NATIONAL MENTAL
HEALTH SURVEY OF INDIA

The Pilot study was planned and undertaken in the district of Kolar which is the Public Health Observatory of the Centre for Public Health at NIMHANS.

The objectives were to

  • Understand the feasibility of the sampling design proposed and adopted for the NMHS.
  • Pilot the use of MINI instrument for the NMHS.
  • Test the feasibility of using handheld devices for data collection.
  • Estimate the prevalence of different mental health problems in the district of Kolar from a randomly selected population.
  • Identify challenges and operational feasibility of the proposed study methodology and its relevance to national survey.
  • Organize the logistics including budgetary requirements, manpower and coordination mechanisms for the larger national survey.

Implications and recommendations for the main study

The pilot study undertaken in Kolar district field tested different components of the methodology proposed to be adopted for the main study and was able to estimate the extent of mental morbidity in a district of India. The key implications for the main study were observed to be as detailed below.

  • Certain modules of MINI were difficult for both the interviewer and respondent. The modules on major depression; suicidality; social phobia; alcohol; psychotic disorders and mood disorders with psychotic features needed detailed description and giving examples to make the questions comprehensible to the respondents. The training to be more robust and to focus on quality of interviews along with more examples and explanations and to look for greater reliability rather than clinometric properties.
  • Pilot study experience revealed that appropriate and relevant translation, high quality of training for data collectors, good supervision by the team and greater interview quality as measured by high levels of inter-rater reliability are most essential to obtain reliable results.
  • MINI drug use modules were modified for the pilot study to better reflect the drugs that are expected to be used in Indian setting and were found to be adequate.
  • Measuring height and weight posed specific difficulty in the field survey. Hence, the eating disorder modules may be excluded.
  • As there are no field based studies reported for MINI from India, a separate exercise was undertaken. The results were reviewed with what was observed in the clinical setting and available from literature.
  • MINI Kid posed specific challenges especially amongst children less than 13 year. Hence, after suitable modification to the study methodology, MINI-Kid would be piloted for use amongst 13 to 17 years old in select states of the country.
  • To understand the properties of MINI, inter-rater reliability (IRR) exercise will be undertaken on a sub-sample at each site and higher IRR values will be ensured by repeated training and periodic refresher training.

    Detailed discussions were held with Dr Sheehan to – share the performance of MINI in the community survey, discuss problems encountered in administration, potential impact of MINI properties and ways of improving performance of MINI. The details of the discussions of the meeting are provided as Annexure 6. In summary, it was felt that to improve the properties of the instrument, apart from overcoming all survey related challenges, there is a need for

    • Ensuring a culturally valid translation,
    • Availability of dedicated teams at national and state levels,
    • Good quality and continued training in the beginning and also during survey,
    • Ensuring a high inter-rater reliability,
    • Conducting the interviews in the appropriate manner, and obtaining quality data
  • Instruments for screening ID / ASD, tobacco use and Epilepsy did not pose any specific problem. Hence they could be used as it is. However, the NTAG recommended the use of ID and ASD screeners for the adolescent sample and only ID screener for the adult component of the survey.
  • The Pathways to Care posed difficulties in ensuring adequate response; Disability assessment schedule and the socio-economic burden questions were reported to be repetitive and difficult to comprehend with respect to mental health problems. The multi-category occupation response was reported to be very cumbersome. All these questions have been modified and the new questionnaire viz., Health care and treatment, Socio-economic burden, and Sheehan Disability Scale have been included.
  • The instruments used for measuring / assessing mental health resources and services did not pose any specific difficulties and could be used with minor modifications.
  • A higher non-response rate implies greater numbers to be covered to obtain the desired number of completed interviews. This can be achieved by increasing the sample size by 30%.
  • Need for dedicated transport and local accommodation to the field staff to be considered in the budget.
  • Use of tablets for data collection removed the manual data entry errors and hence tablets to be used for data collection during the main study also.
  • The breakages / non-functionality to be considered at about 20%.
  • To optimise the use of data collection using tablets, apart from daily backup at individual tablet user level and co-ordinator level, data to be transferred on a weekly basis.

The critical determinants for successful conduct of the survey would also include micro-planning for day to day work, regular and periodic meeting of the entire study team with strict monitoring.

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