Abstract
BackgroundMental 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.MethodsCross-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.ResultsMore 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)).ConclusionsRather 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 registrationProspectively registered at ClinicalTrials.GovNCT01996241. November 27, 2013
Highlights
Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India
Measurements The questionnaire comprised three parts: a brief demographic and economic questionnaire asked to an adult family member; a structured questionnaire asked by a female interviewer to adolescent girls in private in their own homes; and an anonymous short self-completed questionnaire containing sensitive questions that girls completed by themselves
Participants had a median of 3 siblings (IQR 2–4; range 0–9) and many (63.3%) were from households with an illiterate household head. 16.7% had parents who had migrated for work in the past year and a small proportion of girls (8.4%) had migrated for work in the past year, with or without their family
Summary
Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India. 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. Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries (LMIC), including India. Common mental health disorders, such as depression and anxiety, often emerge during adolescence, with many persisting across the life course [4, 5]. Rather than being a static organ, the brain is known to be in a highly dynamic stage of development during adolescence, but the causes of common mental disorders in youth have been less researched. Loneliness and lack of parental support are associated with suicidal ideation among youth in South-East Asia and Western Pacific countries [11], and sexual abuse in childhood is associated with suicidal behaviours in adulthood [12]
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