1
|
Muhammad T, Srivastava S, Muneera K, Kumar M, Kelekar U. Treatment for Insomnia Symptoms is Associated with Reduced Depression Among Older Adults: A Propensity Score Matching Approach. Clin Gerontol 2024; 47:436-451. [PMID: 37153958 DOI: 10.1080/07317115.2023.2208582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The study aimed to investigate the effect of utilization of treatment for insomnia symptoms on the prevalence of major depressive disorder among older adults in India. METHODS We used the data from the Longitudinal Ageing Study in India (LASI), 2017-18. The sample included 10,911 older individuals who reported insomnia symptoms. The propensity score matching (PSM) approach was used to compare the depressive disorder among those who received vs. not received treatment. RESULTS Only 5.7% of older adults reporting insomnia symptoms received treatment. On average, prevalence of depressive disorder among men and women who received treatment for insomnia symptoms was lesser by 0.79 and 0.33 points, respectively, than those who did not receive treatment. In the matched sample, treatment for insomnia symptoms was significantly associated with lesser prevalence of depression for both older men (β= -0.68, p < .001) and older women (β= -0.62, p < .001). CONCLUSIONS The current findings suggest that treatment for insomnia symptoms can reduce the risk of depressive disorder among older adults and the effects are higher among older men than women.
Collapse
Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - K Muneera
- School of Management Studies, National Institute of Technology, Calicut, Kerala, India
| | - Manish Kumar
- Population Research Centre, Dharwad, Karnataka, India
| | - Uma Kelekar
- School of Business, College of Business, Innovation, Leadership and Technology
- Marymount Center for Optimal Aging, Marymount University, Arlington-VA, USA
| |
Collapse
|
2
|
Orozco-Núñez E, Ojeda-Arroyo E, Cerecer-Ortiz N, Guerrero-López CM, Ramírez-Pérez BM, Heredia-Pi I, Allen-Leigh B, Feeny E, Serván-Mori E. Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis. Health Res Policy Syst 2024; 22:46. [PMID: 38605301 PMCID: PMC11007965 DOI: 10.1186/s12961-024-01125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/17/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.
Collapse
Affiliation(s)
- Emanuel Orozco-Núñez
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Enai Ojeda-Arroyo
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Nadia Cerecer-Ortiz
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Carlos M Guerrero-López
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | | | - Ileana Heredia-Pi
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Betania Allen-Leigh
- Center for Population Health Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Emma Feeny
- The George Institute for Global Health, Sidney, Australia
| | - Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico.
| |
Collapse
|
3
|
Shawon MSR, Hossain FB, Hasan M, Rahman MR. Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: Analysis of nationally representative survey data. Glob Ment Health (Camb) 2024; 11:e46. [PMID: 38690568 PMCID: PMC11058515 DOI: 10.1017/gmh.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Background Assessing gender disparity in mental health is crucial for targeted interventions. This study aims to quantify gender disparities in mental health burdens, specifically anxiety and depression, and related care-seeking behaviors across various sociodemographic factors in Nepal, highlighting the importance of gender-specific mental health interventions. Methods Data from the 2022 Nepal Demographic and Health Survey was utilized, employing the Generalized Anxiety Disorder 7 scale (GAD-7) and Patient Health Questionnaire (PHQ-9) scales for anxiety and depression symptoms, respectively. Multiple logistic regression models assessed gender associations with these conditions and care-seeking behaviors. Results Women had a higher point prevalence of anxiety (21.9% vs. 11.3%) and depression (5.4% vs. 1.7%) than men. Large variations were noted in gender disparities in the prevalence of anxiety and depression, influenced by age, geographical areas, level of education and household wealth. After adjustment for sociodemographic factors, women were more likely to experience anxiety (adjusted odds ratio (aOR) = 2.18, 95% confidence interval [CI]: 1.96-2.43) and depression (aOR = 3.21, 95% CI: 2.53-4.07). However, no difference was observed in the rates of seeking care for anxiety or depression (aOR = 1.13, 95% CI: 0.91-1.40). Conclusions Our findings show a higher point prevalence of mental health issues among women than men, influenced by sociodemographic factors, underscoring the need for gender-focused mental health interventions in Nepal and globally.
Collapse
|
4
|
Pai M, Muhammad T. Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis. Sci Rep 2024; 14:442. [PMID: 38172263 PMCID: PMC10764745 DOI: 10.1038/s41598-023-50613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
The purpose of this study was to examine (a) the socioeconomic status (SES)-related inequalities associated with handgrip strength (HGS); and (b) the extent to which several demographic, health, and behavioral factors contributed to such SES disparities in HGS among older adults in India. Data were drawn from the 2017-2018 wave 1 of the Longitudinal Ageing Study of India (LASI). The study sample included 27,707 older adults (13,199 men and 14,508 women) aged 60 years and older. HGS was assessed using a handheld Smedley's Hand Dynamometer with a cut-off of 19.5 kg for men and 12.5 kg for women. Bivariate analysis showed the weighted percentage distribution of weak HGS across respondent characteristics. Multivariate logistic regression assessed factors linked to weak HGS. The concentration curve and index (CCI) was used to determine the inequalities in the prevalence of weak HGS by wealth index scores. Wagstaff's decomposition approach was used to test the contribution of each explanatory variable to weak HGS. Around 9% of older adults in this study reported a weak HGS. It was significantly higher among those aged 80 or older (19.21%) and males (15.55%). Weak HGS was concentrated among older adults from poor SES (CCI: 0.05, p < 0.001). A higher percentage of wealth-based inequality in weak HGS was explained by being underweight (38.83%), belonging to the richest wealth quintile (27.95%), and having a higher subjective social status (32.20%). Moreover, about 23.29% of the inequality in weak HGS was explained by Western region and 22.54% by female gender. Additionally, having a secondary level of education explained a higher percentage (22.09%) of inequality, followed by current working status (- 20.68%). Rural residence (13.08%), limitations in instrumental activities of daily living (IADL) (12.21%), and engagement in yoga-related activities (11.55%) explained a higher percentage of wealth-based inequalities. The findings provide evidence of significant SES-related inequalities in HGS and the contribution of various demographic, health, and behavioral factors to such inequality. As such, public health policies and programs focusing on reducing the burden of disability must consider the contribution of social and economic equity to the preservation of muscle strength among older adults.
Collapse
Affiliation(s)
- Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - T Muhammad
- Pennsylvania State University, University Park, PA, 16802, USA.
| |
Collapse
|
5
|
Annajigowda HH, Nirisha LP, Ganjekar S, Rao GN, Gururaj G, Varghese M, Benegal V. Common mental disorders among women in reproductive age group: An analysis of national mental health survey, India 2016. Indian J Psychiatry 2023; 65:1238-1243. [PMID: 38298883 PMCID: PMC10826868 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_832_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background Common mental disorders (CMDs) have a higher prevalence among women in their reproductive age (WRA) compared to the general population. Large Indian epidemiological studies focusing on the prevalence and socioeconomic correlates of CMDs among WRA are lacking. The associated disability and treatment gap particularly in the women population is unknown. Aim To estimate the current prevalence, correlates, disability, socioeconomic impact, and treatment gap of CMDs among WRA from a nationally representative sample from India. Materials and Methods The National Mental Health Survey of India 2016 is a multisite nationwide household survey conducted across India using a uniform methodology. Overall, 39,532 adults were surveyed with a response rate of 88%. The diagnosis was based on Mini International Neuropsychiatric Interview 6.0.0. CMDs among WRA (18-49 years) for this secondary analysis included depression and anxiety disorders. Results The prevalence of CMDs among WRA in India was 5.83%. Two important risk factors for CMDs included being divorced and living in the urban metro. Nearly 70% of women reported disabilities of varying severity. The overall treatment gap was around 82% (urban nonmetro > metro > rural population). On average, the cost of treatment of CMDs was ₹ 2,000 per month. Conclusion CMDs are prevalent among WRA groups with significant disabilities and treatment gaps in India. The disability and treatment gap associated with CMDs among WRA can be handled by integrating mental health into general medical/obstetric care.
Collapse
Affiliation(s)
- Harshitha H. Annajigowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Lakshmi P. Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | |
Collapse
|
6
|
Vijayalakshmi S, Rajagopal K, Govindan R, Ganjekar S, Prathyusha PV, Chacko LK. Sexual and reproductive health problems among women with mental illness attending tertiary care psychiatric outpatient clinic in India: A cross-sectional study. J Neurosci Rural Pract 2023; 14:644-649. [PMID: 38059232 PMCID: PMC10696317 DOI: 10.25259/jnrp_62_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/29/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Sexual and reproductive health (SRH) is a vital concern among women with mental illness (WMI) due to the increased risk for unplanned pregnancy, sexually transmitted infections (STIs), and poor obstetric outcomes. Objective of the study was to explore the current use of family planning (FP) methods, symptoms of STIs and sexual dysfunction among WMI. Materials and Methods This descriptive study involved 404 WMI of reproductive age (18-49 years) attending tertiary care psychiatric outpatient clinics in India. During face-to-face interviews, centers for disease control and prevention (CDC)-reproductive health assessment toolkit-FP questionnaire, STI questionnaire and Female sexual function index (FSFI) were used to collect the data. Results Of 404 WMI, 261(64.6%) were users, and 137 (33.9%) were non-users of FP methods. About 6(1.5%) WMI did not respond FP methods question. Female sterilization was the highest among the users, 244(93%). Among non-users, 100 (73%) were unaware of choosing the effective method of FP. Most of the WMI, 377(93.3%), were unaware of STIs. The symptoms of STI reported include unusual genital discharge 62(15.3%) and genital ulcers/ sores 58(14.4 %). Most of them, 76(63.3%), were not on any treatment. The most common reason for not taking treatment was feeling ashamed 70(92.1%). Female sexual dysfunction was reported in 176(43.6%). Most of the WMI had difficulties in the arousal domain 288(71.3%), followed by low desire 233(57.7%) and dissatisfaction 186(46%). Conclusion Most WMI underwent sterilization. Non-users of FP methods were not aware of choosing the effective method. Awareness about STIs was poor, and feeling ashamed was the primary reason for not availing of medical help. Nearly half of the WMI reported sexual dysfunction, among which arousal difficulties, low desire and dissatisfaction were common. Health professionals need to increase awareness about FP methods and symptoms of STIs among WMIs. Women require appropriate counselling regarding SRH and treatment for sexual dysfunction.
Collapse
Affiliation(s)
- Sundaram Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kaipangala Rajagopal
- Department of Obstetrics and Gynaecology, Kanachur Institute of Medical Science, Mangaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - P. V. Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Leena Kunnath Chacko
- Department of Community Health Nursing, Yenepoya Nursing College, Yenepoya Deemed to be University, Mangaluru, Karnataka, India
| |
Collapse
|
7
|
Mathias K, Jain S, Fraser R, Davis M, Kimijima–Dennemeyer R, Pillai P, Deshpande SN, Wolters M. Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001736. [PMID: 37639400 PMCID: PMC10461838 DOI: 10.1371/journal.pgph.0001736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
This scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.
Collapse
Affiliation(s)
- Kaaren Mathias
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Uttarakhand, India
- Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
| | - Sumeet Jain
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Meghan Davis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Pooja Pillai
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Uttarakhand, India
| | - Smita N. Deshpande
- Department of Psychiatry, St John’s National Academy of Medical Sciences, Bengaluru, India
| | - Maria Wolters
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
8
|
Rai S, Awale R, Ghimire DJ, Rao D. Pathways of association between husbands’ migration and mental health of their wives who stay behind. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
9
|
Rajkumar E, Julia GJ, Sri Lakshmi K NV, Ranjana PK, Manjima M, Devi RR, Rukmini D, Christina G, Romate J, Allen JG, Abraham J, Jacob AM. Prevalence of mental health problems among rural adolescents in India: A systematic review and meta-analysis. Sci Rep 2022; 12:16573. [PMID: 36195719 PMCID: PMC9532445 DOI: 10.1038/s41598-022-19731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/02/2022] [Indexed: 11/12/2022] Open
Abstract
Adolescent mental health problems have been recognised as a major issue in low-income countries including India. Through a meta-analytic approach, the present review delineate the overall prevalence of each of the most discussed mental health problems among rural adolescents in India, comprising depression, anxiety disorders, generalised anxiety disorder, panic disorder, separation anxiety, social anxiety disorder, suicidality, hyperactivity, emotional problems, conduct problems and peer problems. The review also presents the potential determinants of such mental health problems. Using PRISMA guidelines, a total of thirty-five studies were finalized from databases such as PubMed, Science Direct, JSTOR, Web of Science, Google Scholar and ProQuest. From the findings, it is observed that male and female adolescents does not differ significantly in the prevalence of most mental health problems. However, social anxiety was found to be more prevalent among females when compared to males. In meta-regression, factors like tools used (screening tools vs diagnostic interviews), sample size, setting (school-based vs community-based), sampling technique and year of publication were found to influence the prevalence rates of certain mental health problems, reported in the studies. Major determinants influencing the prevalence of mental health problems in rural adolescents were age, socio-economic status, academic and family environment. Individual factors such as social media usage, physical activity, and substance use also contribute to mental health problems. As India accounts for one-fifth of the world's adolescent population, the findings of this review can have global implications.
Collapse
Affiliation(s)
- Eslavath Rajkumar
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India.
| | - Grace Jacob Julia
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India.
| | - N V Sri Lakshmi K
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - P K Ranjana
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - Mahesh Manjima
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
| | | | - Dubey Rukmini
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - George Christina
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - John Romate
- Department of Psychology, Central University of Karnataka, Kalaburagi, Karnataka, India
| | - Joshua George Allen
- Humanities & Applied Sciences, Indian Institute of Management Ranchi, Ranchi, Jharkhand, India
| | - John Abraham
- Department of Family Medicine/Geriatrics, St. John's Medical College, Academy of Medical Science, Bangalore, Karnataka, India
| | - Anieta Merin Jacob
- Department of Oral Medicine and Radiology, Sri Venkateshwara Dental College and Hospital, Bangalore, Karnataka, India
| |
Collapse
|
10
|
Patel AR, Kovacevic M, Hinton D, Newman E. "I put a stone on my heart and kept going": An explanatory model of how distress is generated and regulated among Indian women from slums reporting gender-based violence. Transcult Psychiatry 2022; 59:522-538. [PMID: 34860626 DOI: 10.1177/13634615211055003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical variation in the expression of panic disorder, depression and anxiety, and posttraumatic stress disorder (PTSD) has have been documented across cultures. However, local (emic) cultural models that explain how people make sense of their illness experiences remain relatively understudied in India among trauma-exposed populations. Further, the integration of emic findings into clinical care is limited, underscoring the need for emic perspectives following trauma to improve the development or adaptation of trauma-focused treatments in India. This study describes an emic explanatory model of distress, which includes idioms of distress, perceived causes of distress, and coping/help-seeking behaviors among Indian women from slums reporting gender-based violence. This explanatory model can be used as a culturally grounded way to develop clinical case conceptualizations to adapt and deliver psychological treatments for this under-served population.
Collapse
Affiliation(s)
| | | | - Devon Hinton
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
11
|
Navarro-Mantas L, de Lemus S, García-Sánchez E, McGill L, Hansen N, Megías JL. Defining Power and Agency in Gender Relations in El Salvador: Consequences for Intimate Partner Violence and Women's Mental Health. Front Psychol 2022; 13:867945. [PMID: 35519647 PMCID: PMC9063008 DOI: 10.3389/fpsyg.2022.867945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
Intimate partner violence (IPV) affects thousands of women around the world and is prevalent in the Global South. Unequal social structures perpetuate hierarchies and maintain women’s vulnerability to violence. Difficulties women face in accessing education, economic resources, and employment diminish their power in intimate relationships, increasing the likelihood of IPV. These factors can also have a significant effect on women’s mental health. However, some studies show that economic empowerment does not necessarily translate into greater agency for women if they cannot use the resources they earn to pursue whatever goals or values they regard as important in life. Agency is women’s ability to identify their life goals and act upon them through critical evaluation (intrinsic agency) and autonomous decision-making (instrumental agency). In this article, we aim to analyze the relationship between women’s power (educational and economic) and agency and their influence on intimate partner violence and on women’s mental health in the context of El Salvador. Currently, El Salvador has one of the highest percentages of femicide worldwide. We used data from the first national survey on violence against women in El Salvador to determine empowerment indicators and investigated their influence on intimate partner violence and women’s mental health. Results from a representative sample of 1,274 women aged between 15 and 64 years old and, using a structural equation modeling revealed that education was a protective factor against IPV, but economic power appeared to put women at greater risk of IPV. Education was positively related to both intrinsic and instrumental agency, but only instrumental agency was negatively associated with the likelihood of being a victim of IPV. Finally, both intrinsic and instrumental agencies were positively related to women’s mental health. We discuss the importance of identifying specific factors related to women’s power and agency to prevent IPV and mental health problems and to promote more gender equity in the Global South.
Collapse
Affiliation(s)
- Laura Navarro-Mantas
- Mind, Brain and Behaviour Research Centre, University of Granada (CIMCYC-UGR), Granada, Spain
| | - Soledad de Lemus
- Mind, Brain and Behaviour Research Centre, University of Granada (CIMCYC-UGR), Granada, Spain
| | - Efraín García-Sánchez
- Mind, Brain and Behaviour Research Centre, University of Granada (CIMCYC-UGR), Granada, Spain
| | - Lucy McGill
- Department of Social Psychology, Institute of Psychology, University of Groningen, Groningen, Netherlands
| | - Nina Hansen
- Department of Social Psychology, Institute of Psychology, University of Groningen, Groningen, Netherlands
| | - Jesús L Megías
- Mind, Brain and Behaviour Research Centre, University of Granada (CIMCYC-UGR), Granada, Spain
| |
Collapse
|
12
|
Patel AR, Newman E, Richardson J. A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence. BMC Womens Health 2022; 22:22. [PMID: 35090450 PMCID: PMC8795349 DOI: 10.1186/s12905-022-01595-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background Despite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. Similarly, the PTSD checklist-5 (PCL-5) has not yet been validated in India. This study describes the adaptation, validation, and results from the adapted HTQ, and embedded PCL-5, for Indian women from slums reporting GBV. Method This study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-15). Results The majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha = .88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha = .80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 and .80, ps < .05). Discussion This is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant trauma reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01595-3.
Collapse
Affiliation(s)
- Anushka R Patel
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA. .,Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California San Francisco, 2727 Mariposa St, San Francisco, CA, 94110, USA.
| | - Elana Newman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
| | - Julia Richardson
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
| |
Collapse
|
13
|
Supporting addiction affected families effectively: a feasibility randomised controlled trial of a psychosocial intervention delivered by lay counsellors in Goa, India. Glob Ment Health (Camb) 2022; 9:448-459. [PMID: 36618725 PMCID: PMC9806960 DOI: 10.1017/gmh.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/09/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Despite evidence of the burden of alcohol use on families, there is a lack of adequate and targeted support. We aimed to examine the feasibility, acceptability and impact of Supporting Addiction Affected Families Effectively (SAFE), a brief lay counsellor-delivered intervention for affected family members (AFMs). METHODS Parallel arm feasibility randomised controlled trial [1:1 allocation to SAFE or enhanced usual care (EUC)]. The primary outcome was mean difference in symptom score assessed by the Symptom Rating Test and secondary outcomes were difference in coping, impact and social support scores measured by the Coping Questionnaire, Family Member Impact Questionnaire, and Alcohol, Drugs and the Family Social Support Scale. Process data examining feasibility and acceptability were also collected. The primary analysis was intention to treat at the 3-month endpoint. RESULTS In total, 115 AFMs were referred to the trial, and 101 (87.8%) consenting participants were randomised to the two arms (51 SAFE arm and 50 EUC arm). Seventy-eight per cent completed treatment, with the mean number of sessions being 4.25 sessions and mean duration being 53 min. Ninety-five per cent completed outcome assessment. There were no statistically significant differences between SAFE and EUC on any of the outcome measures, except for the between-group adjusted mean differences for social support scores (AMD -6.05, 95% CI -10.98 to -1.12, p = 0.02). CONCLUSION Our work indicates that it is possible to identify AFMs through community networking, and have high rates of participation for lay counsellor-delivered psychosocial care. Nevertheless, there is a need for further intervention development to ensure its contextual relevance and appropriateness.
Collapse
|
14
|
Wang H, Cousineau C, Hu YA, Hu G, Qi S, Sun A, Wu H, Rozelle S, Singh M. Examining the Relation between Caregiver Mental Health and Student Outcomes in Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312613. [PMID: 34886336 PMCID: PMC8656998 DOI: 10.3390/ijerph182312613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
Research continues to highlight the central relationship between caregivers' mental health and their children's development. This study examined the relation between primary caregivers' mental health and school-aged children's outcomes, including student mental health, resilience, and academic performance, in rural China. Using cross-sectional data from economically poor areas in the Gansu province, 2989 students (mean age = 11.51, 53.33% male, 46.67% female) and their primary caregivers (74.2% female) completed the 21-item, self-report Depression Anxiety Stress Scale. Students also completed the 25-item Connor-Davidson Resilience Scale and a standardized math test. The results indicated a high prevalence of caregiver depression (31%), stress (39%), and anxiety (24%). Characteristics that were significantly correlated with caregiver mental health issues included being a grandparent, having a low socioeconomic status and low education level, and living in a household with at least one migrant worker. Apart from caregiver stress and student resilience, caregiver mental health issues were negatively correlated with all student outcomes, including student mental health, resilience, and academic performance. Although additional empirical research is needed to investigate the associations between caregiver mental health and student outcomes, our results suggest that rural communities could benefit greatly from programs focused on improving the mental health of caregivers and this, in turn, may have a positive impact on student outcomes.
Collapse
Affiliation(s)
- Huan Wang
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Claire Cousineau
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Yuwei Adeline Hu
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Grace Hu
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Sunny Qi
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Adrian Sun
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Helen Wu
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Palo Alto, CA 94305-6055, USA; (H.W.); (C.C.); (Y.A.H.); (G.H.); (S.Q.); (A.S.); (H.W.); (S.R.)
| | - Manpreet Singh
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry and Child Development, School of Medicine, Stanford University, Palo Alto, CA 94305-5719, USA
- Correspondence: ; Tel.: +1-(650)-725-5922
| |
Collapse
|
15
|
Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh. Nutrients 2021; 13:nu13124303. [PMID: 34959855 PMCID: PMC8708397 DOI: 10.3390/nu13124303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022] Open
Abstract
Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m2), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.
Collapse
|
16
|
Health and Lifestyle, Safety, Relationship and Personality Factors Influence Gender, Sex and Sexuality Issues among Youth—A Case Record Analysis from Youth Mental Health Promotion Clinics in Karnataka, India. SEXES 2021. [DOI: 10.3390/sexes2040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Promoting positive identity and seeking early support for gender, sex and sexuality (GSS) issues among youth is vital. Understanding and addressing factors associated withGSS among them is critical. We assessed four-year case records (January 2017–December 2020) of all first visit youth mental health promotion clinic (YMHPC) clients (15–35 years) for factors associated with GSS issues in Karnataka. Overall, prevalence of GSS issues was 1.8% (189/10,340). Increased risk of GSS issues was observed among clients reporting suicidality (AOR = 4.27, 95% CI = 2.70–6.74) and relationship issues (AOR = 3.63, 95% CI = 2.36–5.57), followed by issues of safety (AOR = 2.56, 95% CI = 1.72–3.81), personality (AOR = 2.48, 95% CI = 1.60–3.85), health and lifestyle (AOR = 2.27, 95% CI = 1.77–4.19), smokers (AOR = 2.30, 95% CI = 1.24–4.27), and those who felt depressed (AOR = 2.10, 95% CI = 1.43–3.09) and worthless (AOR = 2.08, 95% CI = 1.28–3.39). Clients aged 21–25 years (AOR = 1.80,95% CI = 1.27–2.54), male (AOR = 1.72, 95% CI = 1.20–2.46) and who had been married (AOR = 2.32, 95% CI = 1.51–3.57) had a higher risk of GSS issues than those aged 15–20 years and other counterparts, respectively. Clients who drank alcohol (AOR = 0.49, 95% CI = 0.30–0.81) had reduced risk of GSS issues. The findings re-iterate the importance of early recognition of factors (essential precursors) of GSS issues among youth. The study highlights the importance of promoting awareness and improving primordial prevention of possible GSS issues in later life. This study has important implications on youth mental health promotion programs, especially in countries like India.
Collapse
|
17
|
Exploring the COVID-19 pandemic experience of maternity clinicians in a high migrant population and low COVID-19 prevalence country: A qualitative study. Women Birth 2021; 35:493-502. [PMID: 34774447 PMCID: PMC8570406 DOI: 10.1016/j.wombi.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022]
Abstract
Background Australia experienced a low prevalence of COVID-19 in 2020 compared to many other countries. However, maternity care has been impacted with hospital policy driven changes in practice. Little qualitative research has investigated maternity clinicians’ perception of the impact of COVID-19 in a high-migrant population. Aim To investigate maternity clinicians’ perceptions of patient experience, service delivery and personal experience in a high-migrant population. Methods We conducted semi-structured in-depth interviews with 14 maternity care clinicians in Sydney, New South Wales, Australia. Interviews were conducted from November to December 2020. A reflexive thematic approach was used for data analysis. Findings A key theme in the data was ‘COVID-19 related travel restrictions result in loss of valued family support for migrant families’. However, partners were often ‘stepping-up’ into the role of missing overseas relatives. The main theme in clinical care was a shift in healthcare delivery away from optimising patient care to a focus on preservation and safety of health staff. Discussion Clinicians were of the view migrant women were deeply affected by the loss of traditional support. However, the benefit may be the potential for greater gender equity and bonding opportunities for partners. Conflict with professional beneficence principles and values may result in bending rules when a disconnect exists between relaxed community health orders and restrictive hospital protocols during different phases of a pandemic. Conclusion This research adds to the literature that migrant women require individualised culturally safe care because of the ongoing impact of loss of support during the COVID-19 pandemic.
Collapse
|
18
|
Bou Malhab S, Sacre H, Malaeb D, Lahoud N, Khachman D, Azzi J, Haddad C, Salameh P. Factors related to autonomy among Lebanese women: a web-based cross-sectional study. BMC WOMENS HEALTH 2021; 21:369. [PMID: 34670539 PMCID: PMC8527961 DOI: 10.1186/s12905-021-01501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Background Autonomy involves making independent decisions and creating lasting and equitable power relationships within families. Many factors, dependent on both the woman and her partner, can influence self-dependence, and subsequent decision-making, exerting a protective or triggering effect on its development. Therefore, the primary objective of the study was to assess autonomy in a sample of Lebanese women. The secondary objective was to evaluate the association between socioeconomic status, psychological factors, and autonomy. Methods A web based cross-sectional online study was conducted between June 8 and August 1, 2020. The questionnaire developed on Google Forms was distributed through social media and WhatsApp groups, using the snowball technique. The Women’s Autonomy Index (WAI) was created using three items adapted from a previous study. In addition, the Composite Abuse Scale Revised—Short Form (CASR-SF) was used to assess three domains of abuse: physical, sexual, and psychological. The Perceived stress scale short version to measure stress perception, the Lebanese Anxiety Scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. The Statistical Package for the Social Sciences (SPSS) software version 25 was used for data analysis. Linear regressions were performed, taking the Women’s Autonomy Index as the dependent variable. Results The sample consisted of 369 Lebanese women. University education level (beta = 1.263), alcohol consumption (beta = 0.586), intermediate income level (beta = 0.702), high income (beta = 0.911), employment (beta = 0.559), and older age (beta = 0.033) were significantly associated with higher WAI. Living in South Lebanon (beta = − 0.668) and being Druze (beta = − 323) were associated with lower WAI. Significantly higher mean scores of anxiety and perceived stress were found among women with low autonomy. Conclusion In Lebanon, the autonomy of women depends on several personal and partner-related characteristics (education, socioeconomic status, age), in addition to the cultural (geographic and religious) environment. Furthermore, low autonomy is associated with higher perceived stress and anxiety and probable depression and domestic abuse. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01501-3.
Collapse
Affiliation(s)
- Sandrella Bou Malhab
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon.,Faculté de santé, Université Sainte Famille, Batroun, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Diana Malaeb
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Nathalie Lahoud
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Faculty of Public Health, Lebanese University, Fanar, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Dalia Khachman
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Joelle Azzi
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, JalEddib, Lebanon. .,INSERM, Univ. Limoges, CH Esquirol, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,University of Nicosia Medical School, Nicosia, Cyprus
| |
Collapse
|
19
|
Habtamu K, Desie Y, Asnake M, Lera EG, Mequanint T. Psychological distress among Ethiopian migrant returnees who were in quarantine in the context of COVID-19: institution-based cross-sectional study. BMC Psychiatry 2021; 21:424. [PMID: 34433430 PMCID: PMC8385266 DOI: 10.1186/s12888-021-03429-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In association with the novel coronavirus (SARS-CoV-2) disease 2019 (COVID-19) pandemic, many numbers of Ethiopian migrants are returning to their home country, and they are required to stay in mandatory quarantine centers. This results in severe disruptions of life routines, social isolation, and loss of freedom. Studies on psychological distress among Ethiopian migrant returnees in the context of COVID-19 are scarce. This study aimed to investigate the prevalence of psychological distress and associated factors among migrant returnees who were in quarantine during the time of COVID-19. METHODS A cross-sectional study was conducted with 405 migrant returnees recruited from quarantine centers in Addis Ababa. We developed a structured questionnaire to collect data on sociodemographic, migration related, quarantine related and COVID-19 related characteristics of participants. We used the 21 item Depression, Anxiety and Stress Scale to assess psychological distress. Univariate and multivariable negative binomial regression models were fitted to assess the association between exposure variables with depression, anxiety and stress separately. RESULTS A little more than half of the participants (55%) had depressive symptoms; around half had anxiety symptoms (48.9%) and more than a third (35.6%) experienced symptoms of stress. We found significantly higher prevalence of anxiety (ARR = 0.59; 95% CI = 0.39, 0.91) and depressive symptoms (ARR = 0.56; 95% CI = 0.39, 0.81) among women than men. Fear of discrimination after the quarantine was significantly associated with depressive (ARR = 0.76; 95% CI = 0.63, 0.92) and anxiety symptoms (ARR = 0.77; 95% CI = 0.62, 0.97). Experiencing COVID-19 like symptoms is associated with depressive (ARR = 0.40; 95% CI = 0.25, 0.65), anxiety (ARR = 0.35; 95% CI = 0.20, 0.62) and stress symptoms (ARR = 0.43; 95% CI = 0.28, 0.66). Have no a plan of what to do after the quarantine (ARR = 1.30; 95% CI = 1.09, 1.54) was significantly associated with increasing stress scores. CONCLUSIONS We found a very high prevalence of depressive, anxiety and stress symptoms among Ethiopian migrant returnees who were in quarantine due to the COVID-19 pandemic. Screening, integration of mental health services with other socioeconomic and psychosocial services, and effective and efficient referral may be useful to address the burden of psychological distress in this group.
Collapse
Affiliation(s)
- Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, P.O.BOX: 1176, Addis Ababa, Ethiopia.
| | - Yekoyealem Desie
- grid.7123.70000 0001 1250 5688School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, P.O.BOX: 1176, Addis Ababa, Ethiopia
| | - Mulat Asnake
- grid.7123.70000 0001 1250 5688School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, P.O.BOX: 1176, Addis Ababa, Ethiopia
| | - Endirias Gina Lera
- Research, Consultancy and Community Service Department, Ethiopian Police University, Sendafa, Ethiopia
| | - Temesgen Mequanint
- Research, Consultancy and Community Service Department, Ethiopian Police University, Sendafa, Ethiopia
| |
Collapse
|
20
|
Bezerra HDS, Alves RM, Nunes ADD, Barbosa IR. Prevalence and Associated Factors of Common Mental Disorders in Women: A Systematic Review. Public Health Rev 2021; 42:1604234. [PMID: 34692182 PMCID: PMC8419231 DOI: 10.3389/phrs.2021.1604234] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: To identify the prevalence and factors associated with common mental disorders in adult women. Methods: Searches were carried out in the PubMed, Web of Science, Science Direct, Scopus, Cinahl, Google Scholar and Open Gray databases. The study protocol was registered with PROSPERO under number CRD42020168231. Cross-sectional studies showing the prevalence of common mental disorders in women over 18 years were included. Studies with men, children and pregnant women of another age group and with other mental disorders and other types of studies were excluded. The Joanna Briggs Institute checklist was used to assess the risk of bias. Results: Nineteen studies were included in this review. The prevalence of CMD ranged from 9.6% to 69.3%. The main associated factors were unemployment, indebtedness, low income, being a housewife, smoking, low education, poor self-rated health, being single, divorced or widowed. The risk of bias in the studies was classified as low and moderate. Conclusion: This review revealed a variable prevalence rate of CMD in adult women. Public policies are needed to create strategies to prevent the mental illness of these women.
Collapse
|
21
|
Barchi F, Winter SC, Dougherty D, Ramaphane P, Solomon PL. The Association of Depressive Symptoms and Intimate Partner Violence Against Women in Northwestern Botswana. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:4787-4805. [PMID: 30095029 DOI: 10.1177/0886260518792986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although links between mental health and intimate partner violence (IPV) have been discussed extensively in the scholarly literature, little empirical data exist about these phenomena in Botswana. This study addressed this gap by examining the nature, extent, and risk factors associated with symptoms of major depressive disorders (MDD) using cross-sectional data collected in 2009-2010 in northwestern Botswana. A random sample of 469 women participated in semistructured interviews about their lives, health, and experiences with violence. Thirty-one percent of respondents were found to meet the symptom criteria for MDD. Factors associated with MDD included emotional or physical violence by an intimate partner and being in a relationship in which both partners consumed alcohol. One in five women reported a recent experience of emotional violence, while 37% of respondents reported recent physical IPV. Women who have experienced emotional or physical IPV in the last 12 months have 89% and 82% greater odds, respectively, of having symptoms of MDD (p < .05) than women who have not recently experienced either form of violence. Women in relationships in which both partners consumed alcohol had more than twice the odds of MDD compared with women in relationships where neither partner or only one partner drank. Given the significant association of violence, alcohol, and MDD, screening for all three conditions should be part of routine care in health care settings in Botswana. Interventions to reduce IPV and alcohol consumption may help alleviate the burden of MDD in women in this setting.
Collapse
|
22
|
A descriptive study of patients diagnosed with psychogenic nonepileptic seizures at a tertiary epilepsy center in the Czech Republic: One-year follow-up. Epilepsy Behav 2021; 118:107922. [PMID: 33752043 DOI: 10.1016/j.yebeh.2021.107922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE To delineate sociodemographic data of a large sample of Czech Republic patients diagnosed with psychogenic non-epileptic seizures (PNES) at the time of diagnosis and at a follow-up visit one year after discharge. This study collected reports of past stressors, quality of relationships in childhood, family background, traumatic events, and recent adversities in patients diagnosed with PNES. METHOD Patients (219w/79m, 37.56 (13.15) years, 12.13 (2.05) years of education) were assessed through a semi-structured interview on clinical and historical data while they were inpatients at the Epilepsy Center, Na Homolce Hospital, Prague. Subsequently, they were re-evaluated one year after discharge from the hospital with the same method. A comparison of this sample to normal controls was subsequently conducted. RESULTS We found a higher female (73.5%) predominance; mean duration of seizures was 69.14 months. The majority of patients were single (46.13%) or divorced (16.84%), and 48% received disability benefits. A diversity of developmental risk factors as well as immediate precursors of PNES onset were identified. One year after hospitalization, significant changes were found in all seizure and healthcare characteristics of our sample. When compared to healthy volunteers, the patients also presented with a higher prevalence of stressors and traumatic events in childhood. CONCLUSIONS Cross-cultural research contributes important information on the universal components of PNES as well as the unique features observed in distinct localities of differing cultures and ethnicities. This study allows for comparison of sociodemographic features in a Central European sample to the more frequently studied English-speaking samples.
Collapse
|
23
|
Oldra CM, Lazarotto AK, Wendt GW, Ferreto LE, Follador FAC, Vieira AP. Depression mediates the links between climacteric symptoms and food and nutritional insecurity. Climacteric 2021; 25:311-315. [PMID: 33709860 DOI: 10.1080/13697137.2021.1892628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study is perhaps the first to evaluate the influence of depression on the relationship between climacteric symptoms and food and nutritional insecurity (FNI). METHODS In this cross-sectional study with a relatively large sample of climacteric women (N = 400), sociodemographic and clinical variables were investigated. We measured FNI, depression and climacteric symptoms with psychometrically sound instruments, namely the Brazilian Food Security Scale, the Center for Epidemiologic Studies Depression Scale and the Kupperman Index, respectively. RESULTS Statistically significant differences were observed in the means of FNI according to education, income, marital status, history of depression, use of antidepressants and current depression. Furthermore, depression had strong indirect effects on the relationship between climacteric symptoms and FNI. CONCLUSION Our study suggests that targeting depression could benefit climacteric women, especially those with severe symptoms and in FNI.
Collapse
Affiliation(s)
- C M Oldra
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - A K Lazarotto
- Faculty of Medicine, University Center of Pato Branco (UNIDEP), Pato Branco, Brazil
| | - G W Wendt
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - L E Ferreto
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - F A C Follador
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - A P Vieira
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| |
Collapse
|
24
|
Hathi P, Coffey D, Thorat A, Khalid N. When women eat last: Discrimination at home and women's mental health. PLoS One 2021; 16:e0247065. [PMID: 33651820 PMCID: PMC7924788 DOI: 10.1371/journal.pone.0247065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/01/2021] [Indexed: 01/21/2023] Open
Abstract
The 2011 India Human Development Survey found that in about a quarter of Indian households, women are expected to have their meals after men have finished eating. This study investigates whether this form of gender discrimination is associated with worse mental health outcomes for women. Our primary data source is a new, state-representative mobile phone survey of women ages 18-65 in Bihar, Jharkhand, and Maharashtra in 2018. We measure mental health using questions from the World Health Organization's Self-Reporting Questionnaire. We find that, for women in these states, eating last is correlated with worse mental health, even after accounting for differences in socioeconomic status. We discuss two possible mechanisms for this relationship: eating last may be associated with worse mental health because it is associated with worse physical health, or eating last may be associated with poor mental health because it is associated with less autonomy, or both.
Collapse
Affiliation(s)
- Payal Hathi
- Departments of Sociology & Demography, University of California, Berkeley, Berkeley, California, United States of America
- r.i.c.e., a Research Institute for Compassionate Economics, India
| | - Diane Coffey
- r.i.c.e., a Research Institute for Compassionate Economics, India
- Population Research Center, University of Texas at Austin, Austin, Texas, United States of America
- Indian Statistical Institute, Delhi Centre, Delhi, India
| | - Amit Thorat
- r.i.c.e., a Research Institute for Compassionate Economics, India
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
| | - Nazar Khalid
- r.i.c.e., a Research Institute for Compassionate Economics, India
- Department of Demography, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
25
|
Govindasamy K, Jacob I, Solomon RM, Darlong J. Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India. PLoS Negl Trop Dis 2021; 15:e0009030. [PMID: 33481790 PMCID: PMC7857628 DOI: 10.1371/journal.pntd.0009030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 02/03/2021] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy is a Neglected Tropical Diseases (NTDs) known to cause stigma and discrimination in low-and middle-income countries. It often results in visible impairments, thus pre-disposing to poor mental health. Aim of the study was to estimate the prevalence of depression and anxiety among people affected by Leprosy and to determine the associated factors. METHODOLOGY/PRINCIPAL FINDINGS A multi-centric, cross-sectional study was carried out in four leprosy endemic states of India-Chhattisgarh, Maharashtra, West Bengal and Tamil Nadu in randomly selected blocks (a sub-unit of district), from one district in each state. From selected blocks those registered for leprosy treatment at public health or referral centres, people above the age of 18 years were interviewed with PHQ-9 and GAD-7 questionnaires for Depression and Anxiety, respectively. Disease profile like leprosy classification, deformity grade, number and site of the patches and socio-economic status were collected along with individual data. Of the total 220 respondents, prevalence of depression and anxiety symptoms was, 33% (73) and 19% (42), respectively. Presence of disability (47%) and Female gender (46%) were significantly associated with depression. Presence of disability (32%), Lower income group (27%) and low education (22%) were significantly associated with symptoms of anxiety. As the severity of disability increased, risk of developing depression and anxiety increased. CONCLUSION The study indicates that more than 30% of people affected by leprosy have mental health problems, which emphasizes the importance of mental health care services in leprosy. Women, those who had lower level of education, those belonging to lower socio-economic status and those with any level of disability due to leprosy are at risk of developing depression and/or anxiety. The study concludes more attention to be paid to the categories identified to be at risk.
Collapse
Affiliation(s)
| | - Immanuel Jacob
- Counselling department, TLM Community Hospital, Vadathorasalur, Tamil Nadu, India
| | | | - Joydeepa Darlong
- Research Domain, The Leprosy Mission Trust India, New Delhi, India
| |
Collapse
|
26
|
Bhat A, Goud BR, Pradeep JR, Jayaram G, Radhakrishnan R, Srinivasan K. Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study. Cult Med Psychiatry 2020; 44:461-478. [PMID: 31916181 DOI: 10.1007/s11013-019-09664-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Major Depressive Disorder (MDD) is associated with low rates of treatment and medication non-adherence, more so in low- and middle-income countries (LMICs). Mobile mental health (mHealth) interventions offer promise as a tool to address these problems. However, the feasibility and acceptability of mHealth interventions among rural women in LMICs is unknown. We examined barriers to accessing mental health treatment, reasons for non-adherence, and attitudes towards mHealth solutions among women with MDD in rural south India. Six focus groups were conducted among women with MDD (n = 69) who had been in treatment at a rural community health center. The discussion was transcribed and analyzed using a modified grounded-theory approach. Women perceived limited autonomy within their family structure, and experienced financial and systemic barriers as contributing to poor treatment access and non-adherence. Illiteracy, limited personal access to mobile phones, and preference for in-person clinical consultation were identified as barriers to use of mHealth. This is the first qualitative study, to our knowledge, that examines attitude towards mHealth among women with MDD in a rural setting in India. The study identified contextual barriers that will be important to address before implementing mHealth interventions.
Collapse
Affiliation(s)
- A Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, NE Pacific Street, 1959, Seattle, WA, 98052, USA.
| | - B Ramakrishna Goud
- Department of Community Health, St John's Medical College, Bengaluru, India
| | - J R Pradeep
- Department of Psychiatry, St John's Medical College Hospital, Bengaluru, India
| | - G Jayaram
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - K Srinivasan
- Department of Psychiatry, St John's Medical College Hospital, Bengaluru, India
- Division of Mental Health and Neurosciences, St Johns Research Institute, Bengaluru, India
| |
Collapse
|
27
|
Costa-Font J, Györi M. The weight of patriarchy? Gender obesity gaps in the Middle East and North Africa (MENA). Soc Sci Med 2020; 266:113353. [DOI: 10.1016/j.socscimed.2020.113353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 02/02/2023]
|
28
|
Emran A, Iqbal N, Dar IA. 'Silencing the self' and women's mental health problems: A narrative review. Asian J Psychiatr 2020; 53:102197. [PMID: 32540753 DOI: 10.1016/j.ajp.2020.102197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
In the context of women's mental health several propositions have been made to account for their increased susceptibility to certain psychiatric illnesses. However, given the topic's multifacetedness, no single explanation is found sufficient in itself. 'Silencing the Self' theory sheds new light on this issue because it acknowledges the importance of social and cultural processes. Besides with its relational perspective, it centers on the primacy of core relationships and its influence on a woman's mental health. Even though, since its inception three decades ago, the theory has been studied in relation to various psychological and physical disorders; it has hitherto received inadequate attention by scholars. Nonetheless, it has the potential to inform our understanding when formulating women's mental health issues. The aim of this review is to provide a comprehensive narrative account of the extant work on 'silencing the self' in relation to psychiatric illnesses like depression, eating disorder and premenstrual dysphoric disorder. It attempts to synthesize the work done till date, as a starting point for further investigation of unexamined areas.
Collapse
Affiliation(s)
- Ashti Emran
- Dept. of Psychology, Jamia Millia Islamia, New Delhi 110025, India.
| | - Naved Iqbal
- Dept. of Psychology, Jamia Millia Islamia, New Delhi 110025, India
| | | |
Collapse
|
29
|
Pathare S, Shields-Zeeman L, Vijayakumar L, Pandit D, Nardodkar R, Chatterjee S, Kalha J, Krishnamoorthy S, Jain N, Kapoor A, Shahjahan M, Chauhan A, Smit F. Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India. Trials 2020; 21:572. [PMID: 32586362 PMCID: PMC7318485 DOI: 10.1186/s13063-020-04472-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a major public health challenge globally and specifically in India where 36.6% and 24.3% of all suicides worldwide occur in women and men, respectively. The United Nations Sustainable Development Goals uses suicide rate as one of two indicators for Target 3.4, aimed at reducing these deaths by one third by 2030. India has no examples of large-scale implementation of evidence-based interventions to prevent suicide; however, there is a sizeable evidence base to draw on for suicide prevention strategies that have been piloted in India or proven to be effective regionally or internationally. METHOD The SPIRIT study is designed as a cluster-randomized superiority trial and uses mixed methods to evaluate the implementation, effectiveness and costs of an integrated suicide prevention programme consisting of three integrated interventions including (1) a secondary-school-based intervention to reduce suicidal ideation among adolescents, (2) a community storage facility intervention to reduce access to pesticides and (3) training for community health workers in recognition, management, and appropriate referral of people identified with high suicidal risk. DISCUSSION Combining three evidence-based interventions that tackle suicide among high-risk groups may generate a synergistic impact in reducing suicides at the community level in rural areas in India. Examination of implementation processes throughout the trial will also help to prepare a roadmap for policymakers and researchers looking to implement suicide prevention interventions in other countries and at scale. TRIAL REGISTRATION Clinical Trial Registry of Indian Council of Medical Research, India: CTRI/2017/04/008313. Registered on 7 April 2017. http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=18256&EncHid=&userName=SPIRIT Trial registry was last modified on 28 June 2019.
Collapse
Affiliation(s)
- Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Laura Shields-Zeeman
- Netherlands Institute for Mental health and Addiction (Trimbos Institute), Da Costakade 45, Utrecht, 3521 VT the Netherlands
| | | | - Deepa Pandit
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Renuka Nardodkar
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Susmita Chatterjee
- George Institute for Global Health Elegance Tower, 311-312, Third Floor, JasolaVihar, New Delhi, 110025 India
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Sadhvi Krishnamoorthy
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Nikhil Jain
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | - Arjun Kapoor
- Centre for Mental Health Law and Policy, Indian Law Society, Law College Road, Pune, 411004 India
| | | | | | - Filip Smit
- Netherlands Institute for Mental health and Addiction (Trimbos Institute), Da Costakade 45, Utrecht, 3521 VT the Netherlands
- University Medical Centers Amsterdam, location Vumc, Amsterdam, the Netherlands
| |
Collapse
|
30
|
Zubieta C, Lichtl A, Trautman K, Mentor S, Cagliero D, Mensa-Kwao A, Paige O, McCarthy S, Walmer DK, Kaiser BN. Perceived Feasibility, Acceptability, and Cultural Adaptation for a Mental Health Intervention in Rural Haiti. Cult Med Psychiatry 2020; 44:110-134. [PMID: 31228034 PMCID: PMC6925348 DOI: 10.1007/s11013-019-09640-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mental healthcare is largely unavailable throughout Haiti, particularly in rural areas. The aim of the current study is to explore perceived feasibility, acceptability, and effectiveness of potential culturally adapted interventions to improve mental health among Haitian women. The study used focus group discussions (n = 12) to explore five potential interventions to promote mental health: individual counseling, income-generating skills training, peer support groups, reproductive health education, and couples' communication training. Findings indicate that individual counseling, support group, and skills training components were generally anticipated to be effective, acceptable, and feasible by both male and female participants. That being said, participants expressed doubts regarding the acceptability of the couples' communication training and reproductive health education due to: a perceived lack of male interest, traditional male and female gender roles, lack of female autonomy, and misconceptions about family planning. Additionally, the feasibility, effectiveness, and acceptability of the components were described as dependent on cost, proximity to participants, and inclusion of a female health promoter that is known in the community. Given the lack of research on intervention approaches in Haiti, particularly those targeting mental health, this study provides a foundation for developing prevention and treatment approaches for mental distress among Haitian women.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - David K Walmer
- Family Health Ministries, Chapel Hill, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Bonnie N Kaiser
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Department of Anthropology, University of California San Diego, 9500 Gilman Drive, 0532, La Jolla, CA, 92093, USA.
| |
Collapse
|
31
|
Depression among women of reproductive age in rural Bangladesh is linked to food security, diets and nutrition. Public Health Nutr 2020; 23:660-673. [PMID: 31915095 PMCID: PMC7058425 DOI: 10.1017/s1368980019003495] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To quantify the relationship between screening positive for depression and several indicators of the food and nutrition environment in Bangladesh. DESIGN We used cross-sectional data from the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh to examine the association of depression in non-peripartum (NPW) and peripartum women (PW) with food and nutrition security using multivariable logistic regression and dominance analysis. SETTING Rural north-eastern Bangladesh. PARTICIPANTS Women of reproductive age. RESULTS Of 2599 women, 40 % were pregnant or up to 1 year postpartum, while 60 % were not peripartum. Overall, 20 % of women screened positive for major depression. In the dominance analysis, indicators of food and nutrition security were among the strongest explanatory factors of depression. Food insecurity (HFIAS) and poor household food consumption (FCS) were associated with more than double the odds of depression (HFIAS: NPW OR = 2·74 and PW OR = 3·22; FCS: NPW OR = 2·38 and PW OR = 2·44). Low dietary diversity (<5 food groups) was associated with approximately double the odds of depression in NPW (OR = 1·80) and PW (OR = 1·99). Consumption of dairy, eggs, fish, vitamin A-rich and vitamin C-rich foods was associated with reduced odds of depression. Anaemia was not associated with depression. Low BMI (<18·5 kg/m2) was also associated with depression (NPW: OR = 1·40). CONCLUSIONS Depression among women in Bangladesh was associated with many aspects of food and nutrition security, also after controlling for socio-economic factors. Further investigation into the direction of causality and interventions to improve diets and reduce depression among women in low- and middle-income countries are urgently needed.
Collapse
|
32
|
Mushavi RC, Burns BFO, Kakuhikire B, Owembabazi M, Vořechovská D, McDonough AQ, Cooper-Vince CE, Baguma C, Rasmussen JD, Bangsberg DR, Tsai AC. "When you have no water, it means you have no peace": A mixed-methods, whole-population study of water insecurity and depression in rural Uganda. Soc Sci Med 2020; 245:112561. [PMID: 31790879 PMCID: PMC6936324 DOI: 10.1016/j.socscimed.2019.112561] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/03/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lack of access to clean water has well known implications for communicable disease risks, but the broader construct of water insecurity is little studied, and its mental health impacts are even less well understood. METHODS AND FINDINGS We conducted a mixed-methods, whole-population study in rural Uganda to estimate the association between water insecurity and depression symptom severity, and to identify the mechanisms underlying the observed association. The whole-population sample included 1776 adults (response rate, 91.5%). Depression symptom severity was measured using a modified 15-item Hopkins Symptom Checklist for Depression. Water insecurity was measured with a locally validated 8-item Household Water Insecurity Access Scale. We fitted multivariable linear and Poisson regression models to the data to estimate the association between water insecurity and depression symptom severity, adjusting for age, marital status, self-reported overall health, household asset wealth, and educational attainment. These models showed that water insecurity was associated with depression symptom severity (b = 0.009; 95% confidence interval [CI], 0.004-0.15) and that the estimated association was larger among men (b = 0.012; 95% CI, 0.008-0.015) than among women (b = 0.008; 95% CI, 0.004-0.012. We conducted qualitative interviews with a sub-group of 30 participants, focusing on women given their traditional role in household water procurement in the Ugandan context. Qualitative analysis, following an inductive approach, showed that water insecurity led to "choice-less-ness" and undesirable social outcomes, which in turn led to emotional distress. These pathways were amplified by gender-unequal norms. CONCLUSIONS Among men and women in rural Uganda, the association between water insecurity and depression symptom severity is statistically significant, substantive in magnitude, and robust to potential confounding. Data from the qualitative interviews provide key narratives that reveal the mechanisms through which women's lived experiences with water insecurity may lead to emotional distress.
Collapse
Affiliation(s)
- Rumbidzai C Mushavi
- Harvard Medical School, Boston, USA; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA.
| | - Bridget F O Burns
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA
| | | | | | | | - Amy Q McDonough
- Center for Global Health, Massachusetts General Hospital, Boston, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justin D Rasmussen
- Center for Global Health, Massachusetts General Hospital, Boston, USA; Department of Psychology & Neuroscience, Duke University, Durham, USA
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda; Oregon Health and Science University-Portland State University School of Public Health, Portland, USA
| | - Alexander C Tsai
- Harvard Medical School, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA; Mbarara University of Science and Technology, Mbarara, Uganda; Harvard Center for Population and Development Studies, Cambridge, USA
| |
Collapse
|
33
|
dos Santos DB, Mediano MFF, Júnior LFR, dos Santos B, de Lorenzo AR, Kuschnir MCC. Association Between Work and Common Mental Disorders in School Adolescents: The ERICA Study. Clinics (Sao Paulo) 2020; 75:e1794. [PMID: 33146352 PMCID: PMC7561057 DOI: 10.6061/clinics/2020/e1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/17/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Adolescence is characterized by continuing profound mental, physical, and social changes and entering into the labor market during this phase may have negative consequences on physical and mental health. Common mental disorders (CMD) are characterized as disorders of mental functions, including symptoms of depression and anxiety as well as various nonspecific and somatic complaints such as reduced ability to concentrate, tiredness, irritation, and forgetfulness. Despite its increasing prevalence, few studies have addressed CMD and its association with work, in adolescents. In the present study, we aimed to identify the main factors associated with CMD and evaluated its association with work, in school adolescents. METHODS A cross-sectional study was conducted with 12 to 17-year-old adolescent students using a self-administered questionnaire with questions related to work. CMD was verified using the General Health Questionnaire of 12 items. In total, 3424 adolescents were studied. RESULTS The prevalence of CMD and work in the last year was 28.72% and 19.63%, respectively. After adjustment for potential confounding variables, multivariate analysis showed associations of CMD with female gender (OR=2.72) and work (OR=1.70). CONCLUSION In the present study, a high number of cases of CMD were observed among the studied adolescents. Female gender and work history in the last year were negatively and independently associated with the presence of CMD.
Collapse
Affiliation(s)
- Daniele Baptista dos Santos
- Departamento de Pesquisa e Educacao, Instituto Nacional de Cardiologia, Ministerio da Saude, Rio de Janeiro, RJ, BR
| | - Mauro Felippe Felix Mediano
- Departamento de Pesquisa e Educacao, Instituto Nacional de Cardiologia, Ministerio da Saude, Rio de Janeiro, RJ, BR
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, RJ, BR
- *Corresponding author. E-mail:
| | | | - Braulio dos Santos
- Departamento de Pesquisa e Educacao, Instituto Nacional de Cardiologia, Ministerio da Saude, Rio de Janeiro, RJ, BR
| | - Andrea Rocha de Lorenzo
- Departamento de Pesquisa e Educacao, Instituto Nacional de Cardiologia, Ministerio da Saude, Rio de Janeiro, RJ, BR
| | - Maria Cristina Caetano Kuschnir
- Departamento de Pesquisa e Educacao, Instituto Nacional de Cardiologia, Ministerio da Saude, Rio de Janeiro, RJ, BR
- Faculdade de Medicina, Universidade Estacio de Sa, Rio de Janeiro, RJ, BR
| |
Collapse
|
34
|
Lalu J, Balan R, Sasidharan D. An insight into the elderly mind during COVID-19 pandemic: World Mental Health Day 2020. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_151_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
35
|
Patel AR, Weobong B, Patel VH, Singla DR. Psychological treatments for depression among women experiencing intimate partner violence: findings from a randomized controlled trial for behavioral activation in Goa, India. Arch Womens Ment Health 2019; 22:779-789. [PMID: 31363925 PMCID: PMC6841649 DOI: 10.1007/s00737-019-00992-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/11/2019] [Indexed: 12/03/2022]
Abstract
Intimate partner violence (IPV) strongly predicts depression, but it is unknown if women experiencing IPV can benefit from depression treatments in contexts where depression and IPV are prevalent. This study explored whether women experiencing IPV in Goa, India, can benefit from the Healthy Activity Program (HAP), a culturally adapted behavioral activation treatment, compared with enhanced usual care (EUC). Cross-sectional and longitudinal analyses were performed on data from a clinical trial. Measures assessed at baseline and 3 and 12 months included depressive symptoms. Measures assessed at 3 and 12 months included activation and IPV. Independent t tests were conducted to assess if participants experiencing IPV had higher depressive symptoms and lower activation at 3 and 12 months; hierarchical linear regression was conducted to determine if 3-month IPV predicted 12-month depressive symptoms across trial arms (Hypothesis 1). Hierarchical linear regression was then conducted to examine if the relationship between 3-month activation and 12-month depressive symptoms was moderated by 3-month IPV within each trial arm (Hypothesis 2). As expected, participants experiencing IPV had significantly lower activation levels and higher depressive symptoms compared with participants who did not experience IPV at 3 and 12 months in cross-sectional analyses. Similarly, IPV endorsed at 3 months significantly predicted depressive symptoms at 12 months. However, activation was significantly associated with less severe depressive symptoms at 12 months, irrespective of IPV endorsement among HAP participants. For EUC participants, IPV remained the only significant predictor of depressive symptoms at 12 months. Results suggest that women experiencing IPV can still benefit from behavioral activation.
Collapse
Affiliation(s)
- Anushka Rajesh Patel
- Department of Psychology, The University of Tulsa, 800 S. Tucker Drive, Tulsa, OK, 74104, USA
| | - Benedict Weobong
- School of Public Health, Department of Social and Behavioural Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vikram Harshad Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Bardez, Porvorim, Goa, 403501, India
| | - Daisy Radha Singla
- Department of Psychiatry, University of Toronto and Sinai Health System, 600 University Ave, Rm914A, Toronto, Ontario, M5T 1R8, Canada.
| |
Collapse
|
36
|
Jones R, Haardörfer R, Ramakrishnan U, Yount KM, Miedema S, Girard AW. Women's empowerment and child nutrition: The role of intrinsic agency. SSM Popul Health 2019; 9:100475. [PMID: 31993480 PMCID: PMC6978483 DOI: 10.1016/j.ssmph.2019.100475] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022] Open
Abstract
Women's empowerment is associated with improved child nutrition, and both underpin the achievement of multiple Sustainable Development Goals (SDGs). We examined pathways by which women's empowerment influences child nutritional status. We pooled nationally representative data from Demographic and Health Surveys (2011-2016) collected from married women with children aged 6-24 months in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda (n = 13,780). We operationalized child nutritional status using anemia, height-for-age z-score (HAZ), and weight-for-age z-score (WHZ). We operationalized women's empowerment using a validated measure comprised of three latent domains: social/human assets ("assets"), intrinsic agency (attitudes about intimate partner violence), and instrumental agency (influence in household decision making). We used structural equation models with latent constructs to estimate hypothesized pathways from women's empowerment to child nutritional status with further mediation by maternal body mass index (BMI) and stratification by wealth. Women's empowerment domains were directly and positively associated with maternal BMI (estimate±SE: assets, 0.17 ± 0.03; intrinsic agency, 0.23 ± 0.03; instrumental agency, 0.03 ± 0.01). Maternal BMI was directly and positively associated with child HAZ (0.08 ± 0.04) and child WHZ (0.35 ± 0.03). Assets were indirectly associated with child HAZ and WHZ through intrinsic agency and maternal BMI. In the lowest wealth category, the direct effects from women's empowerment to child nutritional status were significant (assets and instrumental agency were associated with anemia; intrinsic agency associated with HAZ). In the highest wealth category, direct effects from women's empowerment on child nutritional status were significant (intrinsic and instrumental agency associated with WHZ). Improving women's empowerment, especially intrinsic agency, in East Africa could improve child nutrition directly and via improved maternal nutrition. These findings suggest that efforts to realize SDG 5 may have spillover effects on other SDGs. However, strategies to improve nutrition through empowerment approaches may need to also address household resource constraints.
Collapse
Affiliation(s)
- Rebecca Jones
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA
- Hubert Department of Global Health, Emory University, USA
| | - Kathryn M. Yount
- Hubert Department of Global Health, Emory University, USA
- Department of Sociology, Emory University, USA
| | | | - Amy Webb Girard
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA
- Hubert Department of Global Health, Emory University, USA
| |
Collapse
|
37
|
G. V. V, S. M. Suicide Attempts and Pattern Among the Beginners and Established Female Commercial Sex Workers. JOURNAL OF PSYCHOSEXUAL HEALTH 2019. [DOI: 10.1177/2631831819849726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this study was to explore the pattern of suicide and extent of depression among female commercial sex workers (CSWs). Methodology: 200 female CSWs classified as beginners and established depending on the number of years of sex work were referred to Victoria Hospital in Bengaluru, India, by an NGO called Swathi Mane which works for the betterment of these women. Results: The pattern of suicide and the number of attempts among both the groups were different indicating that the number of years of sex work played a major role among these women in deciding the number of attempts and pattern of suicide. The reasons for attempting suicide also are interesting to the fact that the women who are new to this profession suffer from depression and guilt and attempt suicide, while women who are into this profession for quite some time now are accustomed to this trade and have lesser or no suicide attempts. The depression scores among these two groups were also higher as per Hamilton Rating Scale for Depression scores.
Collapse
Affiliation(s)
- Vaniprabha G. V.
- Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Madhusudhan S.
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| |
Collapse
|
38
|
Gailits N, Mathias K, Nouvet E, Pillai P, Schwartz L. Women's freedom of movement and participation in psychosocial support groups: qualitative study in northern India. BMC Public Health 2019; 19:725. [PMID: 31182064 PMCID: PMC6558745 DOI: 10.1186/s12889-019-7019-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. METHODS This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. RESULTS The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. CONCLUSIONS Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.
Collapse
Affiliation(s)
- Nicola Gailits
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 1P8, Canada.
| | - Kaaren Mathias
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, Delhi, New Delhi, 110019, India
| | - Elysée Nouvet
- School of Health Studies, Western University, Labatt Health Sciences Bldg, Rm 215. 1151 Richmond St., London, ON, N6A 5B9, Canada
| | - Pooja Pillai
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, Delhi, New Delhi, 110019, India
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| |
Collapse
|
39
|
Richardson RA, Harper S, Bates LM, Nandi A. The effect of agency on women's mental distress: A prospective cohort study from rural Rajasthan, India. Soc Sci Med 2019; 233:47-56. [PMID: 31176057 DOI: 10.1016/j.socscimed.2019.05.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
Agency, the ability to identify goals and then act upon them, is a core component of women's empowerment and has important implications for the rights and well-being of women and girls. However, inadequate measurement of agency impedes empirical investigation, and few studies have investigated the relation between agency and health. Using a theory-based measure of women's agency, we investigated the longitudinal association between agency and mental distress among women living in rural Rajasthan, India. Women completed baseline interviews between June and October 2016 and follow-up interviews between June and November 2017 (n = 2859). We measured mental distress with the Hindi version of the 12 item General Health Questionnaire, which asked women 12 questions about symptoms of mental distress (score range: 0-12). We measured agency using a measurement model which was composed of 23 indicators tapping into four domains of agency and validated in a prior research study. We modeled the relation between women's agency and mental distress using Poisson regression and an individual-level fixed effects approach to account for time-fixed characteristics of individuals. In models that controlled for time-varying confounding (e.g., household wealth, number of sons), a one standard deviation increase in agency was associated with a reduction of 0.21 distress symptoms (95% CI: -0.32, -0.09), which corresponds to a 7% reduction (95% CI: 3%, 11%) relative to the mean. We found that specific domains of agency varied in their association with mental distress; namely, an increase in women's agency regarding her attitudes about gender norms corresponded to a reduction in mental distress, whereas an increase in women's agency regarding speaking up in public corresponded to an increase in mental distress. Our research demonstrates that agency may be a determinant of mental health and that comprehensive measurement can reveal nuanced relationships.
Collapse
Affiliation(s)
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Lisa M Bates
- Department of Epidemiology, Columbia University, New York, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| |
Collapse
|
40
|
Balinda IG, Sugrue DD, Ivers LC. More Than Malnutrition: A Review of the Relationship Between Food Insecurity and Tuberculosis. Open Forum Infect Dis 2019; 6:ofz102. [PMID: 30949541 PMCID: PMC6441779 DOI: 10.1093/ofid/ofz102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Despite a significant reduction in tuberculosis (TB) mortality over the past decade, TB remains a leading cause of death worldwide. Food insecurity—through pathways such as malnutrition, mental health impact, and high-risk health behaviors—affects the risk of TB disease, treatment failure, and mortality. We searched the literature for studies reporting on the links between food insecurity and TB. In contrast to the well-documented interactions between food insecurity and HIV/AIDS, we found that the association between food insecurity and TB remains largely understudied—this is especially true with regard to non-nutritional correlations. Mental health and behavioral linkages between TB and food insecurity deserve further attention. An improved understanding of the pathways through which food insecurity impacts TB is crucial to inform evidence-based integration of interventions such as psychological counseling, psychiatric care, harm reduction programs, and efforts to address social determinants of disease within current TB programs.
Collapse
Affiliation(s)
- Ingabire G Balinda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
41
|
Mathias K, Kermode M, San Sebastian M, Davar B, Goicolea I. An asymmetric burden: Experiences of men and women as caregivers of people with psycho-social disabilities in rural North India. Transcult Psychiatry 2019; 56:76-102. [PMID: 30141376 DOI: 10.1177/1363461518792728] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Caring for a family member with a psycho-social disability can be both rewarding and burdensome. This study analyses the experiences of caregivers of people with psychosocial disabilities (PPSDs) in rural communities in North India using relational gender theory. In-depth interviews with 18 female and male caregivers of PPSDs probed the social, emotional and health impacts of their caregiving role. Nine themes were identified that were grouped under three meta-themes: intra-personal, inter-personal and institutional impacts. Under the intra-personal meta-theme, all caregivers experienced high tension, with women describing almost overwhelming stress. Women minimised their role as caregivers, and felt negative and hopeless about their futures, while men had a more positive view of the future and themselves. Embodied experiences of psychological and social distress were consistently described by women, but not by men. Within the interpersonal meta-theme, men experienced opportunity for social connection and social support that was seldom available to women. Interpersonal violence with other household members was described by both men and women. Within the institutional meta-theme, both men and women described strength in unity, and gestures leading to the reordering of gender relations. These findings underline the significant and diffuse impacts of a gender order that values males and disadvantages females as caregivers of PPSDs, with the asymmetry of a greater burden for women. The findings point to the urgent need for global mental health policies that support and empower caregivers and that strengthen gender equality.
Collapse
|
42
|
Beattie TS, Prakash R, Mazzuca A, Kelly L, Javalkar P, Raghavendra T, Ramanaik S, Collumbien M, Moses S, Heise L, Isac S, Watts C. Prevalence and correlates of psychological distress among 13-14 year old adolescent girls in North Karnataka, South India: a cross-sectional study. BMC Public Health 2019; 19:48. [PMID: 30630455 PMCID: PMC6327490 DOI: 10.1186/s12889-018-6355-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India. There is a paucity of research on the determinants of psychological distress, particularly among the poorest girls in the poorest communities. The purpose of this study was to assess the prevalence and correlates of different indicators of psychological distress among 13-14 year old low caste girls in rural, south India. METHODS Cross-sectional survey of 1191 low caste girls in two districts in north Karnataka, conducted as part of a cluster randomised-control trial. Bivariate and multivariate logistic regression analysis assessed correlates of different indicators of psychological distress. RESULTS More than one third of girls (35.1%) reported having no hope for the future. 6.9% reported feeling down, depressed or hopeless in the past 2 weeks. 2.1% reported thinking they would be better off dead or of hurting themselves in some way in the past 2 weeks. 1.6% reported sexual abuse, 8.0% rrecent eve teasing and 6.3% having no parental emotional support. Suicidal ideation was independently associated with sexual abuse (AOR 11.9 (3.0-47.0)) and a lack of parental emotional support (AOR 0.2 (0.1-0.5)). Feeling down, depressed or hopeless was independently associated with recent eve-teasing (AOR 2.9 (1.6-5.4)), a harassing or abusive school environment (AOR 3.9 (1.8-8.2)), being frequently absent (AOR 2.8 (1.5-5.5)) or having dropped out of school (AOR 2.1 (1.0-4.3)), and living in Vijayapura district (AOR 2.5 (1.6-4.1)). Having no hope for the future was independently associated with a range of factors, including recent "eve-teasing" (AOR 1.5 (1.0-2.4)), being engaged (AOR 2.9 (0.9-9.7)), not participating in groups (AOR 0.5 (0.4-0.6)) and a lack of emotional support (AOR 0.6 (0.4-0.7)). CONCLUSIONS Rather than being a time of optimism, a third of low caste girls in rural north, Karnataka have limited hope for the future, with some contemplating suicide. As well as having important development benefits, interventions that address the upstream structural and gender-norms based determinants of poor mental health, and provide adolescent services for girls who require treatment and support, should have important benefits for girls' psychological wellbeing. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.GovNCT01996241 . November 27, 2013.
Collapse
Affiliation(s)
- Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Leslie Kelly
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - T Raghavendra
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | | | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Moses
- Departments of Community Health Sciences and Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India.,Departments of Community Health Sciences and Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
43
|
Soyannwo T, Adebayo AM, Sigbeku O. Mental health problems of reproductive age group women in a rural community of south west Nigeria. J Ment Health 2018; 29:45-51. [PMID: 30354901 DOI: 10.1080/09638237.2018.1487533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Mental health is a component of reproductive health which is generally not given priority in low and middle income countries. Efforts to improve women's health have focused majorly on issues associated with reproduction such as family planning and child-bearing while women's mental health has been relatively neglected.Aim: This study was conducted to determine prevalence and factors influencing mental health problems in non-pregnant reproductive age women in a rural community of south west Nigeria.Methods: A community-based cross-sectional survey was conducted using a cluster sampling technique to select the study population. Mental health was assessed based on respondents' experience of any symptoms of depression and anxiety. Data were analysed using descriptive statistics, Chi-square and multivariate logistic regression model at p < 0.05.Results: The mean age of the respondents was 25.6 ± 7.8 years. The prevalence of depression and anxiety was 28.9% each while 19.8% experienced both. Gynecological conditions were a predictor of anxiety (OR 2.7; 95% CI 1.3-5.6) while previous history of miscarriage was a predictor of depression (OR 10.5; 95% CI 1.0-108.8).Conclusions: Our study demonstrated that mental health problems were quite prevalent in women of reproductive age group. We recommend that mental health be integrated into reproductive health policies.
Collapse
Affiliation(s)
- Tolulope Soyannwo
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria, and
| | - Ayodeji Matthew Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwakemi Sigbeku
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria, and
| |
Collapse
|
44
|
Ogbo FA, Mathsyaraja S, Koti RK, Perz J, Page A. The burden of depressive disorders in South Asia, 1990-2016: findings from the global burden of disease study. BMC Psychiatry 2018; 18:333. [PMID: 30326863 PMCID: PMC6192293 DOI: 10.1186/s12888-018-1918-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/02/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Globally, depressive disorders are one of the most common forms of mental illness. Using data from the most recent Global Burden of Disease, Injury, and Risk Factor Study 2016 (GBD 2016), we aimed to describe the burden of disease attributable to depressive disorders in terms of prevalence and disability-adjusted life years (DALYs) in South Asia countries (namely India, Pakistan, Bangladesh, Nepal and Bhutan). METHODS GBD 2016 used epidemiological data on depressive disorders (major depression and dysthymia) from South Asia and a Bayesian meta-regression tool (DisMod-MR 2.1) to model prevalence and DALYs of depressive disorders by age, sex, country and year. DALYs were calculated from the years lived with disability (YLDs), derived from the prevalence of depressive disorders and disability weights, obtained from a community and internet-based surveys. The analyses adjusted for comorbidity, data sources and multiple modelling, and estimates were presented with 95% uncertainty intervals (UI). RESULTS In 2016, the age-standardised prevalence of depressive disorders in South Asia was 3.9% (95% UI: 3.6-4.2%), 4.4% (95% UI: 4.4-4.8%) in Bangladesh, 3.9% (95% UI: 3.6-4.2%) in India, 3.0% (95% UI: 2.8-3.3%) in Pakistan, 4.0% (95% UI: 3.7-4.3%) in Nepal and 3.7% (95% UI: 3.4-4.1%) in Bhutan. In South Asia, depressive disorders accounted for 9.8 million DALYs (95% UI: 6.8-13.2 million) or 577.8 (95% UI: 399.9-778.9) per 100,000 population in 2016. Of these, major depressive disorders (MDD) accounted for 7.8 million DALYs (95% UI: 5.3-10.5 million). India generated the largest numbers of DALYs due to depressive disorders and MDD, followed by Bangladesh and Pakistan. DALYs due to depressive disorders were highest in females and older adults (75-79 years) across all countries. CONCLUSION Our findings show the substantial public health burden of depressive disorders in South Asian populations and healthcare systems. Given the scale of depressive disorders, improvement in overall population health is possible if South Asian countries prioritise the prevention and treatment of depressive disorders.
Collapse
Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Sruthi Mathsyaraja
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Rajeendra Kashyap Koti
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Janette Perz
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Andrew Page
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| |
Collapse
|
45
|
Richardson RA, Harper S, Schmitz N, Nandi A. The effect of affordable daycare on women's mental health: Evidence from a cluster randomized trial in rural India. Soc Sci Med 2018; 217:32-41. [PMID: 30292875 DOI: 10.1016/j.socscimed.2018.09.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/17/2018] [Accepted: 09/29/2018] [Indexed: 11/30/2022]
Abstract
Access to affordable daycare might improve population mental health. However, evidence is sparse and restricted to middle- and high-income country settings. We conducted a cluster-randomized controlled trial in one low-income setting, rural Rajasthan, India. Communities lacking daycare facilities were identified (n = 160) and randomly selected for assistance in setting up a community-based daycare program (n = 80) or not (n = 80). Women eligible for the daycare program living in these communities completed structured interviews before the intervention (participation rate = 89%) and approximately one year after rollout of the intervention (participation rate = 96%), resulting in a final analytic sample of 3041. Mental distress was measured with the Hindi version of the 12-item General Health Questionnaire (score range: 0-12). We modeled the relation between access to daycare and number of mental distress symptoms (GHQ-12 score) with negative binomial regression using an intention-to-treat approach, which groups women according to if they lived in communities randomized to affordable daycare. We also evaluated the effect of access to daycare on secondary outcomes that may be related to mental distress, including women's work burden, agency, and intimate partner violence (IPV). We found that access to daycare resulted in modest reductions in symptoms of mental distress (mean difference = 0.21, 95% CI: -0.43, 0.02). We found some evidence that daycare reduced IPV, but virtually no change in women's work burden or agency. Our results provide some indication that access to affordable daycare might be one policy lever to improve population mental health.
Collapse
Affiliation(s)
- Robin A Richardson
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Norbert Schmitz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada; Department of Psychiatry, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4A 1R3, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| |
Collapse
|
46
|
Indu PS, Anilkumar TV, Vijayakumar K, Kumar KA, Sarma PS, Remadevi S, Andrade C. Reliability and validity of PHQ-9 when administered by health workers for depression screening among women in primary care. Asian J Psychiatr 2018; 37:10-14. [PMID: 30096447 DOI: 10.1016/j.ajp.2018.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression is twice more prevalent among women but remains unidentified in primary care. OBJECTIVE We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18-60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women. RESULTS The internal consistency reliability (Cronbach's alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86-0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88-0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4-92.6), specificity of 90.1% (95% CI, 84.5-95.6%), positive predictive value of 73.4% (95% CI, 62.4-84.4%) and negative predictive value of 93.9% (95% CI, 90.2-97.6%). The accuracy was 88.2% (84.0-92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73-0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%. CONCLUSION When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.
Collapse
Affiliation(s)
| | | | | | - K A Kumar
- Former Director of Medical Education, Kerala, India
| | - P Sankara Sarma
- Department of Biostatistics, Achutha Menon Centre for Health Science Studies, Sree Chithira Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Saradamma Remadevi
- School of Health Policy and Planning, Kerala University of Health Sciences, Kerala, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
| |
Collapse
|
47
|
Fahey N, Soni A, Allison J, Vankar J, Prabhakaran A, Moore Simas TA, Byatt N, Phatak A, O'Keefe E, Nimbalkar S. Education Mitigates the Relationship of Stress and Mental Disorders Among Rural Indian Women. Ann Glob Health 2018; 82:779-787. [PMID: 28283129 PMCID: PMC5485235 DOI: 10.1016/j.aogh.2016.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) are a constellation of mental health conditions that include depression, anxiety, and other related nonpsychotic affective disorders. Qualitative explanatory models of mental health among reproductive-aged women in India reveal that distress is strongly associated with CMD. The relationship of perceived stress and CMD might be attenuated or exacerbated based on an individual's sociodemographic characteristics. OBJECTIVES To screen for Common Mental Disorders (CMD) among reproductive-aged women from rural western India and explore how the relationship between perceived stress and CMD screening status varies by sociodemographic characteristics. METHODS Cross-sectional survey of 700 women from rural Gujarat, India. CMD screening status was assessed using Self-Reported Questionnaire 20 (SRQ-20). Factors associated with CMD screening status were evaluated using multivariable logistic regression. Effect modification for the relationship of perceived stress and CMD screening status was assessed using interaction terms and interpreted in terms of predicted probabilities. FINDINGS The analytic cohort included 663 women, with roughly 1 in 4 screening positive for CMD (157, 23.7%). Poor income, low education, food insecurity, and recurrent thoughts after traumatic events were associated with increased risk of positive CMD screen. Perceived stress was closely associated with CMD screening status. Higher education attenuated the relationship between high levels of stress and CMD screening status (82.3%, 88.8%, 32.9%; P value for trend: 0.03). Increasing income and age attenuated the link between moderate stress and CMD. CONCLUSIONS Our findings suggest a high burden of possible CMD among reproductive-aged women from rural western India. Higher education might mitigate the association between elevated stress and CMD. Future efforts to improve mental health in rural India should focus on preventing CMD by enhancing rural women's self-efficacy and problem-solving capabilities to overcome challenging life events and stressors, thereby reducing the risk of CMD.
Collapse
Affiliation(s)
| | - Apurv Soni
- University of Massachusetts, Worcester, MA.
| | | | | | | | | | | | - Ajay Phatak
- Pramukhswami Medical College, Gujarat, India
| | | | | |
Collapse
|
48
|
Effectiveness of community-based depression intervention programme (ComDIP) to manage women with depression in primary care- randomised control trial. Asian J Psychiatr 2018; 34:87-92. [PMID: 29677524 DOI: 10.1016/j.ajp.2018.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND In low and middle income countries where mental health resources are limited, community based depression intervention models, which can be implemented through the existing health system, are extremely relevant. OBJECTIVE To test the effectiveness of Community based Depression Intervention Programme (ComDIP), newly developed by us, to reduce severity of depression in women, compared to the treatment as usual (TAU). METHODS An RCT (Trial registration Number: CTRI/2011/08/001978, Clinical Trials Registry -India) was conducted in a primary care setting in Trivandrum, Kerala, South India. Health workers screened 422 women, aged 18-60 years, using PHQ-9. Sixty women with HAM-D (Hamilton Depression Rating scale) score above 19 were randomized to receive either ComDIP or TAU. Primary care physicians and health workers together implemented ComDIP which had psycho-social intervention and drug treatment. Those in TAU arm were referred to available mental health services. Primary outcome was measured at 8 weeks, by HAM-D. RESULTS At baseline and 8 weeks, mean (SD) HAM-D scores were 29.2 (5.8) and 12.2 (9.3) respectively among women in ComDIP; and 28.6 (5.1) and 21.7 (12.4) respectively among those in TAU (p = 0.02, effect size = 0.82). CONCLUSIONS ComDIP, implemented through existing health system is an effective public health programme to manage women with depression in primary care.
Collapse
|
49
|
Bowling J, Dodge B, Banik S, Bartelt E, Mengle S, Guerra-Reyes L, Hensel D, Herbenick D, Anand V. Social support relationships for sexual minority women in Mumbai, India: a photo elicitation interview study. CULTURE, HEALTH & SEXUALITY 2018; 20:183-200. [PMID: 28664771 DOI: 10.1080/13691058.2017.1337928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India's oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants' photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants' extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.
Collapse
Affiliation(s)
- Jessamyn Bowling
- a Department of Applied Health Science, Center for Sexual Health Promotion , Indiana University , Bloomington , IN , USA
| | - Brian Dodge
- a Department of Applied Health Science, Center for Sexual Health Promotion , Indiana University , Bloomington , IN , USA
| | - Swagata Banik
- b Public Health Program , Baldwin Wallace University , Berea , OH , USA
| | - Elizabeth Bartelt
- a Department of Applied Health Science, Center for Sexual Health Promotion , Indiana University , Bloomington , IN , USA
| | | | - Lucia Guerra-Reyes
- a Department of Applied Health Science, Center for Sexual Health Promotion , Indiana University , Bloomington , IN , USA
| | - Devon Hensel
- d Department of Pediatrics , Indiana University , Indianapolis , IN , USA
- e Department of Sociology , Indiana University-Purdue University , Indianapolis , IN , USA
| | - Debby Herbenick
- a Department of Applied Health Science, Center for Sexual Health Promotion , Indiana University , Bloomington , IN , USA
| | | |
Collapse
|
50
|
Loutfi D, Lévesque JF, Mukherjee S. Impact of the Elderly on Household Health Expenditure in Bihar and Kerala, India. JOURNAL OF HEALTH MANAGEMENT 2018. [DOI: 10.1177/0972063417747696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ageing in India is leading to an increase in chronic diseases. Given the limited health insurance coverage, this could lead to a variety of economic- and access-related consequences for the households. Against this backdrop, this article aims at examining the impact of the presence of the elderly on household health expenditure, avoidance of treatment, loss of income and use of alternate sources of funding to pay for care. The article uses data from 2004 National Sample Survey Organisation survey on healthcare for two Indian states, namely, Bihar and Kerala. The rate of catastrophic health expenditure (CHE) is found to be higher in Kerala and is associated with a higher proportion of households having elderly members, who, in turn, have higher incidence of chronic disease. While the presence of elderly in the household, incidence of chronic disease and treatment from private sources are linked to CHE, our results suggest that other groups, such as households without elderly, may simply be delaying the economic consequences of paying for healthcare by borrowing. Though the ageing population is leading to increased health expenditure for households due to increased chronic illness, the impact of using private treatment is much less clear.
Collapse
Affiliation(s)
| | - Jean-Frédéric Lévesque
- Conjoint Professor, Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW, Australia
| | - Subrata Mukherjee
- Associate Professor, Institute of Development Studies Kolkata, Kolkata, West Bengal, India
| |
Collapse
|