Are poor people more likely to suffer from depression than the wealthy? Is there a link between disability and mental disorder? What role does gender play? Researchers from the UK Institute of Psychiatry and the Goa Institute of Psychiatry & Human Behaviour, India, investigated the relationship between poverty, disability and depression in Goa.

Nearly half of the people attending primary healthcare clinics suffer from depression or anxiety, the study found. Poverty, disability and gender are all strongly associated with these disorders. Doctors recognise only a third of all cases, and rely on drugs to treat them. Improved mental healthcare, along with specialist training for doctors, must be a priority for primary health services in developing countries.

The term ‘common mental disorders’ (CMDs) refers to states of anxiety and depression. In industrialised countries, these conditions have been linked to unemployment and poverty. India has seen a significant rise in living standards in recent years. However, poverty is still widespread and the gap between rich and poor is increasing. How does this affect the mental health of the population?

While the link between poverty and physical disease is well established, there is surprisingly little research on the effect of low income on mental health. The study aimed to fill this knowledge gap by investigating the incidence of CMDs among patients at primary healthcare clinics in Goa. These people tend to be poorer than the average population. A second aim was to find out how well doctors and the clinics recognise and treat CMDs.

Important findings of the research include:

• Nearly half of the people in the study sample suffer from CMDs.
• CMDs are strongly linked to poverty and disability.
• Women are more likely than men to have a CMD, particularly if they are poor.
• Doctors in primary healthcare centres recognise a third of all cases of CMD, but rely on inappropriate oral drugs and injectable vitamins to treat them.
• Communication between the most vulnerable patients and their doctors is poor: while many patients have suicidal ideas, very few discuss these with their doctor.

Recommendations to improve mental health services include the need to:

• prioritise diagnosis and treatment of CMDs in primary health settings in developing countries
• shift the focus from psychotic forms of mental illness to CMDs in primary care
• incorporate an understanding of the relationship between gender, poverty and CMDs into the development of health policy
• train primary healthcare doctors to diagnose and treat CMDs correctly and to encourage patients to communicate their suicidal thoughts.

Source(s):
‘Poverty, psychological disorder and disability in primary care attenders in Goa, India’ by V. Patel et al British Journal of Psychiatry 172 (1998)

Funded by: The Wellcome Trust, UK

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.