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An asymmetric burden gendered experiences of caregivers of people with psycho-social disabilities in North India
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.ORCID-id: 0000-0001-7234-3510
Vise andre og tillknytning
(engelsk)Inngår i: Transcultural Psychiatry, ISSN 1363-4615, E-ISSN 1461-7471Artikkel i tidsskrift (Fagfellevurdert) Accepted
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-127171OAI: oai:DiVA.org:umu-127171DiVA, id: diva2:1043977
Tilgjengelig fra: 2016-11-01 Laget: 2016-11-01 Sist oppdatert: 2018-06-09
Inngår i avhandling
1. Shadows and light: examining community mental health competence in North India
Åpne denne publikasjonen i ny fane eller vindu >>Shadows and light: examining community mental health competence in North India
2016 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Alternativ tittel[sv]
Studier av psykisk ohälsa i norra Indien ur ett folkhälsoperspektiv
Abstract [en]

Background

Globally, there is increasing emphasis on the importance of understanding the ways in which social inequality and injustice impact individual and community mental health. Set in the states of Uttar Pradesh and Uttarakhand, India, this thesis examines the complex relationships between individuals, communities and the social environment in relation to mental health. North India is characterised by stark gender and socio-economic inequalities and social exclusion for people with psycho-social disability (PPSD) and mental health services in these study areas were essentially absent. Community mental health competency means people are collectively able to participate in efforts to promote, prevent, treat and advocate for mental health. This thesis reflexively examines the presence and absence of community mental health competence in the upper Ganges region.

Methods

A mixed methods approach allowed for a multi-level examination of community mental health competence, and generated four sub-studies. In-depth interviews with thirteen PPSD and eighteen caregivers in Bijnor and Saharanpur (Uttar Pradesh state) were carried out in 2013 providing data for qualitative analysis. These data were analysed using qualitative content analysis to examine experiences of exclusion and inclusion of PPSD in sub-study I, and thematic analysis to examine the gendered experiences of caregivers in sub-study II. A community based sample of 960 people in Dehradun district (Uttarakhand) were surveyed in 2014 to examine the prevalence, treatment gap and social determinants of depression in substudy III, and the attitudes and preferred social distance from people with depression and psychosis were investigated in sub-study IV. Multi-variate regression analysis in both studies was conducted with Stata software Version 13.1.

Results

Within the domain of knowledge, relatively low community mental health literacy, a diverse range of explanatory models of mental health, and creative and persistent efforts in helpseeking were the themes identified. Within the domain of safe social spaces, social exclusion was harsh and prevalent for PPSD, with contrasting sub-domains of belonging, social support, social participation and ahimsa (non-violence). Women were disadvantaged more than men in most spheres of caregiving.

Social determinants of depression with an adjusted odds ratio of more than 2.0 included being a member of the most oppressed caste or tribal group, having taken a recent loan, and not completing primary schooling. The prevalence of depression was 6.0% in the community sample, and there was a 100% treatment gap for counselling, and a 96% treatment gap for anti-depressant therapy, even though 79% of those with depression had visited a primary care provider in the previous three months. Social determinants of health and access to care are proposed as additional domains of community mental health competency. The prevailing gender regime that values males and disadvantages women influenced every domain of community mental health competency, particularly increasing caregiver burden, social exclusion and experiences of physical violence for women. 

Conclusions

In this thesis I have refined and strengthened a conceptual framework that portrays community mental health competence as a tree, where foundational roots of social determinants of mental health support four branches depicting access to care, knowledge, safe social spaces and partnerships for action. This tree model proposes that all five domains must operate in unison to support action for community mental health involving: development of community knowledge; promoting social inclusion, gender equality and participation; addressing upstream health determinants; and increasing access to mental health care. 

sted, utgiver, år, opplag, sider
Umeå: Umeå universitet, 2016. s. 72
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1856
Emneord
Global mental health, Gender, Health determinants, India, Mental health competence, Social distance, Social exclusion, Caregiver, Depression
HSV kategori
Forskningsprogram
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-127219 (URN)978-91-7601-588-9 (ISBN)
Disputas
2016-12-02, Sal 135, by 9A, Norrlands universitetssjukhus, Umeå, 09:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2016-11-11 Laget: 2016-11-03 Sist oppdatert: 2018-06-09bibliografisk kontrollert

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