Devassy Saju Madavanakadu, Scaria Lorane, Babu Shyba, S P Rajeev, K J Lijo, Jose Amal Tom, Thampi Kiran, Gearing Robin E
Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Rajagiri PO, Cochin, Kerala, 683104, India.
Rajagiri International Centre for Consortium Research in Social Care (ICRS), Rajagiri PO, Cochin, Kerala, 683104, India.
BMC Psychiatry. 2025 Apr 8;25(1):352. doi: 10.1186/s12888-025-06773-9.
Untreated mental illness poses a significant threat to achieving global mental health targets. The increasing incidence of common mental disorders in India exacerbates the treatment gap. Structural fragmentation prevents effective screening and treatment, despite several policies and programs. The study presents a culturally tailored mental health campaign developed within a service design paradigm for mental health screening.
The campaign had three phases: formation of a multidisciplinary service design team, modelling of an intervention, and implementing activities across three levels- macro, meso, and micro- to be implemented by educated youth, utilizing task-sharing strategies. Additionally, the study tested the feasibility of a mental health screening using student volunteers through a cross-sectional door-knock survey that assessed the prevalence of depression, alcohol consumption, and drug abuse among 2,263 community residents from randomly selected geographical locations in Kerala, India. Standardized scales were used to measure the variables.
The youth-led community screening is promising, as the detected incidence rate was comparable to that of screening performed by experts. Participants (n = 2263) from the cross-sectional survey comprised 52% males and 48% females. The study revealed the prevalence rates of moderate and above depression (9.1%), harmful alcohol use, including alcohol use disorder (6.2%), and drug abuse (8.9%). Lower economic attainment was a vulnerability for mental disorders in both genders, with females demonstrating a higher incidence of depression and males with higher alcohol and drug abuse. Compared to males from Above Poverty Line (APL) households, females from Below Poverty Line (BPL) households had an 80% higher likelihood of depression.
The service design team, representing a microcosm of the population, developed culturally appropriate mental health campaigns. The act-reflect-act framework within the Service Design Model integrated need-based services to bring together multiple healthcare stakeholders and ecosystem tiers, facilitated by public private partnership (PPP) to improve coverage and address barriers to accessing public mental health services. The stability of the referral model was ensured through long term initiatives, including establishment of mental health clinics and senior daycare centres.
未经治疗的精神疾病对实现全球精神卫生目标构成重大威胁。印度常见精神障碍发病率的上升加剧了治疗差距。尽管有多项政策和项目，但结构碎片化阻碍了有效的筛查和治疗。本研究展示了一种在服务设计范式内为精神卫生筛查而开发的、符合文化特点的精神卫生宣传活动。
该宣传活动分三个阶段进行：组建多学科服务设计团队、对干预措施进行建模，以及通过受过教育的青年利用任务分担策略在宏观、中观和微观三个层面开展活动。此外，该研究通过横断面敲门调查测试了使用学生志愿者进行精神卫生筛查的可行性，该调查评估了印度喀拉拉邦随机选取地理位置的2263名社区居民中抑郁症、酒精消费和药物滥用的患病率。使用标准化量表来测量这些变量。
由青年主导的社区筛查很有前景，因为检测出的发病率与专家进行的筛查相当。横断面调查的参与者（n = 2263）中男性占52%，女性占48%。该研究揭示了中度及以上抑郁症的患病率（9.1%）、有害饮酒（包括酒精使用障碍，6.2%）和药物滥用（8.9%）。较低的经济水平是两性患精神障碍的一个脆弱因素，女性抑郁症发病率较高，男性酒精和药物滥用率较高。与来自贫困线以上（APL）家庭的男性相比，来自贫困线以下（BPL）家庭的女性患抑郁症的可能性高80%。
代表人群缩影的服务设计团队开发了符合文化特点的精神卫生宣传活动。服务设计模型中的行动—反思—行动框架整合了基于需求的服务，以汇聚多个医疗保健利益相关者和生态系统层面，在公私伙伴关系（PPP）的推动下，提高覆盖率并解决获取公共精神卫生服务的障碍。通过长期举措，包括建立精神卫生诊所和老年日间护理中心，确保了转诊模式的稳定性。
