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Published in: Social Psychiatry and Psychiatric Epidemiology 12/2012

01-12-2012 | Original Paper

Gender inequality and structural violence among depressed women in South India

Authors: Deepa Rao, Randall Horton, R. Raguram

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 12/2012

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Abstract

Purpose

While exploring experiences of psychological distress among psychiatric outpatients in Southern India, we set out to further understand interpersonal and socio-cultural factors that are associated with depressive symptoms.

Methods

Using a grounded theory framework, we thematically coded narrative accounts of the women who sought treatment at the psychiatric clinic. In addition, we included author notes from participant observation and field work experiences in the South Indian psychiatric clinic.

Results

Of the 32 women who participated in the study, 75 % qualified for a diagnosis of a current major depressive episode. Depressive symptoms were associated with experiences of domestic violence and, in Farmer’s terms, structural violence. Although only a partial response to gender-based suffering, allopathic psychiatric treatment seemed the best available means of coping with their circumstances.

Conclusion

The paper moves beyond a medicalized model of disease and behavior to explore social and contextual factors that enabled these women to brave additional stigmas surrounding psychiatric treatment and seek a better outcome for themselves. It concludes by discussing the need for a multi-layered approach to addressing the suffering that women in South India experience.
Literature
1.
go back to reference Pereira B, Andrew G, Pednekar S, Pai R, Pelto P, Patel V (2007) The explanatory models of depression in low income countries: listening to women in India. J Affect Disord 102:209–218PubMedCrossRef Pereira B, Andrew G, Pednekar S, Pai R, Pelto P, Patel V (2007) The explanatory models of depression in low income countries: listening to women in India. J Affect Disord 102:209–218PubMedCrossRef
2.
go back to reference Rao D, Young M, Raguram R (2007) Culture, somatization and psychological distress: a study of symptom presentation in South Indian psychiatric patients from a public hospital. Psychopathology 40:349–355PubMedCrossRef Rao D, Young M, Raguram R (2007) Culture, somatization and psychological distress: a study of symptom presentation in South Indian psychiatric patients from a public hospital. Psychopathology 40:349–355PubMedCrossRef
3.
go back to reference Raguram R, Weiss MW, Channabasavanna SM, Devins GM (1996) Stigma, depression, and somatization in South India. Am J Psychiatry 153:1043–1049PubMed Raguram R, Weiss MW, Channabasavanna SM, Devins GM (1996) Stigma, depression, and somatization in South India. Am J Psychiatry 153:1043–1049PubMed
4.
go back to reference Simon G, Gater R, Kisely S, Piccinelli M (1996) Somatic symptoms of distress: an international primary care study. Psychosom Med 58:481–488PubMed Simon G, Gater R, Kisely S, Piccinelli M (1996) Somatic symptoms of distress: an international primary care study. Psychosom Med 58:481–488PubMed
5.
go back to reference Fabrega H (1990) The concept of somatization as a cultural and historical product of Western medicine. Psychosom Med 52:653–672PubMed Fabrega H (1990) The concept of somatization as a cultural and historical product of Western medicine. Psychosom Med 52:653–672PubMed
6.
go back to reference Frawley D (1997) Ayurveda and the Mind. Motilal Banarsidass Publishers, Delhi Frawley D (1997) Ayurveda and the Mind. Motilal Banarsidass Publishers, Delhi
7.
go back to reference Parkar S, Dawani V, Weiss M (2008) Gender, suicide, and the sociocultural context of deliberate self-harm in an urban general hospital in Mumbai, India. Cult Med Psychiatry 32:492–515PubMedCrossRef Parkar S, Dawani V, Weiss M (2008) Gender, suicide, and the sociocultural context of deliberate self-harm in an urban general hospital in Mumbai, India. Cult Med Psychiatry 32:492–515PubMedCrossRef
8.
go back to reference Varma D, Chandra P, Thomas T, Carey M (2007) Intimate partner violence and sexual coercion among pregnant women in India: relationship with depression and post-traumatic stress disorder. J Affect Disord 102:227–235PubMedCrossRef Varma D, Chandra P, Thomas T, Carey M (2007) Intimate partner violence and sexual coercion among pregnant women in India: relationship with depression and post-traumatic stress disorder. J Affect Disord 102:227–235PubMedCrossRef
9.
go back to reference Chandra P, Satyanarayana V, Carey M (2009) Women reporting intimate partner violence in India: associations with PTSD and depressive symptoms. Arch Womens Mental Health 12:203–209CrossRef Chandra P, Satyanarayana V, Carey M (2009) Women reporting intimate partner violence in India: associations with PTSD and depressive symptoms. Arch Womens Mental Health 12:203–209CrossRef
10.
go back to reference Nayak M, Patel V, Bond J, Greenfield T (2010) Partner alcohol use, violence, and women’s mental health: population-based survey in India. Br J Psychiatry 196:192–199PubMedCrossRef Nayak M, Patel V, Bond J, Greenfield T (2010) Partner alcohol use, violence, and women’s mental health: population-based survey in India. Br J Psychiatry 196:192–199PubMedCrossRef
11.
go back to reference Comeau J, Davies L (in press) Patterns of depressive symptoms and antidepressant use among women survivors of intimate partner violence. Soc Pscyhiaty Psychiatr Epidemiol (epub ahead of print) Comeau J, Davies L (in press) Patterns of depressive symptoms and antidepressant use among women survivors of intimate partner violence. Soc Pscyhiaty Psychiatr Epidemiol (epub ahead of print)
12.
go back to reference Zinzow H, Resnick H, McCauley J, Amstadter A, Ruggiero K, Kilpatrick D (in press) Prevalence and risk of psychiatric disorders as a function of variant rape histories: results from a national survey of women. Soc Psychiatry Psychiatr Epidemiol (epub ahead of print) Zinzow H, Resnick H, McCauley J, Amstadter A, Ruggiero K, Kilpatrick D (in press) Prevalence and risk of psychiatric disorders as a function of variant rape histories: results from a national survey of women. Soc Psychiatry Psychiatr Epidemiol (epub ahead of print)
13.
go back to reference Cisler J, Begle A, Amstadter A, Resnick H, Danielson C, Saunders B, Kilpatrick D (2012) Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: data from the NSA-R. J Trauma Stress 25(1):33–40PubMedCrossRef Cisler J, Begle A, Amstadter A, Resnick H, Danielson C, Saunders B, Kilpatrick D (2012) Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: data from the NSA-R. J Trauma Stress 25(1):33–40PubMedCrossRef
14.
go back to reference Chowdhury K (2010) Domestic Violence Act not backed up. India Today Chowdhury K (2010) Domestic Violence Act not backed up. India Today
15.
go back to reference NFHS-III (2007) Report of National Family Health Survey NFHS-III (2005–2006). Ministry of Health and Family Welfare, Government of India NFHS-III (2007) Report of National Family Health Survey NFHS-III (2005–2006). Ministry of Health and Family Welfare, Government of India
16.
go back to reference Sanghavi P, Bhalla K, Das V (2009) Fire-related deaths in India in 2001: a retrospective analysis of data. Lancet 373:1282–1288PubMedCrossRef Sanghavi P, Bhalla K, Das V (2009) Fire-related deaths in India in 2001: a retrospective analysis of data. Lancet 373:1282–1288PubMedCrossRef
17.
go back to reference Sirohi S (2003) Sita’s curse: stories of dowry victims. Harper Collins, Delhi Sirohi S (2003) Sita’s curse: stories of dowry victims. Harper Collins, Delhi
18.
go back to reference Weiss MG, Kleinman A (1988) Depression in cross-cultural perspective: developing a culturally informed model. In: Dasen P, Berry JW, Sartorius N (eds) Cross cultural psychology and health: toward applications. Sage, Newbury Park, pp 179–206 Weiss MG, Kleinman A (1988) Depression in cross-cultural perspective: developing a culturally informed model. In: Dasen P, Berry JW, Sartorius N (eds) Cross cultural psychology and health: toward applications. Sage, Newbury Park, pp 179–206
19.
go back to reference Das V (2001) Stigma, contagion, defect: issues in the anthropology of public health. Paper presented at the stigma and global health: developing a research agenda, Bethesda, Maryland, September 2001 Das V (2001) Stigma, contagion, defect: issues in the anthropology of public health. Paper presented at the stigma and global health: developing a research agenda, Bethesda, Maryland, September 2001
20.
go back to reference Yang L, Kleinman A, Link B, Phelan J, Lee S, Good B (2007) Culture and stigma: adding moral experience to stigma theory. Soc Sci Med 64:1524–1535PubMedCrossRef Yang L, Kleinman A, Link B, Phelan J, Lee S, Good B (2007) Culture and stigma: adding moral experience to stigma theory. Soc Sci Med 64:1524–1535PubMedCrossRef
21.
go back to reference Link B, Phelan J (2001) Conceptualizing Stigma. Ann Rev Sociol 27:363–385CrossRef Link B, Phelan J (2001) Conceptualizing Stigma. Ann Rev Sociol 27:363–385CrossRef
22.
go back to reference Farmer PE, Nizeye B, Stulac S, Keshavjee S (2006) Structural violence and clinical medicine. Plos Medicine 3(10):e449PubMedCrossRef Farmer PE, Nizeye B, Stulac S, Keshavjee S (2006) Structural violence and clinical medicine. Plos Medicine 3(10):e449PubMedCrossRef
23.
24.
go back to reference Sen A (2000) Development as freedom. Oxford University Press, Delhi Sen A (2000) Development as freedom. Oxford University Press, Delhi
25.
go back to reference Doniger W, Smith BK (1991) The Laws of Manu. Penguin Books, Ltd., London Doniger W, Smith BK (1991) The Laws of Manu. Penguin Books, Ltd., London
26.
go back to reference Mahalingam R, Jackson B (2007) Idealized cultural beliefs about gender: implications for mental health. Soc Psychiatry Psychiatr Epidemiology 42:1012–1023CrossRef Mahalingam R, Jackson B (2007) Idealized cultural beliefs about gender: implications for mental health. Soc Psychiatry Psychiatr Epidemiology 42:1012–1023CrossRef
27.
go back to reference Poongothai S, Pradeepa R, Ganesan A, Mohan V (2009) Prevalence of depression in a large urban South Indian population–the Chennai Urban Rural Epidemiology Study (CURES-70). PLoS ONE 4(9):`185CrossRef Poongothai S, Pradeepa R, Ganesan A, Mohan V (2009) Prevalence of depression in a large urban South Indian population–the Chennai Urban Rural Epidemiology Study (CURES-70). PLoS ONE 4(9):`185CrossRef
28.
go back to reference Patel V, Aray R, Lima M, Ludermir A, Todd C (1999) Women, poverty and common mental disoders in four restructuring societies. Soc Sci Med 49:1461–1471PubMedCrossRef Patel V, Aray R, Lima M, Ludermir A, Todd C (1999) Women, poverty and common mental disoders in four restructuring societies. Soc Sci Med 49:1461–1471PubMedCrossRef
29.
go back to reference Registrar (2001) Census of India. Office of the Registrar General, New Delhi Registrar (2001) Census of India. Office of the Registrar General, New Delhi
30.
go back to reference Gourie-Devi M (2001) NIMHANS hospital information booklet. NIMHANS Publications, Bangalore Gourie-Devi M (2001) NIMHANS hospital information booklet. NIMHANS Publications, Bangalore
31.
go back to reference Weiss MG (1997) Explanatory model interview catalogue (EMIC): framework for comparative study of illness. Transcult Psychiatry 34:235–263CrossRef Weiss MG (1997) Explanatory model interview catalogue (EMIC): framework for comparative study of illness. Transcult Psychiatry 34:235–263CrossRef
32.
go back to reference Csordas T, Dole C, Tran A, Strickland M, Storck M (2010) Ways of asking, ways of telling. Cult Med Psychiatry 34(1):29–55PubMedCrossRef Csordas T, Dole C, Tran A, Strickland M, Storck M (2010) Ways of asking, ways of telling. Cult Med Psychiatry 34(1):29–55PubMedCrossRef
33.
go back to reference First M, Spitzer R, Gibbon M, Williams J (1995) Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition (SCID I/P, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute, New York First M, Spitzer R, Gibbon M, Williams J (1995) Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition (SCID I/P, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute, New York
34.
go back to reference Corbin J, Strauss A (2008) Basics of qualitative research. Sage, Los Angeles Corbin J, Strauss A (2008) Basics of qualitative research. Sage, Los Angeles
35.
go back to reference Miles M, Huberman A (1994) Qualitative data analysis, 2nd edn. Sage, Thousand Oaks Miles M, Huberman A (1994) Qualitative data analysis, 2nd edn. Sage, Thousand Oaks
36.
go back to reference BBC News (2011) Rural reality of India’s 26 rupee a day poverty line BBC News (2011) Rural reality of India’s 26 rupee a day poverty line
38.
go back to reference Das M, Gupta N, Dutta K (2002) Psychiatric training in India. Psychiatr Bull 26:70–72CrossRef Das M, Gupta N, Dutta K (2002) Psychiatric training in India. Psychiatr Bull 26:70–72CrossRef
39.
go back to reference Chatterjee P (2009) Economic crisis highlights mental health issues in India. Lancet 373(9670):1160–1161PubMedCrossRef Chatterjee P (2009) Economic crisis highlights mental health issues in India. Lancet 373(9670):1160–1161PubMedCrossRef
40.
go back to reference Bumiller E (1990) May you be the mother of a hundred sons. Penguin Books India, Delhi Bumiller E (1990) May you be the mother of a hundred sons. Penguin Books India, Delhi
41.
go back to reference Scheper-Hughes N (1992) Death Without Weeping: The Violence of Everyday Life in Brazil. University of California Press, Berkeley and Los Angeles Scheper-Hughes N (1992) Death Without Weeping: The Violence of Everyday Life in Brazil. University of California Press, Berkeley and Los Angeles
42.
go back to reference Behague DP (2008) The domains of psychiatric practice: from centre to periphery. Cult Med Psychiatry 32:140–151PubMedCrossRef Behague DP (2008) The domains of psychiatric practice: from centre to periphery. Cult Med Psychiatry 32:140–151PubMedCrossRef
43.
go back to reference Foucault M (1973/1963) The birth of the clinic: an archaeology of medical perception. Vintage Books, New York Foucault M (1973/1963) The birth of the clinic: an archaeology of medical perception. Vintage Books, New York
44.
go back to reference Good B (1994) Medicine, rationality, and experience: an anthropological perspective. Cambridge University Press, Cambridge Good B (1994) Medicine, rationality, and experience: an anthropological perspective. Cambridge University Press, Cambridge
45.
go back to reference Farmer P (2005) Pathologies of power: health, human rights, and the new war on the poor. University of California Press, Berkeley Farmer P (2005) Pathologies of power: health, human rights, and the new war on the poor. University of California Press, Berkeley
46.
go back to reference Kleinman A (1986) Social origins of distress and disease: depression, neurasthenia, and pain in modern china. Yale University Press, New Haven Kleinman A (1986) Social origins of distress and disease: depression, neurasthenia, and pain in modern china. Yale University Press, New Haven
47.
go back to reference Chakraborty K, Avasthi A, Kumar S, Grover S (2009) Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol 44(6):482–488PubMedCrossRef Chakraborty K, Avasthi A, Kumar S, Grover S (2009) Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol 44(6):482–488PubMedCrossRef
Metadata
Title
Gender inequality and structural violence among depressed women in South India
Authors
Deepa Rao
Randall Horton
R. Raguram
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 12/2012
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-012-0504-y

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