Volume 5, Issue 1, Winter and Spring 2022, Page 1-89

Academic psychiatry journals in South Asian countries: most from India, none from Afghanistan, Bhutan and the Maldives

S.M. Yasir Arafat; Syeda Ayat-e-Zainab Ali; Tamkeen Saleem; Debanjan Banerjee; RAKESH SINGH; Anuradha Baminiwatta; Sheikh Shoib

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 1-9
DOI: 10.52095/gp.2021.4395.1036

As journals play a crucial role in the dissemination of knowledge, reviewing the psychiatry journals would illustrate the mental health research status.

We aimed to identify and assess the academic journals in psychiatry from South Asian countries.
We searched on Google to identify the currently functioning psychiatry journals from South Asian countries. We used “psychiatry journals in South Asia”, “mental health journals in South Asia” as search terms. We also searched by individual country names (Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka).

A total of 19 psychiatry journals were identified and reviewed from five countries; one each from Bangladesh, Nepal, Pakistan, and Sri Lanka while 15 journals from India. Only three journals (15.8%) are indexed in PubMed, four journals (21%) in Scopus, and one in Web of Science inclusively. Major indexation was only found in the journals of India. Indian Journal of Psychiatry appears to be the oldest and currently leading mental health journal in the region.
The review revealed that South Asia has a noticeable deficit in a high-quality academic research publishing system in psychiatry on its own despite the region caters to about a quarter of the global population.

Epidemiology of suicides in Brazil: a systematic review

Leonardo Baldaçara; Alexandrina Meleiro; João Quevedo; Homero Vallada; Antônio da Silva

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 10-25
DOI: 10.52095/gp.2022.4377.1035

Aim: Find and review data about suicide prevalence and incidence in Brazil.
Methods: This is a Systematic Review that used PRISMA protocol and has PROSPERO registration at the number CRD42021288299. Using the PubMed, Scielo databases, Brazilian Ministry of Health, and WHO documents; 203 papers (metanalysis, systematic reviews, cohorts, cross-sectional, and government documents) published from 2010 to 2021 were initially selected, of which forty-three remained in the review. This is a Systematic Review that used PRISMA protocol and has PROSPERO registration at the number CRD42021288299. Risk of bias was assessed by Cochrane Bias Risk Assessment tool.
Results: The data showed that suicide rates in Brazil range between 4.6 and 6.6 per 100,000 inhabitants. From 2000 to 2020 and showed an increased risk of death from suicide in all regions of Brazil, highlighting the South and Midwest regions. Overall, suicide in Brazil is more prevalent in older, among those aged 15 to 45 years (besides there is an increase in adolescent mortality rates), unmarried, males, and those who present mental disorders, and is associated with unemployment and economic deprivation. Indigenous people have elevated levels of suicide compared to non-indigenous. Hanging and poisoning were the most common methods used and the suicide most happen at home.
Limitations: Only English and Portuguese publications were included in the present work. All studies published in the different periods were included. Some biases were observed: some studies had restricted eligibility criteria, different measures, other fail to adequately control confound variables. We protect the quality of article excluding studies were bias could compromise interpretation.
Conclusions: The consolidated information from this present systematic review about suicidal behaviour in Brazil may contribute to the assessment of the current situation and future planning of public health interventions, especially better prevention efforts.

The study of mental illness in Iraq and its common trends: A systematic review

Darya Ahmed

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 26-35
DOI: 10.52095/gp.2022.3774.1026

Background and Objectives: Most of the population worldwide is suffering from mental illness due to one reason, or other but very limited data is available specifically in Iraq. Iraq has had a long history of wars and terrorist activities during the last four decades. Limited research is carried out that focus specifically on mental health and its related subheadings to understand the trends of research in this field. Therefore, this systematic review aims to understand the connection between the studies in a special period on mental health and the areas that these papers cover in this field.
Methods: by using the protocol of PRISMA, 33 full-length English language articles were searched in the major databases, (PubMed, EMBASE and MEDLINE). With the help of specific keywords like "mental health in Iraq," "anxiety," "depression," "Iraq survey," "Psychosis," "postpartum," "prevalence of mental illness in Iraq," "Prevalence of Mental disorders in Iraq." 14 articles were finally selected for further data extraction.
Result: findings revealed a wide coverage of different factors like violence, war, individuals with diabetes, stressful environment, infertile women, parents of children with cancer, and old aged are responsible for mental health problems. Topics such as child and adolescent mental health include hospital-based studies on psychiatric problems of children, community-based investigation on the mental health of a different group of minorities, the prevalence rate among different age groups child and adolescent population, and studies on prevention and intervention strategies for boosting mental health care in the area should be considered for further detail investigation.
Conclusion: This systematic review indicated that research in the mental health field needs to be reconsidered regarding the priorities and focuses according to the need of country. Though major factors have been identified but there is an uneven distribution of the present mental health situation and published studies.

A bibliometric analysis of Koro syndrome

Sujita Kar; S.M. Yasir Arafat; Vikas Menon; Pawan Sharma; Anamika Das; Sayuri Perera; Akanksha Shankar

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 36-41
DOI: 10.52095/gp.2022.4460.1039

Koro is a culture-bound syndrome that primarily affects males of China, South Asia, and Africa. Our objective was to perform a bibliometric analysis of available published literature on Koro, till date
The SCOPUS database was searched, from inception, for publications on Koro using a combination of terms "Koro Syndrome" OR "Genital Retraction”. Available articles were screened to identify the relevant articles.
A total of 62 relevant articles were found in the SCOPUS database and included in the study. Majority (n=46;74.2%) of these were original articles. Medicine (n=61;98%) followed by Psychology (n=8; 12.9%) were the common originating specialties for research on Koro. The oldest publication was in 1973; maximum publications were in 1990 (9.68 %, n=6) followed by in the year 2005 (8.06%, n=5). The British Journal of Psychiatry published maximum articles on Koro (n=6). Culture Medicine and Psychiatry, Journal of Urology and Medicine Clinica had 3(4.8%) publications each. One hundred and thirty-one authors from 67 institutes and twenty-four countries contributed to research output on Koro; of them, most publications were from the United States of America (n=10).
Although "Koro" is a well-known entity, the number of publications on Koro is scarce, sporadic, and not globally representative.

Women with schizophrenia have worse clinical presentation compared to their men counterpart in Kosovo: a cross-sectional study

Manuela Russo; Nikolina Jovanovic; Fitim Uka; Jon Konjufca; Dashamir Berxulli; Aliriza Arenliu

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 42-50
DOI: 10.52095/gp.2022.4548.1043

Objectives: Gender differences have been reported in schizophrenia and suggested that later onset, predominant affective symptoms and better functioning are reported in women, while higher prevalence with more severe negative symptoms, and higher comorbidity for substance abuse in men. However, since the majority of data come from high-income countries, it is almost unknown whether gender differences exist in people with schizophrenia from socially and economically diverse contexts. The objective of this study is to explore gender differences in socio-demographic and clinical characteristics in a sample of people with schizophrenia in Kosovo, a low- and middle-income country (LMIC).
Methods: The study included 101 patients with schizophrenia recruited from community services. Data on demographics, socio-economic characteristics, use of psychological therapy, and medication was collected through direct interviews. Clinical symptoms were assessed by using a combination of self-rated and researcher-rated measures. Gender differences were examined using χ2, independent sample t- tests, and univariate analysis of variance.
Results: The sample was composed of 31.7% (n=32) women. Most demographic characteristics did not differ by gender, apart from marital status (higher proportion of women were separated; p=0.010). Women presented with more depressive (p=0.010) and paranoid symptoms (p=0.011), and attended psychological therapy less frequently (50% women vs 80% men; p=0.014). For both genders, attending psychological therapy was associated with lower negative symptoms (p=0.002).
Conclusions: Women with schizophrenia had worse clinical presentation compared with men, and reported lower psychological therapy attendance. More research is needed to better describe schizophrenia in LMICs, and to understand whether access to mental health services, particularly psychological therapy, is attributable to clinical or contextual factors. Offering psychological therapy to people with schizophrenia of either gender included here could alleviate the burden of negative symptoms.

Monitoring the Adverse Effects of Psychotropic drugs – Need for An Evidence-Based Approach

Sumeet Gupta; Udayan Khastgir; Ogba Onwuchekwa; Ioana Varvari

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 51-63
DOI: 10.52095/gpa.2022.4362.1034

Psychotropic drugs are associated with adverse effects. Mostly adverse effects are reported by patients or elicited by clinicians. For many other adverse effects, it is necessary to do baseline blood tests to avoid giving a medication to patients who are at a high risk of a particular adverse effects and to monitor blood tests to either avoid or to manage specific adverse effects. Most treatment guidelines recommend blood tests to monitor adverse effects of psychotropic drugs. However, mostly these recommendations are based on low levels of scientific evidence and expert opinions. Hence, it is not uncommon to see significant variations amongst different guidelines. Ideally, the monitoring recommendations should take in to account clinical significance and pathophysiology of the adverse effects. Moreover, before proposing any form of monitoring, we must be reasonably sure that such monitoring will be beneficial for patients and lastly monitoring should be cost effective as well. In the field of medicine, monitoring recommendations are increasingly subjected to scientific rigour. In this review, we have compared blood tests monitoring recommendations, by various national and international treatment guidelines, of commonly used psychotropic drugs such as antipsychotic drugs, lithium, and valproate. This is a narrative review, in which we have critically appraised the recommendations and highlighted the need for evidence-based monitoring of adverse effects of psychotropic drugs.

Observation of Rare Psychosocial and Mental Health Symptoms in ISIS Psychiatric Patients: A Pilot Study Among ISIS Affiliates

Darya Ahmed

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 64-69
DOI: 10.52095/gpa.2022.4505.1042

Objectives: The invasion of Iraq and Syria by the so-called "Islamic State of Iraq and Syria" (ISIS) began in 2014. Most of the people were displaced or forced to migrate in great numbers, and as a result, they suffered from mental and emotional disorders. The purpose of this pilot study is to assess ISIS psychiatric patients and report on possible unusual psychosocial symptoms that may occur among them.
Methods: The prospective multicenter study, which included 18 patients from a community mental health facility within the IDP camp in Ninewa, included nine former ISIS members and nine general controls both groups suffering MDD and PTSD. The purpose of this study was to screen for unusual signs and symptoms using a semi-structured interview and a mental health assessment.
Results: There were a total of nine patients from ISIS affiliates, with an average age of 29 years. The ISIS patients met DSM-V diagnostic criteria for MDD, PTSD, and unusual psychosocial symptoms, but the control group only met DSM-V diagnostic criteria for general mental illnesses, not unusual psychosocial symptoms. This is the first time that uncommon psychosocial symptoms including low self-esteem, dread, suicidal thoughts, aggressive behavior, self-blaming, isolation, and disguising identity have been identified among ISIS psychiatric patients.
Conclusion: Extremist groups, particularly ISIS affiliates, are thought to have a considerable prevalence rate of uncommon symptoms, which are thought to be unique to them. Future studies should be encouraged in order to understand more about these unique and unusual characteristics in order to find a more effective therapy and it may be recognized as a novel syndrome.

Quality of Online Media Reporting of Suicidal Behavior in Iran during COVID-19 pandemic in Reference to the World Health Organization Guidelines

S.M. Yasir Arafat; Araz Ahmad; Ayoob Saeed; Omar Feizi; Fahimeh Saeed; Vikas Menon; Sujita Kar; Sheikh Shoib

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 70-76
DOI: 10.52095/gpa.2022.4883.1047

Background: Mass media has a diverse effect on suicidal behavior and has a significant impact on framing prevention strategies for the general population. However, the quality of news reporting of suicide has not been assessed in Iran adequately specially during the COVID-19 pandemic.
Aim: The study aimed to evaluate the quality of online news reporting of suicidal behavior in Iran against the World Health Organization (WHO) suicide reporting guidelines during the COVID-19 pandemic.
Methods: We analyzed the news reports to recognize the reporting characteristics and compared them with the WHO guidelines. A search was carried out in March and April 2021 on Google using the term "suicide news in Iran," and online news stories published in the Farsi language from January to December 2020, were extracted.
Results: A total of 125 news reports was retrieved from thirteen newspapers where all the reports were published in Farsi. Among the reports, 50 (40%) mentioned the name, and 62 (49.6%) mentioned the occupation of the deceased. The name of the method was mentioned in 111 (88.9%) reports, mono causality was reported in 49 (39.2%) reports, the word "suicide" was mentioned in the headline in 117 (93.6%) reports, a method was reported in the headline in 34 (27.2%) reports, and 32 (25.6%) reports published the photo of the deceased. Only four (3.2%) reports mentioned psychiatric disorders, 13 (10.4%) disseminated expert opinion, and none of the reports cited prevention program, helpful contact identity, or education material.
Conclusion: The study showed Farsi news reports were not firmly compliant with WHO guidelines for reporting suicide during the COVID-19 pandemic. Further studies are warranted considering these findings to change into accountable media reporting and to shape the prevention strategies.

Assessing and Responding to Suicide Risk in Health Research in Low-Resource Settings: Implementation of a Suicide Response Protocol in Ghana

Emma Lawrence; Hannah Lawrence; Adu Appiah-Kubi; Ruth Owusu-Antwi; Tom Konney

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 77-82
DOI: 10.52095/gpa.2022.4897.1048

Introduction: Risk for suicide is high in low and middle-income countries (LMICs) where over 75% of deaths by suicide occur. Thus, assessing for suicidal ideation and behavior and intervening appropriately when conducting research in LMICs is a critical step toward lowering risk for suicide among at-risk research participants. This is important even when conducting non-psychiatric research, especially when evaluating high-risk populations such as those experiencing bereavement. In this paper, we address questions that commonly arise as researchers in LMICs consider assessing for suicide risk.

Key considerations: Using expert opinion and review of the literature, we discuss factors to consider when establishing an interdisciplinary research team and effectively assessing for and responding to suicide risk. We pose key questions and responses, using examples from a case study in which our team implemented a suicide assessment and response protocol as part of a research study on maternal mortality in Ghana, a LMIC. Through discussion of this case study, we demonstrate the feasibility and importance of (1) an interdisciplinary research team involving providers from the local community, (2) a practical framework for assessing suicide risk among study participants, and (3) a protocol to respond when risk is indicated. Assessing for suicidal ideation and behavior and intervening appropriately when conducting research in LMICs is a critical step toward lowering risk for suicide among at-risk research participants.

Conclusions: By assessing for risk, appropriate care and follow-up can be provided with the goal of ultimately reducing the likelihood of suicide. To optimize impact, suicide risk protocols should be individualized to the specific setting, language, and available resources.

Similar Attitudes Toward Death among Muslims and Christians in Iraq

Darya Ahmed

GLOBAL PSYCHIATRY ARCHIVES, 2022, Volume 5, Issue 1, Pages 83-89
DOI: 10.52095/gpa.2022.4504.1041

Objectives: Knowing people’s attitudes towards death is useful in examining people’s level of flexibility, problem management, and self-care. The religious and related cultural background of an individual may affect an individual's attitude towards death. Hence, the current study evaluated Christian and Muslim respondents' attitudes towards death in Iraqi society.
Methods: In a cross-sectional study, 100 individuals from the two main religious groups (Muslim and Christian) were group-matched for gender, age, marital status, and personal monthly income. The attitude towards death was measured through a death attitude profile-revised questionnaire, and findings were analyzed via SPSS version 20 by applying Pearson correlation and central tendencies.
Results: Findings revealed that both religions' followers have no fear of death (No death anxiety) and, at the same time, approach acceptance towards death. Although overall, religion had no significant effect on participant attitudes towards death, which means both religion’s followers share the same approaches and attitudes towards death.
Conclusion: From the current research work, it can be concluded that there is no impact of religion on individual attitudes towards death and both religious followers have no death anxiety, meanwhile, both Muslims and Christians have positive attitudes through five-dimensional attitudes toward death. Future studies should focus on a larger population with different cultures and religious backgrounds to generalize these findings to other populations and cultural backgrounds.