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. 2014 Oct;119:155-69.
doi: 10.1016/j.socscimed.2014.08.021. Epub 2014 Aug 19.

The Psychological Toll of Slum Living in Mumbai, India: A Mixed Methods Study

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The Psychological Toll of Slum Living in Mumbai, India: A Mixed Methods Study

Ramnath Subbaraman et al. Soc Sci Med. .
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Abstract

In India, "non-notified" slums are not officially recognized by city governments; they suffer from insecure tenure and poorer access to basic services than "notified" (government-recognized) slums. We conducted a study in a non-notified slum of about 12,000 people in Mumbai to determine the prevalence of individuals at high risk for having a common mental disorder (i.e., depression and anxiety), to ascertain the impact of mental health on the burden of functional impairment, and to assess the influence of the slum environment on mental health. We gathered qualitative data (six focus group discussions and 40 individual interviews in July-November 2011), with purposively sampled participants, and quantitative data (521 structured surveys in February 2012), with respondents selected using community-level random sampling. For the surveys, we administered the General Health Questionnaire-12 (GHQ) to screen for common mental disorders (CMDs), the WHO Disability Assessment Schedule 2.0 (WHO DAS) to screen for functional impairment, and a slum adversity questionnaire, which we used to create a composite Slum Adversity Index (SAI) score. Twenty-three percent of individuals have a GHQ score≥5, suggesting they are at high risk for having a CMD. Psychological distress is a major contributor to the slum's overall burden of functional impairment. In a multivariable logistic regression model, household income, poverty-related factors, and the SAI score all have strong independent associations with CMD risk. The qualitative findings suggest that non-notified status plays a central role in creating psychological distress-by creating and exacerbating deprivations that serve as sources of stress, by placing slum residents in an inherently antagonistic relationship with the government through the criminalization of basic needs, and by shaping a community identity built on a feeling of social exclusion from the rest of the city.

Keywords: Common mental disorders; Depression; India; Informal settlements; Mental health; Poverty; Slums; Urban.

Figures

Figure 1
Figure 1
Sample selection flow chart for the quantitative survey
Figure 2
Figure 2
Histogram depicting the distribution of Slum Adversity Index scores
Figures 3
Figures 3
Histogram depicting the distribution of GHQ scores
Figure 4
Figure 4
Predicted probabilities of having a GHQ score ≥5, at different percentiles of the Slum Adversity Index, after adjusting for income and other covariates in a multivariable logistic regression model

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