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Stigma related to mental health and lack of trained mental health professionals is a major cause for an increased treatment gap, particularly in rural India. The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project delivered a complex intervention involving task sharing, an anti-stigma campaign and use of technology-based, decision-support tools to empower primary care workers to identify and manage depression, anxiety, stress and suicide risk.
The aim of this article is to report changes in stigma perceptions over three time points in the rural communities where the anti-stigma campaign was conducted.
A multimedia-based anti-stigma campaign was conducted over a 3-month period in the West Godavari district of Andhra Pradesh, India. Following that, the primary care-based mental health service was delivered for 1 year. The anti-stigma campaign was evaluated in two villages and data were captured at three time points over a 24-month period (N = 1417): before and after delivery of the campaign and after completion of the health services delivery intervention. Standardised tools captured data on knowledge, attitude and behaviour towards mental health as well as perceptions related to help seeking for mental illnesses.
Most knowledge, attitude and behaviour scores improved over the three time points. Overall mean scores on stigma perceptions related to help seeking improved by −0.375 (minimum/maximum of −2.7/2.4, s.d. 0.519, P < 0.001) during this time. Loss to follow-up was 10%.
The data highlight the positive effects of an anti-stigma campaign over a 2-year period.
About 10% Indians suffer from stress, depression or substance use disorders. Few receive care for these problems, especially in rural areas.
As part of a broader initiative to deliver technology-enabled mental health services for rural communities (adults ≥18 years), information was collected about the prevalence of depression, anxiety and suicide risk.
The study was conducted in 12 villages in the West Godavari district of Andhra Pradesh. Depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Additionally, data were collected about sociodemographic factors and stressful events, among others.
Anxiety, depression and suicidal ideation affected 10.8, 14.4 and 3.5% of participants, respectively (N = 22 377). These were more common among women, and among those who were aged 30–59 years, uneducated, or divorced/ separated/ widowed. Stress due to financial loss was significant.
The study identified a significant number of people at risk of depression, anxiety and suicide, and needing care.
To estimate the proportion of products meeting Indian government labelling regulations and to examine the Na levels in packaged foods sold in India.
Nutritional composition data were collected from the labels of all packaged food products sold at Indian supermarkets in between 2012 and 2014. Proportions of products compliant with the Food Safety Standards Authority of India (FSSAI) regulations and labelled with Na content, and mean Na levels were calculated. Comparisons were made against 2010 data from Hyderabad and against the UK Department of Health (DoH) 2017 Na targets.
Eleven large chain retail stores in Delhi and Hyderabad, India.
Packaged food products (n 5686) categorised into fourteen food groups, thirty-three food categories and ninety sub-categories.
More packaged food products (43 v. 34 %; P<0·001) were compliant with FSSAI regulations but less (32 v. 38 %; P<0·001) reported Na values compared with 2010. Food groups with the highest Na content were sauces and spreads (2217 mg/100 g) and convenience foods (1344 mg/100 g). Mean Na content in 2014 was higher in four food groups compared with 2010 and lower in none (P<0·05). Only 27 % of foods in sub-categories for which there are UK DoH benchmarks had Na levels below the targets.
Compliance with nutrient labelling in India is improving but remains low. Many packaged food products have high levels of Na and there is no evidence that Indian packaged foods are becoming less salty.
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