Background: Although major depression is one of the leading causes of premature death and
disability in India, there is little infrastructure to provide mental health services in the rural North
Indian state of Uttarakhand. The worldwide burden of depression is 50% higher in women than
men, however Indian women experience the double burden of gender disadvantage and poverty
which restricts their autonomy and access to social support, and increases their risk for common
mental disorders (CMDs). In this low resource setting, community mental health (CMH) models
of care may offer the best approach to supporting women with CMDs.
Objective: This study partnered with a local NGO in Uttarakhand to examine the factors
influencing women’s participation in psychosocial support groups (PSSGs), and the groups’
impact on the women and their communities. PSSGs had been set up in the communities for a
minimum of 6 months.
Methodology: Focused ethnographic research was conducted over three months in 2016,
involving ten focus group discussions (FGDs) with seven unique PSSGs, representing a total of
43 women. FGDs were conducted with PSSGs that had been active a minimum of 6 months.
They included both persons with psychosocial disability and their caregivers, primarily divided
into separate PSSGs. FGDs were conducted across three different sites, with predominantly
Muslim and Hindu populations. Additionally, eight key informant interviews were conducted
with community health workers and mental health professionals. Data was translated and
transcribed from Hindi to English.
Results: The principal barrier to PSSG participation was gender inequality, more specifically,
women not being granted permission to leave the home to participate. In terms of impact, the
women explained how learning and talking about their own depression and anxiety increased
their knowledge and improved their mental health. PSSGs created safe social spaces for women
to talk, which increased women’s confidence to speak freely in their community. As a result of
the PSSGs, women felt that they had reimagined their roles as community members, shifting
from the role of receiver of help to provider. Communities were impacted by the PSSGs as
women shared their mental health (MH) knowledge widely, and referred and accompanied
community members to MH services.
Discussion: These findings are significant because women in PSSGs were able to work together
to improve their MH in the context of high gender inequality and mental health stigma. Greater
ability to speak out and act collectively may empower women to contribute to household and
community decisions, and participate economically, advancing their health and social interests.
This research demonstrates how PSSGs can benefit not only the women involved but their
community and its mental health. It highlights the importance of understanding models for CMH
services that build on local resources and can serve as a model for other underserved
communities. / Thesis / Master of Science (MSc)
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/21058 |
| Date | January 2017 |
| Creators | Gailits, Nicola S |
| Contributors | Schwartz, Lisa, Nouvet, Elysée, Global Health |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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