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Gender Disadvantage and Reproductive Health Risk Factors for Common Mental Disorders in Women
A Community Survey in India
Vikram Patel, MD, PhD;
Betty R. Kirkwood, MA;
Sulochana Pednekar, MA;
Bernadette Pereira, MA;
Preetam Barros, MA;
Janice Fernandes, MA;
Jane Datta, BSc;
Reshma Pai, MSc;
Helen Weiss, PhD;
David Mabey, DM, FRCP
Arch Gen Psychiatry. 2006;63:404-413.
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.
Author Affiliations: Departments of Epidemiology & Population Health (Dr Patel and Ms Kirkwood), Infectious and Tropical Diseases (Drs Weiss and Mabey), London School of Hygiene & Tropical Medicine, London, England; Psychosocial and Public Health Program (Dr Patel, Mss Pednekar, Pereira, Barros, Fernandes, Datta, and Pai), Sangath, Goa, India.
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