A 15-day compulsory rotatory rural psychiatry posting was introduced into the MD psychiatry curriculum at NIMHANS to orient trainees to the functioning of community mental health services.

To capture the views and subjective experiences of the 32 residents posted in rural psychiatry services under District Mental Health Program (DMHP) using qualitative interviews.

In-depth qualitative interviews were conducted to understand the residents’ experience in various aspects of the community psychiatry posting. The interviews were audiotaped and later, transcribed. Thematic analysis of transcripts was done.

The analyzed data was converted into 41 codes and 12 themes. The themes related to positive experiences were good clinical exposure and skills to practice in low-resource settings, focus on preventive mental health care, enhanced communication, administration, leadership skills, and increased empathy. After training, the residents also reported gaining insights into the attitude of policy-makers and increased interest and confidence to practice in a rural setting. The themes highlighting the perceived challenges ranged from personal reasons, such as food or transportation, to professional ones like stigma, limited resources, a burdensome amount of paperwork, limited availability of psychotropics, and communication barriers. Residents who expressed interest in practicing rural psychiatry in the future cited a good wage, higher levels of self-satisfaction, confidence, and an emotional connection to their native place as motivating factors. Those who did not want to join DMHP had concerns such as not having adequate skills for working in a low resource setting, compromised basic needs, superiors not being sensitive to mental health issues, additional non-psychiatric work, job instability and lack of academic and research opportunities.

The posting to nearby DMHP centers was feasible and contributed positively to the training experience of the residents. Positive experiences, challenges, and other lessons learned by these residents could help them plan their career in rural psychiatry. It was found that both the residents and the DMHP team contributed to each other’s growth. This posting was likely to boost residents’ confidence to work in rural settings and could also aid in easing the crisis of lack of community-based mental health experts. The authors advocate for the national implementation of such rural psychiatry posting.

None Declared

There are no conclusive findings about the possible protective role of religion on students’ mental health during the COVID-19 pandemic. Therefore, more research is needed.

The purpose of this study was to assess the relationship between the level of emotional distress and religiosity among students from 7 different countries during the COVID-19 pandemic.

Data were collected by an online cross-sectional survey that was distributed amongst Polish (N = 1196), Bengali (N = 1537), Indian (N = 483), Mexican (N = 231), Egyptian (N = 565), Philippine (N = 2062), and Pakistani (N = 506) students (N = 6642) from 12th April to 1st June 2021. The respondents were asked several questions regarding their religiosity which was measured by The Duke University Religion Index (DUREL), the emotional distress was measured by the Depression, Anxiety, and Stress Scale-21 (DASS-21).

Egypt with Islam as the dominant religion showed the greatest temple attendance (organizational religious activity: M=5.27±1.36) and spirituality (intrinsic religiosity: M=5.27±1.36), p<0.0001. On another hand, Egyptian students had the lowest emotional distress measured in all categories DASS-21 (depression: M=4.87±10.17, anxiety: M=4.78±10.13, stress: M=20.76±11.46). Two countries with the dominant Christian religion achieved the highest score for private religious activities (non-organizational religious activity; Mexico: M=3.94±0.94, Poland: M=3.63±1.20; p<0.0001) and experienced a moderate level of depressive symptoms, anxiety, and stress. Students from Mexico presented the lowest attendance to church (M=2.46±1,39) and spirituality (M=6.68± 3.41) and had the second highest level of depressive symptoms (M=19.13±13.03) and stress (M=20.27±1.98). Philippines students had the highest DASS-21 score (depression: M=22.77±12.58, anxiety: M=16.07±10.77, stress: M=4.87±10.08) and their level of religiosity reached average values in the whole group. The performed regression analysis confirmed the importance of the 3 dimensions (organizational religious activity, non-organizational religious activity, intrinsic religiosity) of religiosity for the well-being of students, except for the relationship between anxiety and private religious activities. The result was as presented for depression: R2=0.0398, F(3.664)=91.764, p<0.0001, SE of E: 12.88; anxiety: R2=0.0124, F(3.664)=27.683, p<0.0001, SE of E: 10,62; stress: R2= 0.0350, F(3.664)=80.363, p<0.0001, SE of E: 12.30.

The higher commitment to organizational religious activity, non-organizational religious activity, and intrinsic religiositywas correlated with the lower level of depressive symptoms, stress, and anxiety among students during the COVID-19 pandemic, but taking into account factors related to religiosity explains the level of emotional well-being to a small extent.

None Declared

TDuring COVID-19 pandemic, it was noticed that it was students who were mostly affected by the changes that aroused because of the pandemic. The interesting part is whether students’ well-being could be associated with their fields of study as well as coping strategies.

In this study, we aimed to assess 1) the mental health of students from nine countries with a particular focus on depression, anxiety, and stress levels and their fields of study, 2) the major coping strategies of students after one year of the COVID-19 pandemic.

We conducted an anonymous online cross-sectional survey on 12th April – 1st June 2021 that was distributed among the students from Poland, Mexico, Egypt, India, Pakistan, China, Vietnam, Philippines, and Bangladesh. To measure the emotional distress, we used the Depression, Anxiety, and Stress Scale-21 (DASS-21), and to identify the major coping strategies of students - the Brief-COPE.

We gathered 7219 responses from students studying five major studies: medical studies (N=2821), social sciences (N=1471), technical sciences (N=891), artistic/humanistic studies (N=1094), sciences (N=942). The greatest intensity of depression (M=18.29±13.83; moderate intensity), anxiety (M=13.13±11.37; moderate intensity ), and stress (M=17.86±12.94; mild intensity) was observed among sciences students. Medical students presented the lowest intensity of all three components - depression (M=13.31±12.45; mild intensity), anxiety (M=10.37±10.57; moderate intensity), and stress (M=13.65±11.94; mild intensity). Students of all fields primarily used acceptance and self-distraction as their coping mechanisms, while the least commonly used were self-blame, denial, and substance use. The group of coping mechanisms the most frequently used was ‘emotional focus’. Medical students statistically less often used avoidant coping strategies compared to other fields of study. Substance use was only one coping mechanism that did not statistically differ between students of different fields of study. Behavioral disengagement presented the highest correlation with depression (r=0.54), anxiety (r=0.48), and stress (r=0.47) while religion presented the lowest positive correlation with depression (r=0.07), anxiety (r=0.14), and stress (r=0.11).

1) The greatest intensity of depression, anxiety, and stress was observed among sciences students, while the lowest intensity of those components was found among students studying medicine.

2) Not using avoidant coping strategies might be associated with lower intensity of all DASS components among students.

3) Behavioral disengagement might be strongly associated with greater intensity of depression, anxiety, and stress among students.

4) There was no coping mechanism that provided the alleviation of emotional distress in all the fields of studies of students.

None Declared

Culturally validated neurocognitive measures for children in Low- and Middle-income Countries are important in the timely and correct identification of neurocognitive impairments. Such measures can inform development of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsychological Evaluationo f Children (BENCI) is an openly available, computerized neuropsychological battery specifically developed to evaluate neurocognitive impairment.

This study adapted the BENCI and evaluated its reliability and validity in Kenya.

The BENCI was adapted using translation and back-translation from Spanish to English language. The psychometric properties were evaluated in a case-control study of 328 children (aged 6 – 14 years) living with HIV and 260 children not living with HIV in Kenya. We assessed reliability, factor structure, and measurement invariance with respect to HIV. Additionally, we examined convergent validity of the BENCI using tests from the Kilifi Toolkit.

Internal consistencies (0.49 < α < 0.97) and test-retest reliabilities (-.34 to .81) were sufficient-to-good for most of the subtests. Convergent validity was supported by significant correlations between the BENCI’s Verbal memory and Kilifi’s Verbal List Learning (r =.41), the BENCI’s Visual memory and Kilifi’s Verbal List Learning (r = .32) and the BENCI’s Planning total time test and Kilifi’s Tower Test (r = -.21) and the BENCI’s Abstract Reasoning test and Kilifi’s Raven’s Progressive Matrix (r = .21). The BENCI subtests highlighted meaningful differences between children living with HIV and those not living with HIV. After some minor adaptions, a confirmatory four-factor model consisting off flexibility, fluency, reasoning and working memory fitted well (χ2 =135.57, DF = 51, N = 604, p < .001, RMSEA = .052, CFI = .944, TLI =.914) and was partially scalar invariant between HIV positive and negative groups.

The English version of the BENCI formally translated for use in Kenya can be further adapted and integrated in clinical and research settings as a valid and reliable cognitive test battery.

None Declared

Neuropsychiatric symptoms (NPS) are common during the course of neurocognitive disorders. NPS have been previously reported in early and late stages of Alzheimer’s Disease. However, our understanding of NPS in high-risk states for dementia such as mild cognitive impairment (MCI) and major depressive disorder (MDD) is poor.

To compare the frequency and factor structure of neuropsychiatric symptoms among individuals with Mild Cognitive Impairment (MCI), Major Depressive Disorder (MDD) in remission, and comorbid MCI and MDD (in remission) (MCI-D).

We used baseline data from the Prevention of Alzheimer’s Dementia with Cognitive Remediation Plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression (PACt-MD) study, a multicenter trial across five academic sites in Toronto, Canada (clinical trial No. NCT0238667). We used ANOVA or χ2-test to compare frequency of NPS across groups. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items in the three groups.

We included 374 participants with a mean age of 72.0 years (SD = 6.3). In the overall sample, at least one NPS was present in 64.2% participants, and 36.1 % had at least moderate severity NPS (36.1%). Depression (54%, χ2 < 0.001) and apathy (28.7%, χ2=0.002) were more prevalent in the MCI-D group as compared to MCI and MDD groups. In factor analysis, NPS grouped differently in MCI, MDD, and MCI-D groups. A “psychotic” subgroup emerged among MCI and MCI-D, but not in MDD. Night-time behaviors and disinhibition grouped differently across all three groups.

Prevalence of NPS seems higher in persons with MCI-D as compared to those with only MCI or MDD. The factor structure of NPS differed between MCI, MDD, and MCI-D groups. Future studies should investigate the association of NPS factors with cognition, function, and illness biomarkers.

None Declared

Depression is a leading cause of disability, annually affecting up to 300 million people worldwide, yet fewer than one third of patients receive care. Cognitive behavioural therapy (CBT) is an effective treatment for depression, but there are barriers to access therapy. Electronic CBT (e-CBT) can address these barriers, but the digital format may reduce personalization and patient compliance. A balanced, hybrid model (i.e., combination of e-CBT & supervised care) could make therapy scalable and effective through a stepped-care model: a care model that begins treatment with the least resource intensive, yet effective, method while slowly ‘stepping up’ to intensive care based on patients’ needs.

-To examine the efficacy of a stepped-care e-CBT model for depression through reduction in depressive symptoms.

-To develop a decision-making process that can effectively allocate the appropriate level of care for each patient.

This is a single-blinded randomized controlled trial (RCT). Participants were randomized to either the e-CBT group (n = 53) or the e-CBT with stepped care group (n = 26). Both groups received a 12/13-weeks e-CBT program tailored to depression. The e-CBT program was provided through a secure online mental health clinic called the Online Psychotherapy Tool (OPTT). Participants read through the sessions and completed assignments related to each session. Each participant was designated a care provider who was a trained research assistant. Participants in the experimental group received extra interventions based on their standard questionnaire scores, and textual data.

Figure 1: The average PHQ-9 (A), QLESQ (B), and QIDS (C) scores pre-, mid-, and post- treatment for the e-CBT only (n = 53) and stepped care groups (n = 26).

* Depressive symptoms: PHQ-9 (Patient Health Questionnaire-9) & QIDS (Quick Inventory of Depressive Symptomatology)

* Quality of Life Measure: QLESQ (Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form)

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Stepped care model can be reliable and effective method of delivering targeted care to future patients. Using this approach, the amount of care each patient receives is tailored to their needs, allowing for more efficient usage of scarce resources. This would also lower the general cost of care for each patient. By understanding the therapeutic needs of each patient, we can use these results to develop objective interventions and efficient algorithms to triage individuals. This technique could scale up care capacity without sacrificing the quality of care for each patient.

N. Alavi Shareolder of: OPTT inc, M. Omrani Shareolder of: OPTT inc, J. Jagayat: None Declared, A. Shirazi: None Declared, A. Kumar: None Declared, A. Pannu: None Declared, Y. Shao: None Declared

Poor air quality is associated with poor health. Little attention is given to the complex array of environmental exposures and air pollutants that affect mental health during the life course.

We gather interdisciplinary expertise and knowledge across the air pollution and mental health fields. We seek to propose future research priorities and how to address them.

Through a rapid narrative review, we summarise the key scientific findings, knowledge gaps and methodological challenges.

There is emerging evidence of associations between poor air quality, both indoors and outdoors, and poor mental health more generally, as well as specific mental disorders. Furthermore, pre-existing long-term conditions appear to deteriorate, requiring more healthcare. Evidence of critical periods for exposure among children and adolescents highlights the need for more longitudinal data as the basis of early preventive actions and policies. Particulate matter, including bioaerosols, are implicated, but form part of a complex exposome influenced by geography, deprivation, socioeconomic conditions and biological and individual vulnerabilities. Critical knowledge gaps need to be addressed to design interventions for mitigation and prevention, reflecting ever-changing sources of air pollution. The evidence base can inform and motivate multi-sector and interdisciplinary efforts of researchers, practitioners, policy makers, industry, community groups and campaigners to take informed action.

There are knowledge gaps and a need for more research, for example, around bioaerosols exposure, indoor and outdoor pollution, urban design and impact on mental health over the life course.

The purpose of the study was to design, develop, and validate a newer tool on radiation emergency preparedness responses (RadEM-PREM IPE tool) to measure communication, knowledge, performance skills in multidisciplinary health science learners.

The study design is a prospective, single centric, pilot study. Five subject experts designed, analyzed, and selected items of the instrument for relevant content and domain. Psychometrics that the tool assessed were content validity, internal consistency, test-retest reliability, and intraclass correlation coefficient. Twenty-eight participants completed test-retest reliability for validation of 21 sorted out items calculated percentage of agreement >70% I-CVI/UA (item content validity index with universal acceptability) and S-CVI/UA (scale content validity index with universal agreement method).

Items with percentage agreement >70% and I-CVI over 0.80 were kept, ranged from 0.70 to 0.78 were revised, and below 0.70 were rejected. Items with kappa values ranging from 0.04 to 0.59 were revised and ≥0.74 were retained. Internal consistency assessed using Cronbach’s alpha was 0.449. Positive correlation between attitude and communication (r = 0.448), between performance and communication (r = 0.443) were statistically significant at 0.01 level. Overall, intraclass correlation coefficient for all the measures is 0.646, which is statistically significant at 0.05 level (P < 0.05).

Study concludes that the RadEM-PREM IPE tool would be a new measuring tool to assess knowledge, performance, and communication skills of interprofessional radiation emergency response team learner’s evaluation.