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Gender inequality and social exclusion are the primary factors driving mental health problems in Uttarakhand, with people from socially oppressed castes two or three times more likely to be depressed, researchers including those from India claim.
A survey published in the BMJ Open of nearly 1,000 households of Uttarakhand showed that six per cent of adults were identified as depressed.
People were two or three times more likely to be depressed if they were from the most socially oppressed castes, had taken a recent loan, lived in poor quality housing or had not completed primary school.
Researchers from Umea University in Sweden focused over the last four years on how communities in the states of Uttarakhand and Uttar Pradesh can promote, prevent, treat and advocate for mental health.
"I was surprised to find such a strong relationship between social disadvantage and mental illness," said Kaaren Mathias, a mental health programme manager with the Emmanuel Hospital Association in India.
Further qualitative studies, showed that nearly all people with mental distress had experienced social exclusion and many had experienced economic, verbal and physical violence.
However, people also described experiences of belonging, social support, and social participation.
People with friends or family members experiencing mental distress as well as those who believed that mentally distressed people can recover were more willing to be socially close to them.
The communities in research are characterised by complicated relationships between mental health and social inequalities such as gender, poverty, class, caste and education.
Gender inequality is one of the most significant social factors impacting mental health competency as it leads to a heavier load in caregiving, impoverishment and experiences of violence for women caregivers, researchers said.
"Bringing together the findings from this research, I picture community mental health competence using the picture of a tree, where all parts are organically connected," said Mathias.
"The roots are the many social factors affecting mental health. The trunk connects these with four branches: access to care, knowledge, safe social spaces and partnerships for action," she said.
"The research shows how people with mental distress, caregivers and community members together find coping strategies despite many obstacles and few resources. Amidst the shadows there are patches of light," Mathias said.