychosocial interventions for AUDs. This is further augmented by the growing evidence for the effectiveness of contextually appropriate psychosocial interventions, such as Counselling for Alcohol Problems (CAP) from India, that are designed to increase access to care through delivery by non-specialist health workers. The effective implementation of such interventions integrated into collaborative care models will go a long way in reducing the treatment gap for AUDs in India.
Language	English
Publishing date	2018-02
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	221523-8
ISSN	0019-5545
ISSN	0019-5545
DOI	10.4103/psychiatry.IndianJPsychiatry_25_18
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Article ; Online: Determinants of alcohol use among young males in two Indian states: A population-based study.

Heijdra Suasnabar, Jan M / Nadkarni, Abhijit / Palafox, Benjamin

Tropical medicine & international health : TM & IH

2023 Volume 28, Issue 8, Page(s) 660–676

Abstract: Objectives: There is insufficient evidence about the determinants of alcohol use amongst young people in India and other low-and middle-income countries, despite alcohol's high contribution to disease burden and increasing consumption in this population. ...

Abstract	Objectives: There is insufficient evidence about the determinants of alcohol use amongst young people in India and other low-and middle-income countries, despite alcohol's high contribution to disease burden and increasing consumption in this population. We aimed to identify and estimate the determinants of alcohol use in a representative sample of 2716 young men from Bihar and Uttar Pradesh who participated in the 'Understanding the Lives of Adolescents and Young Adults' (UDAYA) study. Methods: First, we developed an exploratory conceptual framework of potential alcohol use determinants in the study settings based on available literature. We then estimated the effects of 35 potential alcohol use determinants identified in the conceptual framework (including 14 latent factors identified through exploratory factor analysis) on any alcohol use in the past 3 years and regular alcohol use amongst past three-year drinkers, using mixed-effects logistic models. The determinants explored were operationalised using longitudinal data from the UDAYA study. Results: Our adjusted models identified 18 determinants for past 3-year alcohol use and 12 determinants for regular use. Distal determinants (e.g., socioeconomic status), intermediate determinants (e.g., parental alcohol use, media use), and proximal determinants (e.g., emotional regulation, early tobacco use) were identified. Geographical variations in both outcomes indicate potential differences in unmeasured community-level determinants (e.g., alcohol availability and acceptability). Conclusions: Our findings extend the generalizability of several known determinants across settings, yet highlight the importance of addressing alcohol use in young people as a complex and context-dependent issue. Many identified determinants (e.g., education, media use, poor parental support, early tobacco use) are amenable to intervention through multi-sectoral prevention programs/policies. Such determinants should be the focus of ongoing policy/intervention development efforts in the region, and our revised conceptual framework may inform further research in India or similar South Asian settings.
MeSH term(s)	India/epidemiology ; Humans ; Male ; Adolescent ; Young Adult ; Alcohol Drinking/epidemiology ; Social Determinants of Health
Language	English
Publishing date	2023-06-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13907
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Article ; Online: Symptoms of psychological distress reported by women from indigenous communities in South India: implications for methodology and future studies.

Nadkarni, Abhijit / Vasudevan, Pavitra / Krishnakumar, Jyotsna

Archives of women's mental health

2022 Volume 25, Issue 3, Page(s) 667–670

Abstract: Indigenous peoples' across the globe suffer a disproportionate burden of mental illness. However, this burden is not fully explored in India despite having the second largest absolute concentration of indigenous peoples in the world. We did a secondary ... ...

Abstract	'Indigenous peoples' across the globe suffer a disproportionate burden of mental illness. However, this burden is not fully explored in India despite having the second largest absolute concentration of indigenous peoples in the world. We did a secondary analysis of data from a cross-sectional survey in indigenous populations from the Nilgiri Biosphere Reserve in South India. Symptoms suggestive of psychological distress were reported by 39.9% participants. Being alone, tobacco use, hypertension, hypertension in family member, and violent conflict in household were independently associated with psychological distress. More epidemiological studies need to be conducted to map the burden and elaborate the relationships between mental health problems and socio-cultural factors in indigenous populations in India.
MeSH term(s)	Cross-Sectional Studies ; Female ; Humans ; Hypertension ; India/epidemiology ; Mental Disorders/epidemiology ; Psychological Distress
Language	English
Publishing date	2022-03-09
Publishing country	Austria
Document type	Journal Article
ZDB-ID	1463529-X
ISSN	1435-1102 ; 1434-1816
ISSN (online)	1435-1102
ISSN	1434-1816
DOI	10.1007/s00737-022-01215-x
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Article: Closing the treatment gap for alcohol use disorders in low- and middle-income countries.

Nadkarni, Abhijit / Gandhi, Yashi / Bhatia, Urvita / Velleman, Richard

Global mental health (Cambridge, England)

2022 Volume 10, Page(s) e3

Abstract: The alcohol-attributable disease burden is greater in low- and middle-income countries (LMICs) as compared to high-income countries. Despite the effectiveness of interventions such as health promotion and education, brief interventions, psychological ... ...

Abstract	The alcohol-attributable disease burden is greater in low- and middle-income countries (LMICs) as compared to high-income countries. Despite the effectiveness of interventions such as health promotion and education, brief interventions, psychological treatments, family-focused interventions, and biomedical treatments, access to evidence-based care for alcohol use disorders (AUDs) in LMICs is limited. This can be explained by poor access to general health and mental health care, limited availability of relevant clinical skills among health care providers, lack of political will and/or financial resources, historical stigma and discrimination against people with AUDs, and poor planning and implementation of policies. Access to care for AUDs in LMICs could be improved through evidence-based strategies such as designing innovative, local and culturally acceptable solutions, health system strengthening by adopting a collaborative stepped care approach, horizontal integration of care into existing models of care (e.g., HIV care), task sharing to optimise limited human resources, working with families of individuals with AUD, and leveraging technology-enabled interventions. Moving ahead, research, policy and practice in LMICs need to focus on evidence-based decision-making, responsiveness to context and culture, working collaboratively with a range of stakeholders to design and implement interventions, identifying upstream social determinants of AUDs, developing and evaluating policy interventions such as increased taxation on alcohol, and developing services for special populations (e.g., adolescents) with AUDs.
Language	English
Publishing date	2022-12-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2806466-5
ISSN	2054-4251
ISSN	2054-4251
DOI	10.1017/gmh.2022.57
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Article ; Online: Stigma towards dependent drinking and its role on caregiving burden: A qualitative study from Goa, India.

Kumar, Sonali / Schess, Jaclyn / Velleman, Richard / Nadkarni, Abhijit

Drug and alcohol review

2022 Volume 41, Issue 4, Page(s) 778–786

Abstract: Introduction: Stigma towards alcohol use disorders is prevalent in India and can lead to social exclusion and hamper treatment access and outcomes. Family members of individuals with dependent drinking are often their primary caregivers and play a key ... ...

Abstract	Introduction: Stigma towards alcohol use disorders is prevalent in India and can lead to social exclusion and hamper treatment access and outcomes. Family members of individuals with dependent drinking are often their primary caregivers and play a key role in decisions around help-seeking, treatment and recovery. The nature and role of stigma in caregiving, and the consequent burden on family caregivers of those with dependent drinking, has not been qualitatively studied in India. Methods: We conducted in-depth interviews with: (i) men with probable alcohol dependence (n = 11); (ii) family caregivers (n = 12); and (iii) doctors with experience of treating alcohol dependence (n = 13) in community settings in Goa. Data were analysed using inductive thematic analysis. Results: Two primary themes were identified from the data: (i) stigma in the form of ignorance, prejudice and discrimination; and (ii) the impact of this stigma on caregiving decisions and the mental health of caregivers. Discussion and conclusions: We found that stigma functioned as a barrier to a proper course of treatment and care, as well as a detrimental factor for caregiver's mental health and caregiving decision-making. Stigma towards dependent drinking in the forms of ignorance, prejudice and discrimination is prevalent within homes, workplaces and health systems and might exacerbate the caregiving burden among female family caregivers. Policies, educational programs and campaigns aimed at preventing stigma in these forms would likely enable access to more inclusive and appropriate health services, benefit the health of family caregivers and improve the treatment outcomes of drinkers.
MeSH term(s)	Alcoholism/therapy ; Caregivers/psychology ; Family/psychology ; Female ; Humans ; India ; Male ; Qualitative Research ; Social Stigma
Language	English
Publishing date	2022-02-06
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1080442-0
ISSN	1465-3362 ; 0959-5236
ISSN (online)	1465-3362
ISSN	0959-5236
DOI	10.1111/dar.13438
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Article ; Online: Why do men with drinking problems change their behaviour? A qualitative study nested in a randomised controlled trial in India.

Bhatia, Urvita / Velleman, Richard / Nadkarni, Abhijit / Shinde, Sachin / Shah, Aarushi / Patel, Vikram

Alcohol (Fayetteville, N.Y.)

2023

Abstract: The aim of this qualitative study, nested in a randomised controlled trial was to assess the mechanisms of the effects in both arms through examining perceptions of the participants about changes in their drinking behaviour and their attributions for any ...

Abstract	The aim of this qualitative study, nested in a randomised controlled trial was to assess the mechanisms of the effects in both arms through examining perceptions of the participants about changes in their drinking behaviour and their attributions for any perceived changes. We conducted semi-structured interviews with a sub-sample of trial participants. We used thematic analysis to analyse the data. Self-perceived change, mostly positive, was reported regardless of the objectively measured remission status. Participating in the trial itself was a major catalyst for change. Participants in both arms used a variety of similar strategies to make these changes; additionally, for those who received the intervention, both the style of the counsellor (for example, the non-judgemental stance) as well as specific elements of the intervention were seen to influence change in drinking behaviour. Absence of self-reported change was relatively uncommon and primarily related to the felt need for alcohol (e.g. drinking was perceived to be necessary to maintain good health), or the belief that one did not need to or want to change. Experiences of participating in a trial, the counsellor style and specific elements of a brief psychological treatment, play a role in influencing change in harmful drinking behaviours.
Language	English
Publishing date	2023-12-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	605912-0
ISSN	1873-6823 ; 0741-8329
ISSN (online)	1873-6823
ISSN	0741-8329
DOI	10.1016/j.alcohol.2023.12.002
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Article: Community-based counselling programme for pregnant women with alcohol problems in Cape Town, South Africa: a qualitative study of the views of pregnant women and healthcare professionals.

Petersen Williams, Petal / Erasmus, Jodilee / Myers, Bronwyn / Nadkarni, Abhijit / Fuhr, Daniela C

Frontiers in psychiatry

2023 Volume 14, Page(s) 1203835

Abstract: Introduction: South Africa lacks services to detect and address alcohol use during pregnancy, particularly outside of health-care facilities. This study aimed to explore pregnant women and healthcare providers' perceptions of the acceptability, ... ...

Abstract	Introduction: South Africa lacks services to detect and address alcohol use during pregnancy, particularly outside of health-care facilities. This study aimed to explore pregnant women and healthcare providers' perceptions of the acceptability, feasibility and appeal of a community-based counselling programme for pregnant women with alcohol problems. Methods: Twenty-eight in-depth interviews with pregnant women who drink, Community Health Workers (CHWs) and antenatal service providers were conducted. Transcribed interviews were analyzed thematically using a combined deductive and inductive approach. Results: Women reported feeling uncomfortable seeking help for their alcohol use at antenatal clinics, limiting usefulness of current support services. All stakeholders perceived a community-based intervention to be acceptable and feasible as it could be integrated with other CHW-delivered services. Participants thought an intervention should facilitate early linkage to antenatal services and should include partners or family members. The feasibility of an intervention may depend on the relationship between CHWs and clinic-based antenatal staff, and their relationships with pregnant women. Clinic and community challenges to implementation were raised. Clinic-level challenges included shortage of space, staff capacity, high number of pregnant women, long waiting times, financial burden of having to travel to a clinic, lack of comfort and privacy and staff attitudes. Community-level challenges included crime, lack of privacy, lack of attention given competing interests in the home, fear due to abuse, and stigma and discrimination from other community members. Suggestions for overcoming these challenges were provided. Conclusion: Findings provide essential information to facilitate the adaptation of a community-based alcohol counselling programme for greater acceptability, feasibility and cultural appropriateness for the South African context. Intensive training, supervision and support is required to ensure the programme is delivered as planned.
Language	English
Publishing date	2023-07-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1203835
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Article ; Online: The Effects of Husbands' Alcohol Consumption and Women's Empowerment on Intimate Partner Violence in India.

Parekh, Aneree / Tagat, Anirudh / Kapoor, Hansika / Nadkarni, Abhijit

Journal of interpersonal violence

2021 Volume 37, Issue 13-14, Page(s) NP11066–NP11088

Abstract: The influence of husband's alcohol consumption and that of women's empowerment has been largely studied separately in relation to the intimate partner violence (IPV) faced by women, which has hindered a nuanced understanding of gender-based violence in ... ...

Abstract	The influence of husband's alcohol consumption and that of women's empowerment has been largely studied separately in relation to the intimate partner violence (IPV) faced by women, which has hindered a nuanced understanding of gender-based violence in India. This study aimed to understand how husbands' alcohol consumption shapes the relationship between women's empowerment and violence among Indian couples. Data from the 2015-16 National Family Health Survey (NFHS) were used in this study. A composite women's empowerment index was constructed and its association with husbands' drunkenness and odds of facing emotional, physical, severe, and sexual violence was examined. This study found that compared to women whose husbands were
MeSH term(s)	Alcohol Drinking/epidemiology ; Alcoholic Intoxication ; Female ; Humans ; India ; Intimate Partner Violence/psychology ; Risk Factors ; Spouses/psychology
Language	English
Publishing date	2021-02-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2028900-5
ISSN	1552-6518 ; 0886-2605
ISSN (online)	1552-6518
ISSN	0886-2605
DOI	10.1177/0886260521991304
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