|Year : 2017 | Volume
| Issue : 2 | Page : 77-79
Psychiatry research in India: Current status and future directions
Rajesh Sagar1, Siddharth Sarkar2
1 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
2 National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||2-Apr-2018|
Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sagar R, Sarkar S. Psychiatry research in India: Current status and future directions. J Mental Health Hum Behav 2017;22:77-9
From an emerging discipline, psychiatry has progressed to an established field of medical sciences in India. Along with the expansion of psychiatric clinical services and training avenues, research in the field of psychiatry has also progressed in the country. The last few decades have seen an increase in the quantity and improvement of the quality of the research carried out in India in the field of mental health and psychiatry. The gradual expansion of research in this field necessitates consideration of whether the research is contextually relevant and translationally feasible. Hence, it would be an appropriate time to pause and reflect about the current status of psychiatry research in India and to consider (if not foresee) the future directions of such research.
The vastness of the country and the multiplicity of institutions have enabled research in India to progress in several directions simultaneously. The intellectual freedom offered to the academicians has enabled research to be conducted according to their choice. Often, psychiatrists have been inspired from the international trends of research and have tried to see whether findings from elsewhere hold true in India. Indian psychiatrists who have visited other parts of the world for participating in scientific deliberations or getting further training have brought back ideas, skills, and attitudes from elsewhere. In addition, several foreign researchers have been facilitated to conduct research in India. The researchers from elsewhere have understood the phenomenology, society, and service delivery from an etic perspective and have provided valuable insights. Such intermingling with experts from other parts of the world has immensely helped in capacity building, acquiring skills, shaping attitudes, and facilitating co-operation in conduct of psychiatry-related research. This has facilitated the progress of psychiatry as a science.
A unique aspect of research in India has been the integration of dissertation in the postgraduate course., The medical education system mandates the conduct of a thesis before awarding the postgraduate degree in all branches of medicine, including psychiatry. Doing a thesis gives an opportunity to understand the research process closely. The resident pursuing a postgraduate course is expected to plan a research under supervision, get the approval from appropriate ethics committee, conduct the research, do the data collection, analyze the data, interpret the findings, and present the findings in the form of dissertation. Such a dissertation is evaluated by examiners for methodological rigor and appropriateness of presentation and interpretation. Successful completion of the residency is contingent upon dissertation being favorably evaluated by the examiners. The dissertation teaches the resident about mechanics of conducting a research and is helpful in planning and conducting further research during their careers. Some of the dissertations offer unique and interesting insights and have found place in leading journals. Dissertations offer not only means of training residents but also stimulus for research endeavors, especially in places where funding or resource limitations are important considerations.
An important characteristic of the research in psychiatry has been research on cross-cultural issues or culture-specific interpretations. The symptom profile of patients with psychiatric ailments has been described to be different in India than elsewhere. The course and outcome of the diseases has also been found to be different, with schizophrenia being described to have a much better prognosis in India than the western nations. Thus, research on culture-specific issues in India has resulted in enrichment of the field of psychiatry globally and has brought out interesting perspectives on the presentation of mental health problems. Dhat syndrome, described as a culture-bound syndrome of the Indian subcontinent, has spurred research in understanding its phenomenology, comorbidity, clinical course, and treatment. Similarly, presentation of depression has been marked with prominence of somatic symptoms in the Indian context. Thus, culture-sensitive research has resulted in better understanding of the local factors in the occurrence and manifestation of psychiatric disorders.
The directions of psychiatry-related research conducted in India have been diverse ranging from biological psychiatry, social psychiatry, consultation psychiatry, psychopharmacology, cross-cultural psychiatry, service research, phenomenology, ethics, and other related areas. This issue of the Journal of Mental Health and Human Behaviour provides a rough semblance of the varied types of research originating the country. Research originating from the discipline of psychiatry in India has found place in leading national and international journals., Several psychiatry-related journals are published from India including the Journal of Mental Health and Human Behaviour, Indian Journal of Psychiatry, Indian Journal of Psychological Medicine, Industrial Psychiatry, Indian Journal of Social Psychiatry, Annals of Indian Psychiatry, Indian Journal of Behavioural Sciences, Journal of Indian Association for Child and Adolescent Mental Health, Indian Journal of Private Psychiatry, and others. Several of these journals are indexed. Continued patronage for these journals suggests the adequacy of research material for publication and wide readership for this material. A number of publications from international authors in these journals also suggest toward the stature and popularity being attained by journals from India. Proactive utilization of information technology has resulted in the journals being efficiently handled and maintained. In addition, psychiatry-related research originating from India has also found place in multidisciplinary journals including those with high-impact factors.
The impetus on systematic research has gradually gathered momentum in India. Greater utilization of sophisticated statistical approaches and general awareness about the statistical measures vouch for the sensitivity that researchers exhibit toward correct interpretation of the data collected. Many good projects have a biostatistician involved with them. Residents routinely make an attempt to understand the analysis procedure of their dissertation and seek help from experts in statistics, wherever available. This has resulted in more robust use of statistics in psychiatry research. Meanwhile, qualitative techniques have been refined, and both researchers and the readers are more aware of the appropriate qualitative approaches. The gradual focus on evidence (gathering the evidence and evaluating the evidence) has resulted in a measured adoption of evidence-based medicine in the field of psychiatry, though constrained sometimes the lack of evidence from Indian setting and scenario.
The focus on research has also resulted in some unwanted consequences that have been observed in western countries as well., Research publications are considered for selections and promotions in academic setting. This has probably resulted in drives and pressures that were not prominent previously. There is a need to emphasize the value of research as gain in personal expertise and to treat the value of research as more than a numerical figure. Furthermore, the directions of research seem to be aligned to what is more acceptable to the west, than what is more important for India. Probably, incentives need to be re-directed to focus upon what is relevant in the local milieu.
Having explored the current state of psychiatry-related research in India, it would be prudent to ponder about a few imperatives and speculations for the future. First, psychiatry research in India can benefit a lot by taking up issues that are challenges in the Indian clinical setting. These can relate to cultural expression of illnesses, education about illnesses, pragmatic concerns about medications and their adverse effects (especially if genetically linked), barriers and facilitators of treatment, acceptance and efficacy of the various forms of treatment, the unique psychosocial stressors that apply to India (such as gender- or status-related disenfranchisement), cultural understanding of the disorders and cultural remediation of symptoms, therapist–patient relationship, and many others. The questions of relevance come from the clinic, and systematic research may attempt to provide some answers. Service-related research deserves specific attention in this regard. Second, psychiatry research may benefit by making the methodology and theoretical underpinning more rigorous. Research needs to be cognizant of what is considered standard internationally in terms of research processes and try to attain those. This would lead to greater credibility and would effectively advance the science. Help from experts in statistics might be sought wherever required. Best practices should be followed to the extent possible, aware of the locally relevant circumstances. Third, psychiatry research may benefit by collaboration. The collaboration could be between centers, between disciplines, and even between systems of medicine. Multicenter trials conducted across countries are considered the benchmark of efficacy trials for medications. The advantage of collaboration is pooling of resources and expertise though proactively setting up terms of collaboration can help in avoiding distaste of dissatisfaction. Fourth, funding opportunities need to be created for conduct of research. Justified use of funds may help in promoting research, especially those which cannot be done on volunteered time. There are several funding opportunities in the country from diverse bodies (including the national professional societies). However, there is a need to make the process of funding transparent and efficient. Fifth, there is a need for further capacity building. Research needs to be taught and skills need to be acquired. Capacity building in research may progress in the form of training Indian researchers elsewhere, facilitating discussing their findings in different forums, providing small-term to medium-term courses in research methodology, inviting experts from across the globe to share their expertise, and inculcating an attitude of inquiry among students. Since all postgraduate students are involved in research (by the virtue of them doing a dissertation), a separate track may be provided for them in national conferences where they are mentored and they are able to share their findings. This might also be supplemented by short courses during the conferences where the ideas are discussed and common challenges of conducting research addressed. Sixth, there is a need to archive the findings and present it to the world. Publication is an important step of research and as publication of research findings makes it accessible to others. As research is incremental, publication of research findings would prevent duplication and would help others in formulating their theoretical framework for research.
To conclude, research in the field of psychiatry has seen gradual growth and has become internationally reckoned. Dissertation in residency is a strong feature of Indian postgraduate training in psychiatry. However, continued evolution of the research practices would need attention to several facets, especially strengthening the methods of answering the scientific inquiry. Psychiatry as a fraternity would be benefitted with locally relevant questions being answered by methodologically sound responses. We hope to see psychiatry research flourish further over the decades to come.
| References|| |
Das M, Gupta N, Dutta K. Psychiatric training in India. Psychiatrist 2002;26:70-2.
Sharma S. Postgraduate training in psychiatry in India. Indian J Psychiatry 2010;52:S89-94.
Kar SK, Sarkar S. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach. J Hum Reprod Sci 2015;8:130-4.
] [Full text]
Raguram R, Weiss MG, Channabasavanna SM, Devins GM. Stigma, depression, and somatization in South India. Am J Psychiatry 1996;153:1043-9.
Kulhara P, Avasthi A, Chadda R, Chandiramani K, Mattoo SK, Kota SK, et al.
Negative and depressive symptoms in schizophrenia. Br J Psychiatry 1989;154:207-11.
Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al.
Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011;68:241-51.
Sarkar S, Seshadri D. Publish or perish: Are Indians catching up? Indian J Public Health 2015;59:328-9.
] [Full text]
Patra BN, Sarkar S. Should publication be the only means of assessment? Indian J Psychol Med 2013;35:107-8.
] [Full text]
Deo MG. Need for research oriented medical education in India. Indian J Med Res 2009;130:105-7.
] [Full text]
Balhara YP. Publication: An essential step in research. Lung India 2011;28:324-5. [Full text]