Poverty and Mental Health in the Developing World
Acharya, Keya, Contemporary Review
Health experts are sending out an international alert that mental health problems are dramatically increasing worldwide with the World Health Organization (WHO) warning that depression is set to become the main cause of disability and second leading health problem by 2020.
In India, where the number of cases of clinical depression and anxiety is rising even more steeply than elsewhere, opinion is sharply divided on whether poverty is the main cause -- a debate sparked off by a study by Dr Vikram Patel of London's Institute of Psychiatry. Patel's 1996 study, Poverty, Inequality & Mental Health in Developing Countries, an updated version of which has been published in a book, investigates the relationship between poverty, disability and depression in the Indian state of Goa. He found that more than 40 per cent of adults attending primary health care clinics had a common mental disorder (CMD) such as anxiety or clinical depression. Women were two to three times more likely to have CMDs than men.
The study concluded that relative poverty, disability and gender were strongly associated with these disorders. According to Patel, poverty is an important 'risk factor' -- clinical depression can be triggered by adverse life-events such as physical illness, housing problems and unemployment.
'Being poor means you are more likely to experience such events and you will have fewer resources to draw upon,' Patel says. 'The relationship between impoverishment and mental illness is bi-directional. Thus poverty can lead to mental illness which can worsen the economic circumstances of the person and their families.'
Importantly, not all mental disorders are increasing in India. Patel specifically attributes India's growing incidence of anxiety and clinical depression to rising inequality, as witnessed in many other developing countries.
The latest WHO report on mental health, Stop Exclusion, Dare to Care, agrees. 'Mental disorders occur in persons of all genders, ages, and backgrounds ... poverty, war and displacement can influence the onset, severity and duration of mental disorders.'
However, Dr Mohan Isaac, Head of Psychiatry at India's prestigious National Institute of Mental Health and NeuroSciences (NIMHANS), points to the resilience of India's family and social support networks. He cites numerous studies of schizophrenia which have shown better recovery results in developing countries like Nigeria and India, largely because of their strong social support systems. Isaac, adds, 'in the midst of poverty people still live a sane life; otherwise 38 per cent of this country living below the poverty line would be mentally depressed.'
Patel concedes that the humour and spirit of those living in conditions that the rest of unequal India might buckle under, indicate how well the poor are able to cope. The challenge for public health researchers, he argues, is 'to identify the protective and nurturing qualities in those who do not become depressed when faced with awful economic circumstances . …