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      Telepsychiatry in India – Where Do We Stand? A Comparative Review between Global and Indian Telepsychiatry Programs

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          Abstract

          A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21 st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.

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          Most cited references74

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          Indian Psychiatric epidemiological studies: Learning from the past

          The objective of this paper is to provide a systematic review on the epidemiology of psychiatric disorders in India based on the data published from 1960 to 2009. Extensive search of PubMed, NeuroMed, Indian Journal of Psychiatry website and MEDLARS using search terms “psychiatry” “prevalence”, “community”, and “epidemiology” was done along with the manual search of journals and cross-references. Retrieved articles were systematically selected using specific inclusion and exclusion criteria. Epidemiological studies report prevalence rates for psychiatric disorders varying from 9.5 to 370/1000 population in India. These varying prevalence rates of mental disorders are not only specific to Indian studies but are also seen in international studies. Despite variations in the design of studies, available data from the Indian studies suggests that about 20% of the adult population in the community is affected with one or the other psychiatric disorder. Mental healthcare priorities need to be shifted from psychotic disorders to common mental disorders and from mental hospitals to primary health centers. Increase in invisible mental problems such as suicidal attempts, aggression and violence, widespread use of substances, increasing marital discord and divorce rates emphasize on the need to prioritize and make a paradigm shift in the strategies to promote and provide appropriate mental health services in the community. Future epidemiological research need to focus on the general population from longitudinal prospective involving multi-centers with assessment of disability, co-morbidity, functioning, family burden and quality of life.
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            Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies.

            The authors conducted a review and meta-analysis of the literature comparing telepsychiatry with "in-person" psychiatric assessments. Approximately 380 studies on telepsychiatry published between 1956 and 2002 were identified using MEDLINE, PsycINFO, and cross-referenced bibliographies. Of these, 14 studies with an N > 10 compared telepsychiatry with in-person psychiatry (I-P) using objective assessment instruments or satisfaction instruments. Three of these studies compared high bandwidth (HB) with low bandwidth (LB) telepsychiatry. Fourteen studies of 500 patients met inclusion criteria and were included in the meta-analysis. Telepsychiatry was found to be similar to I-P for the studies using objective assessments. Effect sizes were on average quite small, suggesting no difference between telepsychiatry and I-P. Bandwidth was found to be a significant moderator. Three moderators were tested, effect sizes remained largely heterogeneous, and further analyses are needed to determine the direction of effect. There was no difference between I-P and telepsychiatry between the HB and LB groups, although there are anecdotal data suggesting that HB was slightly superior for assessments requiring detailed observation of subjects. Out of a large telepsychiatry literature published over the past 40+ years, only a handful of studies have attempted to compare telepsychiatry with I-P directly using standardized assessment instruments that permit meaningful comparisons. However, in those studies, the current meta-analysis concludes there is no difference in accuracy or satisfaction between the two modalities. Over the next few years, we expect telepsychiatry to replace I-P in certain research and clinical situations.
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              EPIDEMIOLOGICAL FINDINGS ON PREVALENCE OF MENTAL DISORDERS IN INDIA

              Fifteen epidemiological studies on psychiatric morbidity in India have been analysed. National all-India prevalence rates for ‘all mental disorders’ and five specific disorders have been worked out The national prevalence rates for ‘all mental disorders’ arrived at are 70.5 (rural), 73 (urban) and 73 (rural + urban) per 1000 population. Prevalence of schizophrenia is 2.5/1000 and this seems to be the only disorder whose prevalence is consistent across cultures and over time. Rates for depression, anxiety neurosis, hysteria and mental retardation are provided. Urban morbidity in India is 3.5 percent higher than the rural rate, but rural-urban differences are not consistent for different disease categories. In Hindi speaking north India, mental morbidity amongst factory workers is two and half times that of the non-industrial urban inhabitants and five times the rural morbidity. The present data are expected to serve as baseline rates for mental health planners and for psychiatrists interested in epidemiological studies.
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                Author and article information

                Journal
                Indian J Psychol Med
                Indian J Psychol Med
                IJPsyM
                Indian Journal of Psychological Medicine
                Medknow Publications & Media Pvt Ltd (India )
                0253-7176
                0975-1564
                May-Jun 2017
                : 39
                : 3
                : 223-242
                Affiliations
                [1]Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
                [1 ]Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
                Author notes
                Address for correspondence: Dr. Subrata Naskar 9G, Avenue 1 st Road, Kolkata - 700 075, West Bengal, India. E-mail: nsubrata.edu@ 123456gmail.com
                Article
                IJPsyM-39-223
                10.4103/0253-7176.207329
                5461830
                28615754
                fa384b06-fe25-4342-8786-2bddbe2284e1
                Copyright: © 2017 Indian Psychiatric Society

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Categories
                Review Article

                Clinical Psychology & Psychiatry
                india,models,systematic review,telepsychiatry
                Clinical Psychology & Psychiatry
                india, models, systematic review, telepsychiatry

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