Journal of Education and Health Promotion

Designing unified trans‑diagnostic interventions and their efficacy on the common mechanisms of the comorbid obsessive personality disorder with anxiety, depression, and obsessive‑compulsive disorder: A protocol study

. Amin Zirakbash; . Farah Naderi; . Fatemeh Sadat Marashian; . Behnam Makvandi

Volume 13, Issue 1 , January 2023, , Pages 1-5

Abstract

  BACKGROUND: The immense comorbidity among disorders could be ascribed to commontrans‑diagnostic processes. The term trans‑diagnostic has been of interest in both pathologyand psychology. ...  Read More BACKGROUND: The immense comorbidity among disorders could be ascribed to commontrans‑diagnostic processes. The term trans‑diagnostic has been of interest in both pathologyand psychology. Trans‑diagnostic treatments were created as opposed to treatments based onsingle‑diagnosis treatments. It addresses the common underlying mechanisms in a range of comorbiddisorders. Trans‑diagnostic treatment is one of the new psychological treatments, and its efficacy hasbeen proven on many psychological variables. The main focus of the current study is on designingunified trans‑diagnostic interventions and their efficacy on the shared mechanisms of comorbidobsessive personality disorder with anxiety, depression, and obsessive‑compulsive disorder.MATERIALS AND METHODS: the sequential transformative strategy has two stages; qualitativeand quantitative. In The first and qualitative section of the research, explanatory research will becarried out to investigate the trans‑diagnostic intervention using a systematic review. To validatethe trans‑diagnostic intervention, and simultaneously with the trans‑diagnostic intervention, aquestionnaire has been prepared and given to 10 psychology experts and professionals in thetreatment field concerning content validity by evaluators.Quasi‑experimental research will be assessed with a pre‑test, post‑test, and a two‑month follow‑upafter confirming the validity and reliability of the intervention in the quantitative section.CONCLUSION: Designing unified trans‑diagnosis interventions and their efficacy on the commonmechanisms of comorbid obsessive personality disorder with anxiety, depression, and obsessive‑compulsivedisorder is an effective treatment method for helping those suffering from a personality disorder. Clinicalpsychologists, psychology experts, psychiatrists, and mental health experts are all the immediatebeneficiaries of this study. Moreover, clients could benefit from this intervention with less money and time.

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Impact of social media on mental health of the general population during Covid‑19 pandemic: A systematic review

. Uma Phalswal; . Vani Pujari; . Rasmita Sethi; . Ranjana Verma

Volume 13, Issue 1 , January 2023, , Pages 1-12

Abstract

  During the COVID‑19 pandemic, people are using social media more than usual routine because theyrely on online sources to seek health information for themselves and their loved ones. ...  Read More During the COVID‑19 pandemic, people are using social media more than usual routine because theyrely on online sources to seek health information for themselves and their loved ones. The spread ofinaccurate and misleading information via social media has a number of detrimental psychologicaleffects on members of society. The aim of this systematic review was to describe the impact of socialmedia on the mental health of the general population. An extensive systematic search was done till thelast month of 2021 for collecting the evidence using the PRISMA technique. The search was mainlyfocused on the article leading with keywords and search engines used during the course of the studywere Pubmed, Semantic Scholar, Mendeley, and Science direct. Articles for this study were selectedbased on the predetermined eligibility criteria and performed quality assessment by using the NHLBIquality assessment tool. Most of the studies included in this review are found fair (score between9 and 12) quality. Out of 866 publications, 533 articles were included in the initial screening, afterduplication removal 46 full‑text articles were assessed for eligibility and 14 studies were selected forsystematic review. In most of the studies, maximum participants used social media as a primary sourceof information. Relatively high rates of symptoms of depression (14.14% to 48.3%), anxiety (7.4% to47.82%), and prevalence of stress increased to 37.67% are reported after exposure to social mediafor coverage of COVID‑19 news in the general population. Risk factors of psychological distress areassociated with female gender, younger age group, marital status, staying alone, and duration ofexposure to mass media. Increased exposure to COVID‑19 information through mass/social mediais associated with highly significant levels of psychological health issues; mitigating the hazardouseffect of social media exposure during the COVID‑19 pandemic on the psychological health of thegeneral population is an international public health priority.

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Awareness, knowledge, and psycho‑emotional aspect of infertility among women seeking fertility assistance at a tertiary care hospital in Chhattisgarh, a cross‑sectional study

. Vinita Singh; . Gitika Rajpal; . Sagarika Majumdar; . Sucharita Mandal; . Rajshree Sahu

Volume 13, Issue 1 , January 2023, , Pages 1-15

Abstract

  BACKGROUND: The lack of fundamental knowledge and awareness about the biological process ofreproduction is low worldwide but has reportedly higher incidence rates in under‑developed ...  Read More BACKGROUND: The lack of fundamental knowledge and awareness about the biological process ofreproduction is low worldwide but has reportedly higher incidence rates in under‑developed countries.Infertility can have a tremendous effect on a woman’s psychological and social well‑being, pushingher toward mental stress, anxiety, depression self‑blame, self‑isolation, feeling of worthlessness,and lack of interest in life. The present study was conducted to determine the level of knowledge andawareness regarding factors affecting fertility and also to ascertain the emotional status of femalesvisiting the Obstetrics and Gynecology out‑patient department for fertility assistance.MATERIALS AND METHODS: A cross‑sectional study was performed by using a questionnairewhich had two parts; the first part had questions about awareness and knowledge of the subjectof infertility, and the second part had 12 questions that assessed the psychological and emotionalstatus of the participants, and it also explored prevailing myths about infertility based on a validatedquestionnaire.RESULTS: There was a significant difference in mean knowledge score; those who were moreeducated had better knowledge of various aspects of infertility. The overall adequacy for knowledgeand awareness revealed that only 62 (47.7%) of the participants had adequate knowledge (score >6)regarding female infertility. The mean score for knowledge among all the respondents was 6.61 ± 1.48.The overall emotional and psychological score suggested that 30 (23%) of the respondents weredisturbed because of stress because of infertility.CONCLUSION: Infertility can have a serious impact on the psychological well‑being of females,and social pressure and stigma associated with childlessness can further worsen the physical andemotional well‑being of couples, which needs to be addressed before starting treatment of infertilityfor a better response to treatment. The limited knowledge and prevailing mis‑conceptions regardinginfertility need to be sincerely dealt with to complement the medical treatment of infertility.

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The effect of COVID‑19 restrictions on sleep quality of university students and variables predicting sleep quality

. Arzu Bulut; . Halil Sengul; . Yeter Demir Uslu; . Kazım Bas; . Nurperihan Tosun

Volume 12, Issue 11 , December 2022, , Pages 1-9

Abstract

  BACKGROUND/AIM: The COVID‑19 pandemic has created a long period of stress for peopleworldwide and has significantly affected sleep duration. The pandemic revealed new stress factorsthat ...  Read More BACKGROUND/AIM: The COVID‑19 pandemic has created a long period of stress for peopleworldwide and has significantly affected sleep duration. The pandemic revealed new stress factorsthat are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, whichaffects sleep. It should also be noted that reductions in sleep quality rather than sleep duration areassociated with negative consequences on mental health. This study aims to investigate online thathow this situation affected university students.MATERIALS AND METHODS: This research, with a descriptive study design, was conducted inTurkey between June 01, 2021 and July 30, 2021. The sample included 604 people who acceptedvoluntary participation, chosen by the random selection method. In the study, sociodemographicinformation form, Pittsburgh sleep quality index (PSQI), morningness–eveningness questionnairescale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used asdata collection tools. Pearson correlation analysis was utilized to examine the relationship betweenthe scales. Multiple regression analysis was performed to investigate the role of morningness–eveningness, anxiety, depression, and insomnia severity on sleep quality.RESULTS: Sleep quality was negatively correlated with morningness–eveningness scores (r = –0.32,P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40,P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, whileanxiety (ꞵ = 0.041, P < 0.001) and insomnia severity scores (ꞵ = 0.226, P < 0.001) positively predictedsleep quality, depression did not predict it significantly (ꞵ = 0.009, P > 0.05). A significant difference wasfound in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).CONCLUSION: Events related to the COVID‑19 pandemic are associated with reduced sleep qualityin connection with increasing negative moods. Considering the importance of sleep for a healthylife, efforts should be made to raise awareness about this issue and to provide psychological helpto affected individuals.

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Agreement for diagnosis of depression and anxiety between self‑assessment with e‑questionnaire and psychiatric telephone interview among post‑COVID‑19 patients

. Shahrzad Mazhari; . Abdolreza Sabah; . Hoda Gilanipour; . Sareh Keshvardoost

Volume 12, Issue 11 , December 2022, , Pages 1-6

Abstract

  BACKGROUND: Psychological disorders, such as depression and anxiety, are common amongindividuals who have experienced coronavirus disease 2019 (COVID‑19); however, diagnosis maybe ...  Read More BACKGROUND: Psychological disorders, such as depression and anxiety, are common amongindividuals who have experienced coronavirus disease 2019 (COVID‑19); however, diagnosis maybe challenging and subjected to invalidity. This study aimed to examine agreement between onlineself‑assessment and psychiatric telephone interview among COVID‑19 survivors.MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out from Marchto June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID‑19 werecontacted within the first week after discharge and were asked to fill the Hospital Anxiety andDepression scale (HADS) and socio‑demography questionnaire. They were later interviewed usingHamilton Depression Rating Scale (HAM‑D) and Hamilton Anxiety Rating Scale (HAM‑A). Agreementbetween the data extracted from self‑report and telephone interview was analyzed using Cohen’skappa coefficient, sensitivity, and specificity.RESULTS: Out of 200 post‑COVID patients, 60 participants completed all assessments. Prevalenceof depression was observed to be 88% via telephone interview and 45% via self‑assessment.Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview,in comparison to 31% diagnosed with anxiety using self‑report questionnaire. The agreement betweenonline self‑assessment and telephone interview for depression and anxiety was not significant(κ = 0.08 and κ = 0.1, respectively).CONCLUSION: The discordance between online self‑report and clinician’s assessment via phonecontact interview indicates that using self‑report evaluations is not sufficient as the single assessmenttool for mental health monitoring and reflects the need to employ multiple assessments for diagnosisof psychiatric problems in pandemics.

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Prevalence of internet addiction and its impact on selected psychological parameters among UG nursing students

. Jitendra S. Parmar; . Samundy Kumbhakar

Volume 12, Issue 11 , December 2022, , Pages 1-7

Abstract

  BACKGROUND: Currently, the use of the internet is one of the most important tools, which maylead to negative or positive impact on college or school students. The excessive use of electronicmedia ...  Read More BACKGROUND: Currently, the use of the internet is one of the most important tools, which maylead to negative or positive impact on college or school students. The excessive use of electronicmedia may lead to change in the mood, an inability to resist internet usage, a diminishing sociallife, withdrawal symptoms while unengaged, affecting self‑esteem, and adverse work or academicconsequences. The main objective of this study is to explore Internet use and its impact on selectedpsychological parameters such as depression and insomnia among undergraduate (UG) nursingstudents.MATERIALS AND METHODS: A total of 385 college students selected by purposive samplingtechnique were included in the study. Young’s Internet Addiction Test (YIAT20) for Internetaddiction (IA) assessment, and Beck’s depression inventory Scale to assess level of depression,and insomnia severity index (ISI) scale to measure insomnia were used.RESULTS: Among 385 participants, 175 and 210 were male and female, respectively. Demographicvariables such as pursuing course, study year, use of Internet/day; and the purpose of Internetuse such as social networking, games, entertainment, pornography, and news were significantlyassociated with IA. Depression and insomnia were found to be correlated with IA.CONCLUSION: Internet usage more than the normal limit has a profound effect on college or schoolstudents, in particular, depression and insomnia. At times, it ends up in problems in their social andfamily relationship.

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Competency‑based medical education (CBME) curriculum and its effect on prevalence of anxiety, depression and stress amongst medical undergraduates

. Ashish Goel; . Yashendra Sethi; . Arsalan Moinuddin; . Desh Deepak; . Priyanka Gupta

Volume 12, Issue 10 , November 2022, , Pages 1-7

Abstract

  BACKGROUND: A growing body of literature now identifies higher levels of anxiety, depression, andstress among medical students as a distinct mental health domain. The competency‑based ...  Read More BACKGROUND: A growing body of literature now identifies higher levels of anxiety, depression, andstress among medical students as a distinct mental health domain. The competency‑based medicaleducation (CBME) curriculum was introduced to revamp the existing curriculum with an aim to garnerconstructive impact on the mental health of undergraduate medical students. As such, we soughtto draw comparisons between the mental health of medical students, studying the old (2018 batch)and the new (2019 batch) medical education systems in India.MATERIALS AND METHODS: We designed a survey that contained structured questionspertained to anxiety (HAM‑A, GAD‑7), depression (HAM‑D, BDI), and stress (PSS) amongst medicalundergraduate students of 2018 and 2019 batches at the Government Doon Medical College (GDMC),Dehradun, India.RESULTS: Contrasting the 2018 and 2019 batches, the introduction of CBME resulted in a significanttwo‑fold decrease in moderate anxiety, as exhibited by both HAM‑A (6.0 vs 3.0, P = 0.016) andGAD‑7 (3.5 vs 1.0, P = 0.037) scales, although no significant change in mild and severe anxiety, andoverall depression (BDI: P = 0.05, HAM‑D: P = 0.05) or stress (PSS: P = 0.86) was found.CONCLUSION: The CBME system has made a significant impact on the mental health ofundergraduate medical students for anxiety, albeit its effect on depression and stress remainsequivocal. Future studies are warranted to compare the effect of CBME in other undergraduate andpostgraduate courses across the country to help predict the psychological impact of the newfangledCBME education system.

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Prevalence of depression, anxiety and stress among private medical college students in South India: A cross‑sectional study

. Sangeetha Raja; . Gayathri Balasubramanian; . Jamuna Rani R

Volume 12, Issue 10 , November 2022, , Pages 1-5

Abstract

  BACKGROUND: Medical education is competitive across the globe. The long duration of the medicaland paramedical courses and exposure to clinical settings potentially causes mental health ...  Read More BACKGROUND: Medical education is competitive across the globe. The long duration of the medicaland paramedical courses and exposure to clinical settings potentially causes mental health issues.The aim of this study was to estimate the prevalence of depression, anxiety and stress amongundergraduate students in a private medical college in South India.MATERIALS AND METHODS: This cross‑sectional study was conducted among paramedical andmedical students at a private medical college hospital and research center in South India in theyear 2021. The required sample size was calculated as 783 with an expected prevalence of 53%,95% confidence interval (CI), design effect 2.0, and non‑response of 10%. The study participantswere selected based on simple random sampling. After obtaining informed consent, the data wascollected using an email questionnaire. Standard data collection tools such as the Perceived StressScale (PSS); and the Depression, Anxiety and Stress Scale ‑ 21 (DASS‑21) questionnaire wereused. The investigator computed the odds ratio (OR) and adjusted odds ratio (aOR) with a 95% CI.RESULTS: Out of 1200 students, 1015 (85%) responded to the email questionnaire. Among them, 639were females (63%), and 925 were paramedics (91%). Prevalence of depression, anxiety and stresswere 59%, 43% and 11%, respectively. Almost 95% of students experienced moderate‑to‑severestress in the last one month. Prevalence was higher among females and students of medicalcourses. Students of final year of college (aOR = 2.0; 95% CI = 1.2–3.5) and students of medicalcourse (aOR = 1.5; 95% CI = 1.1–2.4) were independently associated with stress among the studyparticipants.CONCLUSION: There is high prevalence of depression, anxiety and stress among medical collegestudents in south India. The final year of study and medical course were independently associatedwith higher stress than others. We recommend periodic assessment of mental health status andadditional mental health care for final year students and medical students.

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Do social phobia and depression go hand in hand? A cross‑sectional study among school‑going adolescents of Northern region of India

. Kezia Gupta; . Jayanti Semwal; . Neha Sharma; . Abhay Srivastava; . Shaili Vyas

Volume 12, Issue 9 , October 2022, , Pages 1-10

Abstract

  BACKGROUND: The preeminent mental health conditions, namely social phobia and depressionamong adolescents, usually remain incognito. The transition period from childhood to adulthoodmakes ...  Read More BACKGROUND: The preeminent mental health conditions, namely social phobia and depressionamong adolescents, usually remain incognito. The transition period from childhood to adulthoodmakes adolescents more liable for low amour‑propre, loneliness, and even increases the suicidaltendencies among them. To burgeon the knowledge regarding social phobia and depression amongadolescents, the present study was put forward with the objective to assess the prevalence of socialanxiety disorders (social phobia) and depression among adolescents.MATERIALS AND METHODS: A cross‑sectional study was conducted for 2 months on 600 studentsaged 10–19 years belonging to classes VIII–XII of government and private schools in the Dehradundistrict recruited through multistage random sampling technique. A pre‑tested semi‑structuredquestionnaire having sociodemographic details, validated self‑administered tools, Social PhobiaInventory tool, and Kutchers Adolescent Depression Scale (Cronbach’s alpha: 0.77 and 0.79) wereused. Statistical package for social sciences, version 23 was used for data analysis. Chi‑square test,Fisher exact test, and Pearson correlation analysis were used for analysisRESULTS: Prevalence of social phobia was found to be 37% among school‑going adolescents.Further, 23.7% of the study participants had mild social phobia, while moderate and severe phobiawas seen among 11.5% and 2.3%, respectively. Females had more moderate and severe socialphobia than males. Adolescents of government schools had more moderate affective distress andsomatic distress as compared to adolescents of private schools.CONCLUSION: Social phobia and depression among school‑going adolescents are on the upsurge.The present study shows that social phobia and depression have a strong correlation amongthemselves, which needs to be addressed as expeditiously as possible. Coping strategies and socialskill therapy and programs are pressing priorities for the fulgent future of adolescents.

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Depression and quality of life among elderly: Comparative cross‑sectional study between elderly in community and old age homes in Eastern India

. Soumya S. Sahoo; . Vazinder Kaur; . Udit K. Panda; . Bhola Nath; . Pragyan P. Parija; . Dinesh P. Sahu

Volume 12, Issue 8 , September 2022, , Pages 1-7

Abstract

  BACKGROUND: Depression among elderly is an emerging public health concern. Along with othercomorbidities, depression affects the quality of life and functional ability of the geriatric ...  Read More BACKGROUND: Depression among elderly is an emerging public health concern. Along with othercomorbidities, depression affects the quality of life and functional ability of the geriatric population.This study aimed to assess the depression and quality of life among elderly and compare theseparameters among the inhabitants of old age home and in the community.MATERIALS AND METHODS: A cross‑sectional study was conducted among the elderly of thecommunity and old‑age homes in the urban areas of Raipur, Chhattisgarh between March andJuly 2016. Hundred elderly (50 in each group) participated in the study. Geriatric Depression Scale15 (GDS‑15) and Older People Quality of Life (OPQoL)‑35 scale were used to assess the geriatricdepression and quality of life, respectively. Association between depression and demographicvariables were analyzed by Chi‑square/Fisher’s exact test. Pearson’s correlation coefficient wascalculated between GDS‑15 and OPQoL‑35 scale.RESULTS: The prevalence of geriatric depression was 59%. Quality of life was better among theold‑age home elderly participants than that of community elderly when compared for score of lifeover all (11.78 vs. 13.56), health (12.8 vs. 14.0), social relationship (10.48 vs. 13.9), control overlife (11.92 vs. 14.08), home and neighborhoods (9.38 vs. 12.36), psychological and emotionalwellbeing (10.96 vs. 13.7), financial circumstances (14.5 vs. 16.7), and leisure and activities (13.86 vs.15.28). Moderate positive correlation was observed between depression and quality of life.CONCLUSION: The higher prevalence in our study emphasizes the need to delineate the actualburden in the elderly population and provide necessary supportive measures. It needs to be addressedadequately through a coordinated primary care approach and community and social support. Timelyand adequate management of depression can improve the quality‑of‑life outcomes.

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Individual counseling in mothers bereaved by pregnancy loss: A randomized clinical trial

. Mahmonir Haghighi; . Khatereh Oladbaniadam; . Hamideh Mohaddesi; . Javad Rasuli

Volume 12, Issue 5 , June 2022, , Pages 1-7

Abstract

  BACKGROUND: The loss of a pregnancy can result in grief, guilt, self‑doubt, anxiety, andpost‑traumatic stress disorder (PTSD). Considering the side effects mentioned for mental ...  Read More BACKGROUND: The loss of a pregnancy can result in grief, guilt, self‑doubt, anxiety, andpost‑traumatic stress disorder (PTSD). Considering the side effects mentioned for mental healthand the fact that the symptoms will linger if left untreated and even adversely affect the subsequentpregnancies. The current study was designed to assess the impact of individual counseling on stress,anxiety, and depression in mothers with pregnancy loss.MATERIALS AND METHODS: The study commenced 100 women who experienced pregnancy loss(in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. Theintervention group received four individual counseling sessions (weekly sessions with a duration of1 h) based on Warden’s principles. The control group received routine care. The Depression AnxietyStress Scale (DASS‑42) was filled out at baseline, the pre‑ and post‑intervention. Analyses wereperformed using the Chi‑square, paired, or individual t‑tests, when necessary. P value < 0.05 wasconsidered significant.RESULTS: There were no significant differences regarding socio‑demographic characteristics andclinical features between groups at baseline. Intra‑group analysis showed that all outcome measuresin the intervention group were significantly improved. According to inter‑groups analysis, a significantassociation was found between pre‑test and post‑test in the intervention group (P < 0.05).CONCLUSION: Results of this study can clarify the psychological effects of pregnancy loss in thesemothers and help the officials and responsible parties to plan the treatment and rehabilitation of thesewomen and include them in the healthcare system.

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Investigating the effectiveness of psychological interventions in response to stress, anxiety, and depression in coronavirus disease 2019 patients: A systematic review

. Fatemeh Rahmati; . Robabe Khalili

Volume 12, Issue 5 , June 2022, , Pages 1-8

Abstract

  Coronavirus disease 2019 (COVID‑19) has caused different kinds of psychological consequences.Identifying and providing psychological plans and protocols can be effective in promoting ...  Read More Coronavirus disease 2019 (COVID‑19) has caused different kinds of psychological consequences.Identifying and providing psychological plans and protocols can be effective in promoting patients’mental health. The study was conducted to investigate the effect of psychological interventions inresponse to stress, anxiety, and depression in COVID‑19 patients. The present study was performedbased on a systematic review. The studies were done by using different combinations of keywordsin databases such as Science Direct, ProQuest, PubMed, and Google scholar search engines andin Persian databases such as Magiran, SID, Iranmedex from July 25 to September 7, 2020. Outof 4533 articles that were found after extensive search, 9 articles were evaluated and qualitativelyanalyzed for data extraction with the 2010 consort checklist. The final articles were from differentcountries of China, the USA, France, Italy, and Iran and were about COVID‑19 patients and theirhealth‑care providers. Interventions ranged from relaxation, music therapy to mental health andextensive psychological skills including adaptation methods, mindfulness and self‑care, and crisismanagement. Anxiety was the highest and then stress and depression were the next indicators. Theresults showed a positive effect of these interventions on stress, anxiety, depression, and even thequality of life, sleep and family and child function. The number of studies in this field is increasing. Wesee a variety of psychological and educational interventions every day. It is hoped that by designingstandard protocols for psychological intervention, effective steps can be taken to improve the mentalhealth of patients and health‑care providers.

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Stress level of dentists during COVID‑19 pandemic in hot spots of Tamil Nadu: A cross‑sectional study

. S. Sushanthi; . M. Indumathy; . Arthi Balasubramaniam

Volume 12, Issue 3 , March 2022, , Pages 1-5

Abstract

  BACKGROUND: The novel 2019 COVID‑19 spreads by respiratory and aerosols, and this elevates the risk of dentistry during this pandemic. Widespread disease, in a short time, creates ...  Read More BACKGROUND: The novel 2019 COVID‑19 spreads by respiratory and aerosols, and this elevates the risk of dentistry during this pandemic. Widespread disease, in a short time, creates stress and has a psychological impact. The aim of this study was planned to assess the stress level of the dentists living or practicing or studying in hot spots which could help to understand mental status among the general dentists during COVID‑19 lockdown.MATERIALS AND METHODS: This cross‑sectional study was conducted during the period of August 10 to August 25, 2020, on an Internet platform after getting consent from the dentists and practitioners using the Perceived Stress Scale (PSS). Chi‑square association was used. Parametric tests such as independent t‑tests and one‑way ANOVA were also used. In all instances, P < 0.05 was considered statistically significant.RESULTS: This study had a total response from 1044 dental students and dentists residing in hot spot zones in Tamil Nadu. Out of them, 68.4% were female and 31.6% were male. 37.9% of the participants were dental practitioners and 32.5% were undergraduate students. There is a significant association between age groups and PSS, work style, and PSS. There is no significant association between gender and PSS and degree and PSS.CONCLUSION: This study shows that levels of distress were higher than expected during the COVID‑19 pandemic among the dentists and majority of the respondents have moderate‑to‑high‑stress levels. As the unlock has been started throughout the country, it is the right time to work with the authorities and focus on formulating protocols for disinfection and sterilization and work on treating the patients with exact safety measures for the welfare of the patients.

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The prevalence of depression, anxiety, and stress among high school adolescent’s children in public and private schools in Rangareddy district Telangana state: A cross‑sectional study

. Kranthi Kumar R; . Aruna G; . Nandini Biradar; . Kola Srikanth Reddy; . Soubhagya M; . Sushma SA

Volume 12, Issue 3 , March 2022, , Pages 1-5

Abstract

  BACKGROUND: The depression, anxiety, and stress is a major educational problem among students all around the world. The purposes of this study were to determine the depression, ...  Read More BACKGROUND: The depression, anxiety, and stress is a major educational problem among students all around the world. The purposes of this study were to determine the depression, anxiety, and stress among the high school adolescent children in public and private schools in Rangareddy district, Telangana state.MATERIALS AND METHODS: The present study was a cross‑sectional study. The study sample considered 120 children from private schools and 259 children from public schools were studied. The study tool used was a questionnaire containing DASS (Depression, Anxiety, and Stress scale and sociodemographic characteristics. The data were expressed as proportion and mean values (Analysis of variance, independed t‑test, and Pearson correlation) spatially tests were used at a significance level of P < 0.05).RESULTS: The overall prevalence of depression in children from the public school was found to be only 5%, that of anxiety was 20.8%, and that of stress was 15.8%; the overall prevalence of depression in children from private schools was found to be 1.9%, that of anxiety was 20.5%, and that of stress was 20.1%.CONCLUSION: In both schools, anxiety and atress were found to be more among study participants. Depression was observed to be less. But if they have more anxiety and stress and if not taken proper care at this point of time, it might get converted into a state of Depression.

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Evaluating the role of residence affecting the mental health among elderly populations in Malaysia: A cross‑sectional study

. Roy Rillera Marzo; . Sudip Bhattacharya; . Mohamad Zulfadhli Bin Mohamad Yunus; . Nurin Irdina Bt Noraidiazhar; . Ain Mastura Nnakaliisa Bt Ssuna Salim; . Thevanai A/P Subramanian; . Nurainun Mardhiah Binti Samril

Volume 12, Issue 2 , February 2022, , Pages 1-8

Abstract

  BACKGROUND: According to the perception of majority of people, especially the elderly, it is believed that elderly people who are sent to old‑age homes are more prone to have ...  Read More BACKGROUND: According to the perception of majority of people, especially the elderly, it is believed that elderly people who are sent to old‑age homes are more prone to have depression compared to those who are living with the community. This study was aimed to assess the significance of the place of residence in relation to the presence of depression among the elderly.MATERIALS AND METHODS: A cross‑sectional descriptive study was conducted between March and August 2020 to assess the depression among the elderly population residing in the Muar district, of Malaysia. A random table was generated of 250 house numbers in Muar where there is at least one geriatric person was living and a random sampling method was used for data collection. A questionnaire was distributed to a sample size of 250 old folks of Muar: those residing in old‑age homes (n = 125) and those residing in their own houses (n = 125). A standard sociodemographic and geriatric depression scale interview was employed for data collection. All details were keyed into the SPSS version 22 software Standard Gradpack 23, and simple description and inferential statistics such as mean, median mode, percentages, and Chi‑square tests were performed to compare the effects of different residences toward the mental health of the elderly.RESULTS: The total mean age of the elderly in both the places was 73.06 ± 9.116 years. Female respondents of this research accounted for 52.8%. In terms of religion, Islam had the highest number of respondents of 46.8%, followed by Buddhist (33.6%), Christian (10.8%), and Hindu (8.8%). The percentage of elderly having more than three children was 45.2%. The marital status and employment status of the elderly in Muar area are mostly widowed (40.8%) and retired (50%). They are predominately literate (81.6%) and most have a monthly income less than RM 2000 (90.8%). We found that the prevalence rate of depression was 70.4% in the elderly residing in old‑age homes and 24.8% in the elderly living in the community. Females had a higher prevalence of depression than males (60.2% vs. 39.8%) among the elderly in old‑age homes, whereas males had a higher prevalence in the community than females (51.6% vs. 48.4%). Logistic regression analysis revealed the place of residence (P < 0.01 and employment status (P = 0.011) as the predictors of depression.CONCLUSION: Results of this study revealed that the high prevalence rate of depression among the elderly is in old‑age homes compared to elderly living in the community.

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The effect of online cognitive behavioral therapy on depressive symptoms in recovered patients with COVID‑19

. Navid Mirzakhani Araghi; . Mehdi Alizadeh Zarei; . Shafagh Saei; . Hamid Reza Yousefi Nodeh; . Ebrahim Mahmoudi

Volume 12, Issue 2 , February 2022, , Pages 1-7

Abstract

  BACKGROUND: COVID‑19 virus is on the rise globally, and people with the disease experience a variety of physical and mental problems. According to studies, depression can be ...  Read More BACKGROUND: COVID‑19 virus is on the rise globally, and people with the disease experience a variety of physical and mental problems. According to studies, depression can be a complication of the virus. So far, limited measures have been taken to prevent and treat emotional–psychological complications of COVID‑19. The aim of this study was to evaluate the effect of online cognitive behavioral therapy (CBT) on depressive symptoms in recovered patients with COVID‑19.MATERIALS AND METHODS: This study was conducted in a quasi‑experimental design. A sample of 150 recovered patients with COVID‑19 who referred to Imam Reza Hospital in Tabriz city, were selected by random sampling method. The patients’ emotional–psychological status was assessed by the Beck Depression Inventory, and they entered the treatment process according to the inclusion criteria. As a therapeutic intervention, a scientific and valid approach called CBT was implemented, which two occupational therapists performed in eight treatment sessions in the context of a social communication application. Paired sample t‑test was used to analyze the time sequence of quantitative data due to its normality.RESULTS: After the last session of the intervention, the effect of this therapeutic approach on reducing the depressive symptoms of patients was evaluated. According to the findings, the Beck score of the participants decreased significantly after the intervention (MD = ‒45/9, P < 0/001).CONCLUSION: Therefore, in order to promote the recovery of patients with COVID‑19 and help health authorities to develop preventive measures and effective treatment of emotional–psychological problems caused by this virus, it is recommended to use the online CBT approach.

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The effect of counseling based on acceptance and commitment therapy on anxiety, depression, and quality of life among female adolescent students

. Sayeh Shiri; . Azizeh Farshbaf‑Khalili; . Khalil Esmaeilpour; . Niloofar Sattarzadeh

Volume 12, Issue 2 , February 2022, , Pages 1-10

Abstract

  BACKGROUND: Adolescence is a stressful time period. Adolescents experience new changes physically, mentally, emotionally, and socially. The purpose of this study was to determine ...  Read More BACKGROUND: Adolescence is a stressful time period. Adolescents experience new changes physically, mentally, emotionally, and socially. The purpose of this study was to determine the effects of acceptance and commitment therapy (ACT) on anxiety (primary outcome), depression, and quality of life (secondary outcomes) of adolescents.MATERIALS AND METHOD: This was a quasi‑experimental study with pre and postintervention design. One hundred female students aged 16–18 years with mild to moderate anxiety selected through multistage cluster sampling from five educational districts of Tabriz. During six group counseling sessions, students were consulted with the acceptance and commitment approach according to the protocol. Beck Anxiety and Depression Inventory and the World Health Organization brief Quality of Life Questionnaire consultation were completed before, immediately after, and 8 weeks after the consultation. Data were analyzed using repeated measure ANCOVA.RESULTS: The mean anxiety score decreased significantly immediately after the intervention (mean difference [MD]: −4.0, 95% confidence interval [CI]: −5.9 to − 2.0; P < 0.001) and 8 weeks later (MD: −3.9, 95% CI: −5.8 to − 1.9; P < 0.001). The mean depression score immediately (P < 0.001) and 8 weeks after intervention (MD; −4.2, CI: −1.6 to − 6.8), P < 0.001) declined significantly. The mean overall quality of life score increased significantly after the intervention (P < 0.001) and 8 weeks later (MD: 4.7, 95% CI: 7.1–2.3, P < 0.001) compared to baseline.CONCLUSIONS: Based on the effectiveness of counseling based on ACT on anxiety, depression, and quality of life in the female students with the mild and moderate anxiety over time, it can be used as a helpful method in high schools.

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Psychosocial perception of health‑care workers in a COVID‑19‑designated hospital in eastern India

. Subrata Das; . Avik Chakraborty; . Samatirtha Chandra

Volume 12, Issue 1 , January 2022, , Pages 1-8

Abstract

  BACKGROUND: COVID‑19 pandemic has changed the life of people in many facets, economic,social, and psychological. Frontline health‑care workers (HCWs) fighting against this pandemic ...  Read More BACKGROUND: COVID‑19 pandemic has changed the life of people in many facets, economic,social, and psychological. Frontline health‑care workers (HCWs) fighting against this pandemic facedsome psychological as well as social issues which are of major concern. The objective of the study isto evaluate the magnitude of mental health problems, namely depression, anxiety, and stress amongfrontline HCWs as well as their perception on ongoing events and surroundings.MATERIALS AND METHODS: It was a prospective, observational study on n = 85 HCWs overa 4‑month period. Study participants were sampled purposively in accordance with inclusion andexclusion criteria; data were collected by online survey method. A semi‑structured scale was used:Part A of which assessed the demography and perception of HCWs on surrounding along with ongoingsocial events and Part B consisted of the Depression, Anxiety, and Stress Scale‑21 that was usedto assess mental health issues. All the associations were tested in percentages and proportions.Statistics was calculated by using SPSS 24th version.RESULTS: Majority of the participants were female doctors and belonged to 21–30 years’ agegroup. Most of them were marginally worried of contacting infection (73%) but were substantiallyapprehensive of transmitting infection to their family (56.5%) and hoped positive outcome ultimatelyin the form of recovery from infection. Majority (96.4%) gathered information from authentic sourcesand were confident of adequacy of their knowledge. Majority (88.3%) were satisfied about theiroccupational safety and responded on scientific solution of pandemic. However, we got a mixedresult about their professional appreciation. Depression symptom score was higher than anxiety andstress symptom score in our participants.CONCLUSIONS: Doctors and nurses both were suffering from mental health issues, and provisionof adequate information and occupational safety may lessen these burdens.

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Relationship between psychological factors and perceived stigma of addiction among women with substance use disorders, Thailand

. Suneerat Yangyuen; . Manop Kanato; . Thidarat Somdee

Volume 12, Issue 1 , January 2022, , Pages 1-6

Abstract

  BACKGROUND: Substance use disorders (SUDs) are one of the most stigmatized health conditionsthat impact drug user’s treatment engagement. However, to date, little is known about ...  Read More BACKGROUND: Substance use disorders (SUDs) are one of the most stigmatized health conditionsthat impact drug user’s treatment engagement. However, to date, little is known about perceivedstigma and its correlates with psychological factors among high‑risk groups such as people withSUDs in the criminal justice system. This study aimed to determine the association of psychologicalfactors and perceived stigma of addiction among women with SUDs.MATERIALS AND METHODS: This cross‑sectional design was conducted on 652 women with SUDswho were treated in all 7 compulsory drug detention centers in Thailand with consecutive samplingtechnique. The data were collected by standardized interviewers with interviewing questionnaire.Multiple logistic regression was applied to examine the effect of psychological factors and perceivedstigma.RESULTS: More than half of SUD patients (57.2%) were methamphetamine abuse or dependence,approximately 69.9% reported high level of perceived stigma, 56.7% had mild depression, 34.8% hadlow level of perceived social support, and the average perceived stress score was 19.2 (standarddeviation, 7.5). The perceived stigma was positively related to depressive symptom and perceivedstress while was inversely related to perceived social support.CONCLUSION: The psychological factors were strongly associated with perceived stigma of addiction.Thus, the detection of psychological problems among SUD patients may be benefit clinicians foridentifying which patients are most at risk of perceived stigma and are the potential targets ofintervention to reduce stigma in clinical practice.

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Emotional difficulties in pregnant females who tested positive for COVID‑19: A cross‑sectional study from South Kashmir, India

. Tanzeela Nazir; . Rehana Amin; . Masood Maqbool

Volume 12, Issue 1 , January 2022, , Pages 1-6

Abstract

  BACKGROUND: It is evident that the novel coronavirus disease pandemic inevitably resulted inincreased stress and anxiety in the general population. Pregnancy is a challenging period, ...  Read More BACKGROUND: It is evident that the novel coronavirus disease pandemic inevitably resulted inincreased stress and anxiety in the general population. Pregnancy is a challenging period, andCOVID‑19 has added risk to women pregnant during the pandemic.AIM: The present study was aimed to assess the emotional difficulties in pregnant females whotested positive for COVID‑19. The current study estimated the prevalence of depression, anxiety,and stress among 63 pregnant ladies who tested positive for COVID‑19.MATERIALS AND METHODS: The study was conducted in Child and Maternity Hospital of GMCAnantnag, Kashmir, India, from April to December 2020. A total of 63 pregnant females who testedpositive for COVID‑19 participated in the study. The COVID‑positive pregnant ladies were interviewedin the outpatient department of the child and maternity clinic 2 weeks after the infection. The interviewscale used was Depression, Anxiety, and Stress Scale‑21. The data were analyzed using Chi‑squaretest and Fisher’s exact test.RESULTS: We found that the mean age of participants was 33.5 ± 7.4. We found that 38.1% of thefemales had positive bad obstetric history. The prevalence of depression, anxiety, and stress was33.32%, 50.83%, and 60.3%, respectively. In correlation analysis, notably bad obstetric history andworking females were significant independent factors for higher levels of depression, anxiety, andstress. The depression was also found more in literate females and the third trimester.CONCLUSION: The study indicates high levels of depression, anxiety, and stress in pregnant femaleswho tested positive for COVID‑19. The emotional difficulties were found to be higher in educated andworking females. The bad obstetric history was found to be an independent factor for higher levels ofemotional difficulties in COVID‑positive pregnant females. This calls for extra measures to promotethe mental health and resilience of pregnant females, especially during a crisis.

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Emotional distress and psychiatric drug use among students in an Italian medical school: Assessing the role of gender and year of study

. Sara Carletto; . Marco Miniotti; . Alberto Persico; . Paolo Leombruni

Volume 11, Issue 11 , December 2021, , Pages 1-8

Abstract

  BACKGROUND: Previous studies have reported that medical students show high rates of depression,anxiety, and stress levels, but mixed findings were found regarding possible differences ...  Read More BACKGROUND: Previous studies have reported that medical students show high rates of depression,anxiety, and stress levels, but mixed findings were found regarding possible differences betweengender and different years of medical training. This study evaluated depression, anxiety, and stresslevels and psychiatric drug use in students in an Italian medical school and investigated the differencesbetween gender and year of study.MATERIALS AND METHODS: This cross‑sectional study included 694 medical students in their1st (n = 286), 4th (n = 209), and 6th (n = 199) year of study. The questionnaire included demographicinformation, self‑report questionnaires regarding depression, anxiety, and stress, and questionsabout psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive andanalytic statistics, including Mann–Whitney U‑test, Fisher’s exact test, and GLM two‑way ANOVA.RESULTS: Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%),and 545 (78.5%) medical students, respectively. Female students in their 4th year of study reportedhigher depression levels than males of the same year (P = 0.004), whereas levels of anxiety werehigher in 6th‑year female students compared with those in their 1st and 4th years (P = 0.001; P = 0.025).Stress levels were consistently higher in females than in males for all 3 years (1st year: P = 0.041;4th year: P < 0.001; 6th year: P = 0.004). No gender differences were found in the use of psychiatricand stimulant drugs.CONCLUSION: This study provides preliminary evidence suggesting the importance of planninginterventions aimed at reducing emotional distress among medical students that should be targetedon gender and year of the study.

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Anxiety, stress and depression levels among nurses of educational hospitals in Iran: Time of performing nursing care for suspected and confirmed COVID‑19 patients

. Hojjat Sheikhbardsiri; . Mohammad Mahdi Doustmohammadi1; . Parya Jangipour Afshar; . Majid Heidarijamebozorgi; . Hamidreza Khankeh; . Mehdi Beyramijam

Volume 11, Issue 11 , December 2021, , Pages 1-6

Abstract

  BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),health‑care workers, especially nurses were encountered with an increasing workload. Therefore, ...  Read More BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),health‑care workers, especially nurses were encountered with an increasing workload. Therefore, dueto the importance of this issue, the present study aimed to examine stress, anxiety, and depressionlevels among nurses during the COVID‑19 pandemic in Iran.MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitalsaffiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety andStress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depressionin nurse personnel with a census method (n = 403). Data were analyzed using descriptive statisticsand analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiplelinear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the levelof P < 0.05.RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significantrelationship was observed between stressed, anxious, and depressed participants in the gender,marital status, level of education, and working hours per month. No statistically significant relationshipwas found between other demographic variables including age, work experience, and employmentstatus with anxiety, depression, and stress categories.CONCLUSION: The results of this study can increase the awareness of health system managers,especially hospitals, about the level of stress, anxiety, and depression and can help in order to providepsychological support programs for improving the mental health of nurses during the COVID‑19pandemic.

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Internet addiction, mental health, and sleep quality in students of medical sciences, Iran: A cross‑sectional study

. Arezo Arzani‑Birgani; . Javad Zarei; . Leila Favaregh; . Erfaneh Ghanaatiyan

Volume 11, Issue 10 , November 2021, , Pages 1-8

Abstract

  BACKGROUND: Internet addiction (IA) is a severe problem, especially in academic communities.The association between IA and unfavorable emotional conditions (e.g., anxiety, stress, anddepression) ...  Read More BACKGROUND: Internet addiction (IA) is a severe problem, especially in academic communities.The association between IA and unfavorable emotional conditions (e.g., anxiety, stress, anddepression) can harm students’ relationships and academic and career performance. The presentstudy evaluated (a) the prevalence of IA in a sample of medical sciences university students; (b) theassociation between IA and depression, anxiety, stress, and sleep disorders; and (c) the associationbetween demographic characteristics and IA, depression, anxiety, and stress.MATERIALS AND METHODS: In this descriptive cross‑sectional study, 268 students from AbadanUniversity of Medical Sciences were selected using Morgan Table. The participants responded tothe Young Internet Addiction Test, the Depression Anxiety Stress Scales‑42, and the PittsburghSleep Quality Index. Data were analyzed using descriptive statistics, Pearson correlation coefficient,independent sample t‑test, one‑way ANOVA, and least significant difference.RESULTS: The mean score of IA was 45.65 ± 35.40. IA was found to be significantly related todepression, anxiety, stress, and sleep disorders (except for sleep disturbance) (P < 0.001). Maleswere found to be more likely than females to suffer from IA, depression, anxiety, stress, and sleepdisorders. Furthermore, age was inversely related to IA, depression, and stress. Finally, medicalsciences students suffered from depression, anxiety, and stress more than students majoring inother fields.CONCLUSIONS: The simultaneous occurrence of IA and depression, anxiety, stress, and sleepdisorders in students indicates that IA is associated with other psychological problems. Therefore,researchers and policymakers need to identify preventive measures to help internet‑addicted students.

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Level of anxiety and depression among health‑care professionals amidst of coronavirus disease: A web‑based survey from India

. Haseeb Khan; . Rahul Srivastava; . Neeraj Tripathi; . Dharmendra Uraiya; . Astha Singh; . Ruchi Verma

Volume 11, Issue 10 , November 2021, , Pages 1-8

Abstract

  BACKGROUND: The spread of novel coronavirus diseases‑2019 (COVID‑19) across the world andits associated morbidity and mortality confronted the nations by various means. COVID19 ...  Read More BACKGROUND: The spread of novel coronavirus diseases‑2019 (COVID‑19) across the world andits associated morbidity and mortality confronted the nations by various means. COVID19 pandemichad significant psychological effects not only on the general population but also on health‑careworkers (HCWs). Hence, we aimed to found the level of anxiety and depression among health‑careprofessionals amidst coronavirus.MATERIALS AND METHODS: This is a cross‑sectional study conducted on 829 participants includingdoctors and nurses and other medical staff who were posted in the COVID ward and COVID intensivecare unit using a well‑structured questionnaire through the Google Forms. The two scales used tomeasure anxiety and depression among the HCWs were the Hamilton anxiety scale (HAM‑A) and thePatient Health Questionnaire (PHQ‑9), Cronbach’s alpha of HAM A is 0.921 and Cronbach’s alphaof PHQ 9 is 0.851. Data analysis was done using SPSS 26, Chi‑square test and Fisher’s exact testwere used to establish the association between categorical independent and dependent variables.RESULTS: The results of this study demonstrate that anxiety and depression were significantlyhigher in doctors and staff nurses as compared to other medical staff. According to HAM‑A, 65.1% ofrespondents were in the mild category, 22.0% mild to moderate, and 12.9% moderate to severe. TheHAM‑A (P = 0.022) and PHQ‑9 (P = 0.001) for anxiety and depression respectively were significantlyhigher in females. The means of the scales got increased after postings in the corona wards.CONCLUSION: Concerning the high occurrence of anxiety and fear among health‑care professionals,appropriate psychological/psychiatric intervention necessitates and emphasizes the need to implementurgent measures to prevent further progress to severe mental health disorder.

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Prevalence and predictors of depression in type 2 diabetes mellitus

. Ravi Kant; . Poonam Yadav; . Shruti Barnwal; . Vishal Dhiman; . Bruzily Abraham; . Kanchan Gawande

Volume 11, Issue 8 , September 2021, , Pages 1-6

Abstract

  BACKGROUND: Type 2 diabetes mellitus (DM) is a multifactorial disease and can be described as anoncommunicable disease of epidemic magnitude. Little is known about the predictors of ...  Read More BACKGROUND: Type 2 diabetes mellitus (DM) is a multifactorial disease and can be described as anoncommunicable disease of epidemic magnitude. Little is known about the predictors of depressionin this population, especially among the Indian population. This study explores the predictors fordepression in patients with type 2 DM.MATERIALS AND METHODS: A cross‑sectional study was performed for a period of 7 monthsduring 2018–2019. The data were collected from 250 subjects at the diabetic clinic and psychiatryoutpatient department of a tertiary care teaching hospital. T2DM with an age group of 18–60 yearswere included. Exclusion criteria were clinical evidence of any significant Axis I psychiatric disorderaccording to the International Classification of Diseases‑10 Diagnostic Criteria for Research otherthan depression and substance use disorders. Data were analyzed with multiple linear regressionanalysis using SPSS‑23 version.RESULTS: Male and female patients were 127 (50.80%) and 123 (49.20%), respectively. Theprevalence of depression was 49.20% among 250 patients with T2DM. Female patients had higherdepression than male patients. We found age (P = 0.013), female gender (P = 0.041), locality of thepatient (P = 0.021), body mass index (BMI) (P = 0.018), and fasting blood sugar (FBS) (P = 0.045)as significant predictors of depression among T2DM patients.CONCLUSIONS: The study concludes that females and elderly patients were more affected bydepression. The predictors of depression were age, gender, locality, BMI, and FBS among diabeticpatients. The findings indicate to screen the patients of T2DM for depression, predominantly femaleand elderly patients, at regular intervals as per clinical demand.

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