Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India

Arch Gen Psychiatry. 2006 Apr;63(4):404-13. doi: 10.1001/archpsyc.63.4.404.

Abstract

Background: Gender disadvantage and reproductive health are major determinants of women's health in developing countries.

Objective: To determine the association of factors indicative of gender disadvantage and reproductive health with the risk of common mental disorders (CMDs) in women.

Design: Cross-sectional survey from November 1, 2001, to June 15, 2003.

Participants: A total of 3000 women randomly selected from a sampling frame of women aged 18 to 45 years in Goa; 2494 women participated.

Main outcome measures: The primary outcome was the presence of a CMD, as defined by the Revised Clinical Interview Schedule. An interview and blood and vaginal/urine specimens were collected to ascertain risk factors.

Results: The prevalence of CMD was 6.6% (95% confidence interval [CI], 5.7%-7.6%). Mixed anxiety-depressive disorder was the most common diagnosis (64.8%). Factors independently associated with the risk for CMD were factors indicative of gender disadvantage, particularly sexual violence by the husband (odds ratio [OR], 2.3; 95% CI, 1.1-4.6), being widowed or separated (OR, 5.4; 95% CI, 1.0-30.0), having low autonomy in decision making (OR, 1.98; 95% CI, 1.2-3.2), and having low levels of support from one's family (OR, 2.2; 95% CI, 1.4-3.3); reproductive health factors, particularly gynecological complaints such as vaginal discharge (OR, 3.2; 95% CI, 2.2-4.8) and dyspareunia (OR, 2.5; 95% CI, 1.4-4.6); and factors indicative of severe economic difficulties, such as hunger (OR, 2.7; 95% CI, 1.6-4.6). There was no association between biological indicators (anemia and reproductive tract infections) and CMD.

Conclusions: The clinical assessment of CMD in women must include exploration of violence and gender disadvantage. Gynecological symptoms may be somatic equivalents of CMD in women in Asian cultures.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Asian Continental Ancestry Group / psychology
  • Asian Continental Ancestry Group / statistics & numerical data*
  • Cross-Sectional Studies
  • Data Collection / statistics & numerical data
  • Domestic Violence / psychology
  • Domestic Violence / statistics & numerical data
  • Family Relations
  • Female
  • Genital Diseases, Female / diagnosis
  • Genital Diseases, Female / epidemiology
  • Genital Diseases, Female / psychology
  • Health Surveys*
  • Humans
  • India / ethnology
  • Mental Disorders / diagnosis*
  • Mental Disorders / ethnology
  • Mental Disorders / psychology
  • Middle Aged
  • Prevalence
  • Reproductive Medicine*
  • Risk Factors
  • Sex Factors
  • Social Support
  • Socioeconomic Factors
  • Spouse Abuse / diagnosis
  • Spouse Abuse / psychology
  • Spouse Abuse / statistics & numerical data