Why are depression and related disorders reaching crisis proportions in the developing world? What are the causes of common mental disorders (CMDs) in low-income countries? Research in Brazil, Chile, India and Zimbabwe, co-ordinated by the UK Institute of Psychiatry, showed that women, those with little education, the poor and older people are most likely to suffer from mental disorders.

The growing gap between rich and poor in these countries is likely to lead to increases in stress, depression and anxiety. Health policy-makers and planners must recognise the vulnerability of women and older people to mental health disorders, and prioritise psychological care in health services and research.

Common mental disorders include anxiety and depression and are frequently found in community and primary care settings. They are an important cause of disability worldwide and a significant public health problem. Female gender and low socio-economic status are recognised as risk factors for CMD in industrialised societies. However, research in developing countries tends to focus on counting cases of CMD rather than investigating the causes.

This research uses data from five separate studies to investigate links between gender, poverty and CMD. Important findings include:

• CMD is associated with female gender, poverty, low education and older age.
• Women are particularly vulnerable to high levels of stress due to multiple roles, violence and unequal power relations with men.
• Relative poverty, in addition to absolute poverty, is a risk factor for CMD. In India and Zimbabwe, being in debt is a particular source of stress and worry.
• Changes in rural societies mean that many older people suffer from loneliness and economic hardship, which can increase their vulnerability to CMD.

Widening inequality may lead to higher levels of CMD in low-income groups in all four countries. Policy strategies to reduce the likelihood of CMD include:

• moving beyond the narrow focus on reproductive and maternal healthcare for women to encompass psychological and social aspects of health
• placing more emphasis on keeping children in school long enough to complete their secondary education
• responding to the needs of older people within the health and social services and increasing research into the needs of older women
• providing credit programmes for the poor to relieve the stress associated with debt.

Source(s):
‘Women, poverty and common mental disorders in four restructuring societies’ by V. Patel et al, Social Science and Medicine 49 (1999)

Funded by: International Development Research Centre, Canada; The Wellcome Trust, UK; FACEPE and CNPq, Brazil; Fondo Nacional de Ciencia y Tecnologia, Chile; CAPES, Ministry of Health, Brazil

id21 Research Highlight: 22 February 2001

Further Information:
Vikram Patel
Sangath Centre
841/1 Alto Porvorim
Goa
INDIA 403521

Tel: +91 832 413527
Fax: +91 832 415244
Contact the contributor: vikpat@goatelecom.com

Institute of Psychiatry, UK

Other related links:
WHO's Mental Health Program provides information on research and events as well as links to related resources.

World Health Day (7th April 2001) is a global advocacy and awareness raising event for mental health.

The Knowledge Exchange Network website holds information on a range of mental health issues.

See this issue of the Bulleting of the WHO on mental health.