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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 187-190

Prevalence of Chittodvega (anxiety disorder) symptoms in Indian village of Nagnur in Telangana: a cross-sectional study


Department of Rasa Shastra and Bhaishajya Kalpana, Sri Sai Ayurvedic Medical College, Aligarh, Uttar Pradesh, India

Date of Submission05-Mar-2021
Date of Decision06-Aug-2021
Date of Acceptance17-Aug-2021
Date of Web Publication28-Sep-2021

Correspondence Address:
Dr. Manjiri A Ranade
Staff Quarter No. F3/2, Sri Sai Ayurvedic Medical College Campus, Sarsol, GT Road, Aligarh, Uttar Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_20_21

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  Abstract 

Introduction: Charaka has described Chittodvega (anxious state of mind) as Manas Dosha Vicar (mental disorders). The signs and symptoms described by charaka are very much similar to an anxious state of mind. Still, the studies done in Ayurveda to assess the prevalence of Chittodvega have used modern definitions of Chittodvega. Hence it is suggested that assessing the prevalence of Chittodvega based on Acharya Charaka symptomatology and assigning a numerical rating scale (NRS) to it. Materials and Methods: This is a community-based cross-sectional study done in the Nagnur Village in Karimnagar District in Telangana. The symptoms described by Charka were tested on a 10-point Likert NRS. The NRS less than 4 is considered mild Chittodvega, 4–7 is considered moderate Chittodvega, and more than 7 is considered severe Chittodvega. The data thus obtained were analyzed. Results: Chittodvega was equally distributed among various age groups and different sociodemographic status among 100 study participants. The prevalence of Chittodvega assessed by different symptomatology varied between 16% and 55%. Nidra Nasha (lack of sleep) and Krodha (anger) were the most common symptoms, whereas Udvega (distress) was the least common symptom. Conclusion: There is a high prevalence of Chittodvega symptoms in the rural population. There is an urgent need to tackle this hidden problem in the population, as it can burden normal living beings. Our study gives an insight into making decisions regarding the need for agencies to make targeted efforts to tackle this rarely explored but very common mental health issue.

Keywords: Chittodvega, numeric rating scale, rural


How to cite this article:
Ranade MA. Prevalence of Chittodvega (anxiety disorder) symptoms in Indian village of Nagnur in Telangana: a cross-sectional study. J Indian Sys Medicine 2021;9:187-90

How to cite this URL:
Ranade MA. Prevalence of Chittodvega (anxiety disorder) symptoms in Indian village of Nagnur in Telangana: a cross-sectional study. J Indian Sys Medicine [serial online] 2021 [cited 2021 Dec 2];9:187-90. Available from: https://www.joinsysmed.com/text.asp?2021/9/3/187/326835




  Introduction Top


Acharya Charaka has described Chittodvega (anxious state of mind) as Manas Dosha Vicar (mental disorders).[1]Raja and Tama are the main Dosas of any Manasa Vikara, including Chittodvega. From the Ayurveda point of view, Chittodvega is a vitiation of Vayu (Prana, Udana, and Vyana), Pitta (Sadhaka), and Kapha (Tarpaka).[2] The signs and symptoms described by charaka are very much similar to an anxious state of mind. Anxiety has physical features such as palpitation, nausea, and chest pain, dryness of mouth, abdominal pain, and headache. Pale skin and sweating are some of the somatic signs of anxiety.

To study the disease as described by Charaka, it is most important to assess the burden of disease in the community. There are no studies till date to assess the prevalence of Chittodvega in communities according to the signs and symptoms described by charaka. So, this study was undertaken to assess the burden of the disease in the rural Indian population, according to the signs and symptoms as described in ancient texts.


  Study Design and Setting Top


This was a community-based cross-sectional study conducted in rural India. The study was designed to assess the prevalence of Chittodvega and its comparison with anxiety disorder as per Diagnostic and Statistical Manual of Mental Disorders [DSM-5]) in rural areas. The study was conducted among adults aged between 18 and 60 years. The Institutional Ethics Committee clearance was obtained vide infra IEC/PIMS/November/20/06.

The following symptoms were tested on a 10-point Likert NRS.

Ayasa (easy fatigability SAT D.1362), Unmattachittavatam (fickle mindedness SAT D.1645), Shirsha Shoonyata (feeling of emptiness in the head SAT D.7596), Krodha (anger SAT D.2517), Angamarda or Angavedana (body pain SAT D.184), Anidra or Nidra Nasha (inability to sleep SAT D.544), Anannabhilasa (aversion of food SAT D.510), and Udvega (agitation SAT D.1629)[4] (SAT = standardized Ayurveda terminologies obtained from NAMASTE Portal).

The NRS score of less than 4 is considered mild anxiety, 4–7 is considered moderate anxiety, and more than 7 is considered severe anxiety.[3]

The purpose of using the numeric analogue scale (NAS) in this study was because the rating scale showed a very high correlation with standard anxiety scales in various populations across India as well as different geographies across the world. The second reason was its usefulness even in the illiterate rural population, which forms the core part of our study participants.

Sample size determination

For a population size of 10,00,000, we assessed the anxiety disorder frequency of around 16% in the general population based on previous studies. When we took a confidence limit of 5%, the estimated sample size for an 80% confidence level was 89. The design effect (DEFF) was considered to be 1 for this cluster sampling. The software used for this purpose is Open Epi available online from https://www.openepi.com/SampleSize/SSMean.htm.


  Selection of Participants Top


To achieve the sample size, the primary investigator approached one participant from each house (double-stage cluster sample: first stage, household selection and second stage, random probability participant selection) in the study area and data were gathered from them after obtaining their written consent. If the house was locked, it was visited the next day and if it was again locked, the house was excluded from the study and the next house was visited.

The following inclusion and exclusion areas were also applied for the selection of participants. Inclusion criteria were as follows:

  1. Adults in the age group of 18–60 years


  2. Adults without coexisting physical illness.


Participants should have been residing in the Nagnur village of Karimnagar district of Telangana for at least the past six months.

Exclusion criteria

  1. Adults having neurodevelopment disorders (mental retardation, etc.)


  2. Participants who did not give written valid and informed consent for participating in this study.


Records of sociodemographic details such as age, sex, socioeconomic status, and education were noted for each participant.

Study outcome and statistical analysis

The NRS (Likert scale) having a rating between 1 and 10 was used to screen for Chittodvega (anxiety) in participants to know about the intensity and frequency of symptoms among them. The data thus obtained were analyzed with Open Epi Version 3.01. The NAS is validated in many population groups across different geographic locations and ethnic and racial variations for the assessment of anxiety. The scale shows a very good correlation with the State-Trait Anxiety Inventory. The reason for choosing the NAS in this study is convenience along with rural and illiterate strata of population, for whom this scale is much easier.


  Results Top


A total of 100 adults were interviewed. The skewness of data for 0.122 indicates that the data are symmetrical for all parameters.

Most of the participants belonged to the age group of 18–30 and 40–50 years (nearly 62%), and more males were enrolled. The education of the population was seen more in the case of those who were illiterate and at the primary levels; however, 30% of the population belonged to the intermediate levels, and 34% were graduates and higher levels. The socioeconomic classes were equally divided into low, middle, and high according to the Kuppuswamy classification updated for 2019. The data are mentioned in [Table 1]. The NAS score was the highest with Nidra nasha, and the second highest symptom was Krodha. Udvega was the least common symptom, as mentioned in [Table 2]. The class intervals and class frequencies of different symptoms are mentioned in [Table 3].
Table 1: Demographic pattern of participants

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Table 2: Mean NAS of symptoms in participants

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Table 3: Prevalence of Chittodvega symptoms among adults from rural area of Nagnur in Telangana

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  Discussion Top


Chittodvega is one form of minor psychological disorders; it does not hinder a patient’s everyday conduct but if uncared for it can turn into a major disorder in future, for instance, Unmada.[5] As mentioned in Caraka Samhita Chikitsasthana, these Vikara are Purvarup of Unmad.

There is a reference of Chittodvega in Charaka Samhita, Viman shtahan. It explains physical and psychic doshas. The reason for chittodvega is the vitiation of Rajasa and Tamasa doshas of the mind. It includes emotional disturbances such as Shoka (grief), Chinta (worry), Kama (lust), Krodha (anger), Lobha (greed), etc.[6] Our study did not specifically take modern definitions of anxiety to diagnose anxiety. The reason is that even if a single symptom is present in sufficient severity, it is enough to derail the daily routine of participants and the family, though it may not be diagnosable with the State Trait Anxiety scale in any particular category. So, symptom-based diagnosis seems more prudent, at least in mental health disorders.

The NAS is validated in many population groups across different geographic locations and ethnic and racial variations for the assessment of anxiety. The scale shows a very good correlation with the State-Trait Anxiety Inventory. The reason for choosing the NAS in this study is convenience along with the rural and illiterate strata of population, for whom this scale is much easier. The study findings correlate with the latest census data in the area, which mentions an illiteracy rate of nearly 15% in the study area. Anxiety was described as significant with an NRS score of 4 and as needing medical attention when the NRS score was above 7. The present study reveals that Krodha (anger) and Nidranasha (insomnia) are common symptoms, whereas Shirsha Shunyata (blank mind), Annabhilasha (dislike for food) are not so common. There was an equal distribution of symptoms in various socioeconomic classes, which implicates the need to focus on every social domain to win over this unreported problem. Our study is in agreement with other researchers in the field who noticed the high incidence of body image anxiety in rural adolescent girls and is an important factor in determining social phobia.[7],[8] The assessment of prevalence in the rural population is very important to make sound policy for its management. Ayurveda can play a very important role in mental health disorders in India, as it caters to masses and in rural areas because modern psychiatric hospitals are mostly concentrated in urban areas.


  Conclusion Top


There is a high prevalence of Chittodvega symptoms in the rural population. There is an urgent need to tackle this hidden problem in the population, as it can burden normal living beings. Our study gives an insight into making decisions regarding the need for agencies to make targeted efforts to tackle this rarely explored but very common mental health issue.

Limitations of the study

As the study design is participant self-reporting, reporting bias cannot be completely eliminated. Though the power of the study is adequate, sample size is from a single village and further studies with multicenter participation are needed to extrapolate the data for larger populations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Charak. Roganikam Vimanam, 6/5. In: Charaka Samhita,Viman Sthana. Available from: http://niimh.nic.in/ebooks/ecaraka/?mod=. [Last accessed on 2020 December 21].  Back to cited text no. 1
    
2.
Charak. Roganikam Vimanam, 6/6. In: Charak Samhita, Viman Sthana. Available from: http://niimh.nic.in/ebooks/ecaraka/?mod=read.[Last accessed on 2020 December 21].  Back to cited text no. 2
    
3.
Selby D, Cascella A, Gardiner K, Do R, Moravan V, Myers J, et al. A single set of numerical cutpoints to define moderate and severe symptoms for the Edmonton symptom assessment system. J Pain Symptom Manage 2010;39:241-9.  Back to cited text no. 3
    
4.
Charak. Unmadnidanam, 7/6. In: Charak Samhita, Nidan Sthana. Available from: http://www.ayurveda-online.net/view_caraka_gr.php?id=1&row=1157.[Last accessed on 2020 December 21].  Back to cited text no. 4
    
5.
Charak. Unmadchikitsitam, 9/4. In: Charak Samhita, Chikitsa Sthana. Available from: http://niimh.nic.in/ebooks/ecaraka/?mod=read. [Last accessed on 2020 December 21].  Back to cited text no. 5
    
6.
Roshni K. Tele-counselling for management of Chittodvega (anxiety disorder) in Ayurveda-composing ancillary methods during the Covid 19 pandemic. CSIT 2020;8:395-401.  Back to cited text no. 6
    
7.
Waghachavare VB, Quraishi SR, Dhumale GB, Gore AD. A cross-sectional study of correlation of body image anxiety with social phobia and their association with depression in the adolescents from a rural area of Sangli district in India. Int J Prev Med 2014;5:1626-9.  Back to cited text no. 7
    
8.
Kallakuri S, Devarapalli S, Tripathi AP, Patel A, Maulik PK. Common mental disorders and risk factors in rural India: Baseline data from the SMART mental health project. BJPsych Open 2018;4:192-8.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
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