Abstract
BackgroundDepression, 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.MethodsThis 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.ResultsThe 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.ConclusionsMental 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.
Highlights
Depression, the world’s leading cause of disability, disproportionately affects women
All factors indicated the significance of uneven gender relations, and related to a main factor: freedom of movement, or women’s autonomy to leave the home in order to attend Psychosocial support group (PSSG)
Examination of the demographics of women participating in PSSGs showed that older women (40–60 years old) were more often uneducated, and the younger women (20–30 years old) had often completed primary or high school
Summary
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. Indian women’s mental health, gender inequality, and access to care Major depression is the leading cause of disability worldwide [1], with mental, neurological and substance use disorders accounting for 10.4% of global DALYs [2]. For Indian women, there are culturally specific and socio-economic causes for depression that must be examined in the context of gender inequality. Women are less likely to seek out proper care for diseases [8], even though, as in the case of depression, they are disproportionately affected and many experience the “double burden of gender disadvantage and poverty” [9]. In response to high levels of distress, interventions focused on the provision of social support for Indian women have been shown to improve their mental health [7, 10]
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