Journal of Preventive Medicine and Public Health

Perspective

Towards Mental Health Equity: Task Shifting Strategy to Overcome Barriers in Primary Healthcare Services in India: Suganya Panneerselvam, Senthilkumar Ramasamy, Sanjana Agrawal; J Prev Med Public Health. 2025;58(5):548-551. Published online June 13, 2025; DOI: https://doi.org/10.3961/jpmph.25.144

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Abstract Summary PDF: Mental illness remains among the top 10 causes of the global burden of disease. According to the National Mental Health Survey of India, 10.6% of adults exhibit mental disorders. India ideally requires 3 psychiatrists per 100 000 population, yet the current ratio is only 0.7 per 100 000. The country thus faces an urgent need to strengthen mental health infrastructure and expand training programs. Vulnerable groups—particularly residents of rural and remote areas, women, and older adults—are disproportionately affected by this situation. Individuals with mental illness often suffer in silence, enduring human rights violations, stigma, and discrimination. India’s National Mental Health Programme seeks to ensure the availability and accessibility of minimum mental health care for all, with a focus on the most vulnerable and underserved populations. The World Health Organization recommends task shifting or task sharing to improve access and deliver healthcare services in remote areas. Community Health Officers (CHOs) and Accredited Social Health Activists use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment. This practice significantly augments the effectiveness of community-level mental health interventions. Integrating mental health into primary health care should facilitate earlier detection and treatment of mental health disorders.; Summary

Key Message
Mental illness remains among the top 10 causes of the global burden of disease. Stigma associated with these disorders exacerbates the problem, leading to social discrimination. The Ayushman Bharat initiative is a transformative step towards strengthening India’s healthcare system. CHOs and ASHAs use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders within their communities. This task-shifting approach empowers local communities and fosters participation, reducing disease burden and offering a sustainable, effective model.

Original Articles

Relationship Between Shift Intensity and Insomnia Among Hospital Nurses in Korea: A Cross-sectional Study: Yuhjin Chung, Hyunjoo Kim, Dong-Hee Koh, Ju-Hyun Park, Seohyun Yoon; J Prev Med Public Health. 2021;54(1):46-54. Published online December 22, 2020; DOI: https://doi.org/10.3961/jpmph.20.555

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Abstract Summary PDF Supplementary Material

Objectives
This study explored the relationship between shift intensity and insomnia among hospital nurses.
Methods
The participants were 386 female hospital nurses who underwent a special health examination for night workers in 2015. The Korean Insomnia Severity Index (ISI), indices of shift work intensity, and other covariates such as amount of exercise, level of alcohol consumption, employment duration, and hours worked were extracted from the health examination data. The indices for shift intensity were (1) number of 3 consecutive night shifts and (2) number of short recovery periods after a previous shift, both assessed over the prior 3 months. Multiple logistic regression analysis adjusted for the aforementioned covariates was performed to evaluate the association of shift intensity with insomnia, defined as an ISI score of ≥8.
Results
The nurses with insomnia tended to be younger (p=0.029), to have worked 3 consecutive night shifts more frequently (p<0.001), to have experienced a greater number of short recovery periods after the previous shift (p=0.021), and to have worked for more hours (p=0.006) than the nurses without insomnia. Among the other variables, no statistically significant differences between groups were observed. Experiences of 3 or more consecutive night shifts (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.29 to 4.20) and 3 or more short recovery periods (OR, 2.01; 95% CI, 1.08 to 3.73) were associated with increased odds of insomnia.
Conclusions
The results suggest that decreasing the shift intensity may reduce insomnia among hospital nurses working rotating shifts.

Summary

Korean summary
불면증상의 척도로서 ‘한국판 불면증 심각도 평가척도’를, 교대근무강도의 지표로서 지난 3개월 간의 ‘3회 연속 야간근무 횟수’와 ‘교대근무 이후 짧은 휴식기간’을 사용하여, 대학병원 야간 근무 간호사 386명의 불면증상과 교대근무강도 간의 연관성을 탐색하고자 하였다. 로지스틱 회귀분석 결과, ‘3회 연속 야간근무 횟수’와 ‘교대근무 이후 짧은 휴식기간’은 불면증상의 오즈비 증가와 관련이 있었다. 이 결과는 교대근무강도를 저하시켜야 순환 교대근무 병원 간호사들의 불면증상을 줄일 수 있음을 시사한다.

Citations

Citations to this article as recorded by

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American Journal of Health Behavior.2023; 47(4): 714. CrossRef
Insomnia among Intensive Care Unit Nurses in the United Arab Emirates and its Association to Work Productivity and Quality of Life
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The Effect of Screening of Stomach Cancer on Stage Shift.: Jung Wan Koo, Won Chul Lee, Cho Hyun Park, Ji Youn Han, In Sik Chung, Nam Sun Paik, Hoon Kyo Kim; Korean J Prev Med. 2000;33(1):25-30.

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Abstract PDF: OBJECTIVES
This study was performed to evaluate the effect of stage shift according to screening of stomach cancer. METHODS: Total 840 cases of stomach cancer patients, undergone a surgical operation at Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea from Jan. 1989 to Dec. 1995, were reviewed by stomach cancer working sheet, and classified as asymptomatic and symptomatic group based on the presence of subjective symptoms on their hospital visit. Their histopathologic stages were analysed. We compared the histopathologic stages of asymptomatic stomach cancer patients with those of symptomatic patients. RESULTS: From the total of 840 patients, asymptomatic patients group comprised 28 cases (3.3%). Proportion of asymptomatic patients tended to increase from 1.9% in 1990, 0.9% in 1991 to 8.6% in 1995. Proportions of asymptomatic patients by stages were 78.6% (stage I), 3.6% (stage III), 17.9% (stage IV) and that of symptomatic patients by stages were 38.2% (stage I), 16.5% (stage II), 24.8% (stage III), 19.1% (stage IV). In less than 40 years old, 50.5% of symptomatic patients were diagnosed as stage I. With increment of ages, proportions of stage I were markedly decreased. It was significantly different between proportion of early gastric cancer in asymptomatic patients (60.1%) and that in symptomatic patients (25.0%). CONCLUSIONS: We confirmed stage shift according to screening of stomach cancer. And proportion of early gastric cancer in asymptomatic patients was higher than that in symptomatic patients. This results suggest that screening of gastric cancer be important to reduce mortality and it be indirectly started from 40 years old.; Summary

Health Assessment of Shift Workers in a Automobile Manufacturing Plant.: Jung Jeung Lee, Jong Hak Chung; Korean J Prev Med. 1995;28(1):103-122.

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Abstract PDF: An investigation on psychophysiological health and social well-being of shift workers been carried out on workers of a automobile manufacturing plant in Ulsan. for 1 month from April, 1993. This cross-sectional survey compared shift workers(n=544) with day workers(n=l15). Each subject completed a questionnaire about his personal habit background. shift schedule. sleep and eating patterns. subjective digestive symptom and psychological well-being and distress using the General Well-Being schedule(GWB) by self administrated questionnaire that was developed for the U. S. Health and Nutrition Examination surveys (HANES I). chi-square analysis was used for discontinuous data and the t-test was used for continous data to determine whether differences noted between the two groups. In terms of sleep quality, a greater percentage of shift workers frequently had trouble getting back to sleep once awakend(p<0.01) and a greater percentage of shift workers awakend tired or sleepy frequently more often than day workers(p<0.05). In rating the quality of their sleep, more shift workers rated their sleep fair to poor than day workers, and greater percentage of shift workers felt tired or sleepy at work two or more times per week(p<0.01) and a much higher percentage of shift workers felt tired or sleepy after work every days(p<0.01). In terms of sleep patterns, a much higher percentage of day workers reported uninterrupted sleep per 24hours than shift workers. The shift workers reported different eating patterns from day workers but there were no statistically significant and rate of their appetite. Thirteen percent of day workers reported the best appetite but only 6.6% of shift workers had the best appetite. The gastric complaints is more frequent in shift workers than day workers(p<0.01). Among subscores in General Well-Being Schedule, anxiety, depression, positive well-being and vitality subscale of shift workers were lower than those of day workers(p<0.05) and general health and self control subscale of shift workers were lower than those of day workers but there were no statistical significant difference. Based on these study result, it could be concluded that the shift work has significant effects on some psychophysiological conditions of the workers.; Summary

Shiftwork and Sickness Absence in Korean Manufacturing Industries.: Jung Sun Park, Domyung Paek, Ki Beom Lee, Kyung Yong Rhee, Kwan Hyung Yi; Korean J Prev Med. 1994;27(3):475-486.

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Abstract PDF: In order to provide necessary information for better health of workers through understanding the actual status of the industries adopting shift systems. The data were gathered from a stratified random sample of 347(0.5%) firms selected out of about 70,000 manufacturing industries throughout the nation in 1993 stratification during sampling was by industrial group and number of workers. The major findings obtained from 288 firms surveyed completely were as follows: 1. About 20.2% of the 288 firms were adopting shift systems and shiftworkers accounted for about 25.1% of the total work force in 288 firms. 2. The bigger number of workers was, the higher the adopting rate of shift system was. 3. The rate of having welfare facilities such as dining room, commuting bus, washing facilities, and health care room etc. was higher in the industries adopting shift systems. 4. The major industrial groups adopting shift systems were the rubber & plastic goods manufacturing industry (54.1 per 100 firms) and the textile manufacturing industry (44.8 per 100 firms). However the proportion of shiftworkers was higher in the textile manufacturing industry (70.5 per 100 firms) and the electronics industry (57.9 per 100 firms). 5. The most predominant work schedule was the weekly rotating, semi-continuos 2-crew 2-shift system (47.5%). 6. In the industries adopting shift systems, shiftworkefs had an adjusted average of 0.29 spells per 100 workers (O.14-0.45 in 95% C.I) compared to 0.23 spells per 100 nonshift dayworkers (0.15-0.31 in 95% C.I) for 1 month. 7. Also in the industries adopting shift systems, the adjusted average annual turn-over rate of shiftworkers was 13.07 per 100 workers (12.03-14.12 in 95% C.I) compared to 10.18 per 100 nonshift dayworkers(9.53-10.82 in 95% C.I).; Summary

Sleeping Patterns and Gastrointestinal Disorders According to the Shift Works in Female Textile Workers.: Ki Ha Yoo; Korean J Prev Med. 1994;27(1):74-83.

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Abstract PDF: To investigate the sleeping patterns and gastrointestinal disorders of shift workers, the auther studied 434 female workers who worked at textile industry ill Taejon city from september 1 ,1992 to september 31 ,1992. Shift pattern were divided into 3 categories; 3 shift (shifts per 8 hours), 2 shift (day and night shift) and day work. The results obtained were as follows: 1. The average sleeping hours when adjusted for the education level of the total study subjects was 6.1 hours. That of 3 shift workers was 6.1 hours, 2 shift workers was 6.0hours, but that of day workers was 6.5 hours. There were no significant difference among the shift workers. 2. For the 3 shift workers, the average physiologic adjusted duration in day shirt(2.2 days) was shorter than that or night shift(2.7 days) and there were significant difference among the rotating shift works (P<0.001). The sleeping problems in day shift was less than those of night shift (P<0.001). 3. 44.9% of 3 shift workers, 39.3% of 2 shift workers and 33.1% of day workers complained gastrointestinal symptoms when adjusted for the age, education level, job tenure, work post. And the rates of gastrointestinal symptoms complained increase with job tenures (P<0.001). 4. The most frequent gastrointestinal diseases were gastitis and gastric ulcer with 14.2 %, Irritable bowel syndrome with 3.1%, duodenitis and duodenal ulcer with 2.1% and combined gastrointestinal disease with 2.1%. Age, eating habit, amount of coffee per day, job tenure, work post and shift pattern showed no significant difference with the gastrointestinal diseases when adjusted for the age. According to the above results, the auther suggested that the shift pattern and job tenure can affect to the sleeping problem and gastrointestinal symptoms.; Summary

Comparison of Subjective Symptoms of Workers in Rapidly and Weekly Rotating Shift Systems.: Young Yeon Jung, Gwang Seo Choi, Kuck Hyeun Woo, Gu Wung Han; Korean J Prev Med. 1992;25(4):374-385.

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Abstract PDF: Some circadian rhythms can become disorganized due to rotating shift work. This lack of organization, termed desynchronization, can produce a group of symptoms such as insomnia, GI disturbance and fatigue among many rotating shift workers. The magnitude of these symptoms are influenced by personal and environmental factors and the patterns of shift work. This study was carried out to investigate the subjective symptoms related to rotational schedules of shift work after personal and environmental factors adjusted. 182 male workers in rapidly rotating shift system and 86 male workers in weekly rotating shift system were conducted the questionnaire on personal factors and subjective sleep, GI and fatigue symptoms. Major findings obtained from this study are as follows: 1. The symptoms of 'feeling tired at work' and 'being irritable' were more frequent in weekly rotating shift workers(P<0.05), and the mean of symptom score was significantly higher in weekly rotating shift workers(P<0.01). 2. According to 6 hours of sleeping which is a definite elevation point of fatigue, there was not a significant difference between two groups in sleeping hours. Among workers in rapidly rotating shift system, the mean of symptom score was significantly higher in workers of less than 6 hours of sleeping(P<0.05), but it was not different among weekly rotating shift workers. 3. The symptoms of GI disturbance were more frequent in weekly rotating shift workers but statistically mot significant. 4. The positive rate of mental and physical fatigue symptoms were significantly higher in weekly rotating shift workers(P<0.01) and mental and physical fatigue symptoms were more frequent in them(P<0.01). 5. After the effect of the factors that were significantly different between two groups by X2-test were controlled, the mean score of sleep disturbance was significantly higher in weekly rotating shift workers(P<0.01) and mental physical fatigue symptoms were more frequent in them(P<0.01). Based on these study results, subjective symptoms were more common in the weekly rotating shift workers. In future, medical examination and laboratory test will be also administered to evaluate a more accurate health outcomes and the review of current shift schedules will be required.; Summary

Health risks related to shift work among female workers of major manufacturing industries in Korea.: Euichul Shin, Kwang Ho Meng; Korean J Prev Med. 1991;24(3):279-286.

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Abstract PDF: Much of the working population in developing countries are engaged in shift work now and the number of shift workers is not expected to decrease in the future mostly because the need for continuity of production is increasing. Therefore, the possible effects of shift work on health are of particular interest, and in fact, there have been many epidemiological studies on shift work since the first world war. However, no studies on health effects of shift work have been reported in Korea, and the existing studies in western world have arrived at quite different conclusions mainly because the conditions of work other than shift work, such as age and selection of workers, work environment, and labor conditions also influence the health of workers. This study was firstly carried out in Korea to investigate the health risks related to shift work with 2,093 female workers randomly selected from three major manufacturing industries in proportion to total number of female workers in those industries. Differences of work conditions other than shift work in this study were adjusted by multivariate analysis. Major findings obtained from this study are as follows: 1. There were significant differences between shift and day workers in the distribution of age, type of industry, condition of noise and dust, regularity of mealtime, working position, and working duration. Shift workers tended to be younger, to have shorter working duration, to have more irregular mealtime, to work in standing position, and to work under more noisy and dusty environment than day workers. 2. Univariate analysis showed that shift work increased the Todai Health Index (THI) scores of digestive tract, respiratory tract, and mental instability symptom categories. Shift work also increased days of sickness absence and number of industrial accident per 100 workers per month. 3. Multivariate analysis that adjusted the differences of demographic, occupational and non-occupational health-related working conditions showed that digestive tract symptoms and mental instability symptom scores were significantly higher in shift workers than those in day workers. Based on those study results, it is concluded that the shift work has significant effects on some psychophysiological conditions of the workers and the effects are also influenced by several other personal and working conditions.; Summary

Circadian Disruptions of Heart Rate Variability among Weekly Consecutive-12-hour 2 Shift Workers in the Automobile Factory in Korea.: Mia Son, Juhon Sung, Myunggul Yum, Jung Ok Kong, Hye Un Lee, In A Kim, Jung Yeon Kim; J Prev Med Public Health. 2004;37(2):182-189.

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Abstract PDF: OBJECTIONS: The objective of this study is to compare the circadian patterns of heart rate variability assessed by 24-hour ambulatory electrocardiographic (ECG) recordings during day shift and night shift among the workers in the 5 days-concecutive- 12-hour shift in an automobile factory in Korea. METHODS: The study population consisted 300 workers, who were randomly selected among the 8700 total workers in one car factory. To analyse circadian variation, the 24-hour ECG recordings (Marquette) were measured during day shift (08: 00-20: 00 h) and night shift (20: 00-08: 00 h). Analysis was performed for all time and frequency domain measures of HRV. 233 workers completed taking 24-hour ECG recordings. RESULTS: This study shows that the 24 hourcircadian variation mainly follows work/sleep cycle rather than day/night cycle among shift workers. This study also shows that among the night shift, the circadian variation between work and sleep cycle decreased compared to the work/sleep cycle among day shift workers. All time and frequency domain parameters (except LF/HF ratio) show significantly different between work and sleep in the day shift and night shift. CONCLUSION: These changes in heart rate variability circadian rhythms reflect significant reductions in cardiac parasympathetic activity with the most marked reduction in normal vagal activity among the shift workers. Especially, it suggests the circadian rhytm has blunted among the night workers. The quantification of the circadian variation in HRV can be a surrogates of workers' potential health risk, as well as suggests possible mechanisms through which the shift works compromise workers' health.; Summary

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