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BACKGROUND: The importance of evidence-informed health policymaking is widely recognized. However, many low- and middle-income countries lack evidence-informed mental health policies due to insufficient data, stigma or lack of resources. Various policies address adolescent mental health in India, but published knowledge on their evidence-informed nature is limited. In this paper, we report results of our analysis of the role of evidence in adolescent mental health policymaking in India. METHODS: This paper reports findings from the document analysis of key policy documentation (n = 10) and in-depth interviews with policy actors including policymakers, researchers, practitioners and intermediaries (n = 13). Framework analysis was used, informed by the components of a conceptual framework adapted from the literature: actors, policy and evidence processes, nature of evidence itself and contextual influences. RESULTS: Results show that adolescent mental health policies in India were generally evidence-informed, with more key evidence becoming generally available from 2010 onwards. Both formal and informal evidence informed mental health policies, particularly agenda-setting and policy development. Mental health policymaking in India is deemed important yet relatively neglected due to competing policy priorities and structural barriers such as stigma. Use of evidence in mental health policymaking reflected differing values, interests, relative powers and ideologies of policy actors. Involvement of government officials in evidence generation often resulted in successful evidence uptake in policy decisions. Policy actors often favoured formal and quantitative evidence, with a tendency to accept global evidence that aligns with personal values. CONCLUSIONS: There is a need to ensure a balanced and complementary combination of formal and informal evidence for policy decisions. Evidence generation, dissemination and use for policy processes should recognize evidence preferences by key stakeholders, while prioritizing locally available evidence where possible. To help this, a balanced involvement of policy actors can ensure complementary perspectives in evidence production and policy agendas. This continued generation and promotion of evidence can also help reduce societal stigma around mental health and promote mental health as a key policy priority.

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BACKGROUND: Suicidality among youth is one of the most challenging public health issues. A thorough understanding of the risk factors that contribute to youth suicidality is necessary. The main aim of the study is to estimate the proportion of suicidality and understand factors associated with suicidality amongst clients attending youth mental health promotion clinics in Karnataka, India. METHODS: A retrospective cross-sectional case record analysis was performed utilising data from real-time digitised management information system specifically developed for the programme. All case records of clients aged 15 to 35 years who received mental health promotion (MHP) services between January 2017 and December 2020 across 30 districts of Karnataka were included in this analysis. Multivariate logistic regression analysis was performed with suicidality among clients as outcome. Socio-demographic characteristics, issues reported, feelings/emotions that indicate underlying mental health issue/crisis, being aware of suicidality among friends and family and personal habits (smoking/chewing tobacco and drinking alcohol) were considered potential exposure variables. FINDINGS: Overall proportion of suicidality among youth presenting to youth mental health promotion clinics in Karnataka was 3.5% (357/10,340). Among factors associated with suicidality, the strongest association was found among those clients who reported attempted suicide among friends (AOR 8.94; 95% CI 5.95-13.45), family members (AOR 5.50; 95% CI 3.66-8.29), being anxious (AOR 4.90; 95% CI 3.43-6.99), inability to trust anyone (AOR 4.07; 95% CI 2.75-6.03), had issues of Gender, Sex and Sexuality (AOR 3.16; 95% CI 1.93-5.17) and relationship issues (AOR 2.77; 95% CI 2.05-3.73). CONCLUSION: The results alert all institutions, organisations and departments that cater to services and development of youth, to be sensitive towards risk factors of suicidality. The study advocates youth mental health promotion clinics to be equipped with measures/interventions to identify and manage such risk factors. This study has implications for Youth mental health promotion in India and other similar South-East Asian countries.

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BACKGROUND: Yuva Spandana (YS) is a unique community-based youth mental health promotion program implemented across Karnataka. OBJECTIVE: We assessed factors affecting PD among the population served by YS between January 1, 2017, and December 31, 2021. MATERIALS AND METHODS: A retrospective cross-sectional analysis was done utilizing the visit forms of 10,340 YS's care recipients. A conceptual framework was developed, and all hypothesized variables within this framework were considered exposures. All exposure variables significant at P < 0.10 in univariate analysis were included in multivariable analysis. Multivariable logistic regression analysis was performed by including each of the significant potential exposure variables from univariate analysis using a forward-stepping process. RESULTS: Care recipients with health and lifestyle issues were at almost two times increased risk for PD (adjusted odds ratio [AOR] =1.74 and 95% confidence interval [CI] - 1.52-2.00), and those with self-development issues were almost 2.5 times more likely to have PD (AOR = 2.44 and 95% CI - 2.12-2.79). Those who reported emotional statuses of feeling worried, lost, incapable, lonely, and distrusting were at 21.4, 3.5, 26.3, 37.9, and 4.7 times higher odds of having PD, respectively. CONCLUSIONS: Isolating the risk factors associated with PD will help tailor the mental health promotion provided by YS to at-risk groups.

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Background: Youth are consideren to be most vulnerable to health and lifestyle issues (HLS) in India. The current study aims to investigate the factors that contribute to health and lifestyle issues among youth attending mental health promotion clinics (YMHP) in Karnataka. Method: Three-year first-visit data from beneficiaries (aged 15-35 years) attending YMHP clinics in Karnataka between 2017 and 2020 were analyzed. Multivariable logistic regression analysis included beneficiaries reporting any HLS issue as the outcome and a host of 57 hypothesized variables as exposures. Results: Overall, 2,615 (25%) beneficiaries reported HLS issues. Years of schooling (AOR 5-7 years = 0.89; 95% confidence interval [CI] =0.60-1.31), (AOR 8-10 years = 0.65; 95% CI = 0.46-0.91), (AOR >10 years = 0.67; 95% CI = 0.49-0.93)], unemployed youth (AOR = 0.52; 95% CI = 0.45-0.61) business and salaried workers (AOR = 1.69; 95% CI = 1.33-2.13), and other occupations (AOR = 2.11; 95% CI = 1.73-2.56), junk food consumption (AOR = 0.76;95% CI = 0.68-0.84), having issues related to relationships with parents (AOR = 3.01; 95% CI = 2.47-3.68) and intergenerational issues (AOR = 1.71; 95% CI = 1.19-2.45), self-development issues (AOR low-self-awareness = 1.57; 95% CI = 1.33-1.85), (AOR low-self-esteem = 1.29; 95% CI = 1.062-1.57), (AOR emotional issues = 1.57; 95% CI = 1.31-1.89), education and academics (AOR = 1.23; 95% CI = 1.09-1.39), safety issues (AOR = 4.11; 95% CI = 3.07-5.50), gender sex and sexuality issues (AOR = 2.44; 95% CI = 1.43-4.15), suicidal ideation (AOR = 1.91; 95% CI = 1.44-2.54), substance use (AOR tobacco chewing = 1.45; 95% CI = 1.09-1.93), (AOR tobacco-smoking = 1.66; 95% CI = 1.18-2.32), (AOR smoking = 4.94; 95% CI = 3.52-6.93) and experiencing emotions (AOR feel anxious = 1.63; 95% CI = 1.41-1.88), (AOR forgetfulness = 1.50; 95% CI = 1.41-1.98), (AOR difficulty in concentration = 1.37; 95% CI = 1.035-1.81), (AOR anger = 1.61; 95% CI = 1.25-2.07), (AOR feel worthless = 2.21; 95% CI = 1.71-2.86) were associated with HLS issues among beneficiaries. Conclusion: This analysis addresses an important but neglected component of HLS issues among youth highlighting the importance of early intervention among youth to prevent the development of diseases later in life. The study has important implications for youth health promotion in India and countries such as India. Health and Lifestyle Issues Among Youth: A record analysis of contributing factors among beneficiaries attending Youth Mental Health promotion clinics (Yuva Spandana Kendras) in Karnataka, India.

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INTRODUCTION: Chewing tobacco and smoking among youth leads to poor health outcomes. Understanding the factors associated with chewing tobacco and smoking is thus important for interventions. METHODS: A case-record analysis among 10340 youth (aged 15-35 years) attending a unique mental health promotion program, Yuva Spandana, across the state of Karnataka in southern India, was performed to assess prevalence of chewing tobacco and smoking. Multiple logistic regression was applied to determine the factors associated with their use. RESULTS: Overall, the prevalence of chewing tobacco and smoking among beneficiaries was 3% and 2.1%, respectively. The risk of tobacco chewing and smoking increased with age and risk was higher among males, married individuals and among all occupational categories, other than students. Adjusted odds ratios of chewing tobacco were found to be highest among business/salaried beneficiaries (AOR=3.48; 95% CI: 2.27-5.34), followed by ever married beneficiaries (AOR=3.41; 95% CI: 1.27-9.17). Adjusted odds ratios of smoking tobacco were highest among males (AOR=12.89; 95% CI: 7.5-22.14), followed by emotional experience of feeling worthless (AOR=4.19; 95% CI: 2.78-6.32), beneficiaries with poor relationship with family members (AOR=3.79; 95% CI: 1.38-10.44), and business/salaried beneficiaries (AOR=2.90; 95% CI: 1.79-4.7). Strength of association of males with smoking was much higher (AOR=12.89; 95% CI: 7.5-22.14) than compared with chewing tobacco (AOR=2.49; 95% CI: 1.89-3.28). CONCLUSIONS: Early identification of these factors associated with chewing tobacco and smoking will help in focusing on youth specific health promotion and interventions to improve their overall health and wellbeing.

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BACKGROUND: India today is home for the largest youth population in the world. Youth is a formative phase transitioning from childhood to adulthood. Relationship is fundamental for a healthy and satisfactory life. Relationships assume importance and maturity during adolescence and youth. Relationships and mental health have a bidirectional effect. The effect of relationships on mental health is stronger than vice versa. MATERIALS AND METHODS: Two-year case record analysis of 8595 beneficiaries aged 15-35 years attending youth guidance centers (Yuva Spandana Kendras) in Karnataka, India, was undertaken to understand factors affecting relationship issues among them. Multivariate logistic regression was performed with any beneficiary having a relationship issue as outcome. RESULTS: Being a student (adjusted odds ratio [AOR] = 1.49; 95% confidence interval [CI] = 1.18-1.89), occupation (AORbusiness/salaried = 3.04; 95% CI = 2.10-4.40 and AORothers = 1.72; 95% CI = 1.22-2.44), marital status (AORmarried = 1.42; 95% CI = 1.06-1.90 and AORothers = 3.44; 95% CI = 1.45-8.15), having health and lifestyle issues (AOR = 3.61; 95% CI = 3.05-4.27), personality issues (AOR = 2.88; 95% CI = 2.43-3.41), safety issues (AOR = 6.28; 95% CI = 5.01-7.87), gender, sex, and sexuality issues (AOR = 3.10; 95% CI = 1.93-4.98), suicidality (AOR = 1.82; 95% CI = 1.17-2.85), alcohol use (AOR = 5.43; 95% CI = 3.92-7.41), and different emotions experienced (AOR ranging from 0.37 to 3.50), had significant association with relationship issues. CONCLUSION: Investing in health promotion interventions focusing on these precursors of relationship issues among youth seems strategic. Our findings have implications for other states in India and other low-middle-income countries like India.

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BACKGROUND: Cell phones are an integral part of modern day life and have become companions for individuals irrespective of age, gender and socio-economic status. In this study, we assessed the factors affecting risk of cell phone addiction among teachers attending Life Skills Training and Counselling Services (LSTCS) program in Karnataka. METHODS: This cross sectional secondary data analysis utilised data from baseline assessment of trainees attending a Life Skills Training and Counselling Services program (LSTCP). Various factors hypothesised to be affecting risk of cell phone addiction (outcome) was analysed using univariate and multivariable logistic regression analysis. All the analysis was done using STATA 12.0 software. RESULTS: Multivariable logistic regression analysis was conducted with risk of cell phone addiction as outcome. A conceptual framework of hypothesized exposure variables was developed based on expert consultation and literature review. Overall, data of 1981 participants was utilized. Gender (AOR=1.91; 95% CI=1.27-2.77), number of peers (AOR=1.01; 95 CI=1-1.008) and social quality of life (AOR=1.01; 95% CI=1.00-1.03) were associated with increased risk of cell phone addiction. Age (AOR=0.98; 95%CI=0.96-1.00), empathy (AOR=0.96;95%;CI=0.93-0.99), communication skills(AOR=0.92, 95%;CI=0.88-0.96) and physical quality of life (AOR=0.96; 95% CI=0.95-0.98) were associated with reduced risk of cell phone addiction. CONCLUSIONS: This study on precursors of risk of cell phone addiction, conducted mostly among apparently healthy individuals, provide important insights into interventions to reduce risk of cell phone addiction. The complexity of associations between peers, gender, quality of life and risk of cell phone addiction needs further exploration.

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A unique youth mental health promotion program called Yuva Spandana is implemented and functional across all districts within Karnataka. Trained guidance providers named Yuva Parivarthakas (YPs) and Yuva Samalochakas (YS) provide support to youth having issues at Yuva Spandana Kendras (YSKs). We highlight the process of development of the program "Yuva Spandana" into a sustainable community-based youth mental health promotion model addressing youth issues across Karnataka and describe the profile of beneficiaries attending YSKs in Karnataka between 2017 and 2019. Yuva Spandana has evolved over time and got established in local-self-governments and communities.

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BACKGROUND: Yuva Spandana (YS) is a youth mental health promotion program implemented across all 30 districts of Karnataka. Yuva Parivarthakas (YPs - youth change agents) are trained to provide mental health promotion services to any "youth with issues" through Yuva Spandana Kendras (guidance centers) situated within district stadiums across Karnataka. Aim of the study was to evaluate the change (comparing before and after training) in different learning domains (cognitive - knowledge, affective - attitude, and psychomotor - practice) among trainees (YPs) attending YS training. METHODS: Quasiexperimental study design was utilized for this study. A semistructured interview schedule was developed and used before and after the training. Data were analyzed by descriptive statistics. The difference in change of mean score was assessed using the paired t-test. The shift in the proportion of trainees post-training in the three domains was assessed using McNemar's test. RESULTS: The mean (±SD) age of trainees was 27.5 ± 3.3 years. Majority of them were males (63.8%), had completed bachelor's degree (53.4%), and were residing in rural Karnataka (77.7%). The knowledge and attitude scores significantly improved (P < 0.001) post-training, without significant improvement in practical skills. CONCLUSION: It is recommended that future training programs need to be focused on creating opportunities to YPs in order to increase their practical skills to work with youth having issues.

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BACKGROUND: Youth focused Life Skills Education and Counseling Services (YLSECS) program, trained teachers/National Service Scheme (NSS) officers to deliver Life Skills Education (LSE) and counseling services to college going youth in the state of Karnataka in India. Available evaluation of life-skills training program have neglected the recording and or reporting of outcome among those trained to implement life-skills training program. Present paper highlights the quality of YLSECS training program and change in perception among teachers/NSS-officers trained in-terms of improvement in their cognitive/affective domains. METHODS: YLSECS program focused on World Health Organization identified ten essential domains of life-skills. Participants of the YLSECS program were trained by adopting facilitatory approach based on the principles of Kolb's learning theory. Quasi experimental study design was used to evaluate the outcome of training among participants. Quality of the training was assessed using scoring system and change in perception was assessed using Likert scale. Statistical significance of change in perception before and after training was assessed by paired't' test for proportion. RESULTS: Overall, 792 participants rated the quality of training as either "good" or "excellent". Post-training, significant (p < 0.001) proportion of the participants reported improved awareness about life-skills (before training 49.9 to 74.4% vs post-training range from 91.6 to 95.1% for various domains). There was statistically significant (p < 0.001) increase in participants reporting "very confident" in teaching various life skill domains (before training from 22.7 to 34.2% for various domains and post-training it ranged from 65.2 to 74.7% for various domains). There was modest increase in participants reporting perceived ability to conduct life-skills workshop "without assistance" post-training (before training from 16.8 to 22.9% for various domains vs post-training ranged from 29.8 to 36.8% for various domains). Interestingly, considerable proportion of participants who prior to training reported being confident in providing life skills training (without any assistance), later (i.e post training) reported they need some/more assistance for the same. CONCLUSION: YLSECS training program significantly improved participants knowledge and confidence in imparting life-skills and highlight the need for continued handholding of participants for effective implementation of LSE and counseling service program.

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