Background Depression, the world’s leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study’s objective was to examine the factors influencing women’s participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community’s mental health. Methods This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers ( N = 10, representing 59 women), and key informant interviews ( N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. Results The principal barrier to participating in psychosocial support groups was restrictions on women’s freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community’s attitude toward gender relations, the women’s own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women’s ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women’s freedom of movement. Conclusions Mental health access and gender inequality are inseparable in the context of Northern India, and women’s mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women’s freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women’s freedom of movement. Electronic supplementary material The online version of this article (10.1186/s12889-019-7019-3) contains supplementary material, which is available to authorized users.

Background The 2014-15 west Africa Ebola outbreak presented a number of ethical challenges in terms of conducting research while managing the outbreak. As Ebola virus disease (EVD) rapidly spread throughout west African countries, intense bioethical debate centred around the ethics of using experimental treatments and how best to allocate these resources. We aimed to identify further ethical and practical challenges. MethodsWe did a narrative synthesis of scholarly literature emerging from research conducted during the west Africa Ebola outbreak. Articles from Jan 1, 2014, to Jan 1, 2017, were retrieved via MeSH and keyword searches of five indexes (Embase, JSTOR, PubMed, Philosopher's Index, and CINAHL). Keywords included "Ebola" with "trial" or "trials" or "ethics" or "ethical" or "study" or "studies." An initial 2062 articles were reduced to 427 articles after title and abstract screening. After full text screening, 145 articles were uploaded to Nvivo 11 for coding. Eligible articles were analysed inductively and deductively using a team-centred codebook and discussion.Findings Alongside the central ethical dilemmas that emerged from bioethicist commentaries, a separate discussion could be heard: authors argued that the intense focus on short-term, individual bioethical dilemmas during the EVD outbreak detracted from big-picture inequalities: lack of health system and health capacity in Ebola-affected countries. These authors insisted on the moral imperative to rebalance unequal transnational power relations when doing research in the global South. More needed to be done to prevent exploitative research, differing standards of care, and false notions of minimal expertise in African researchers. They also highlighted the need to acknowledge the root historical and political causes of Ebola, such as neoliberal economic policies imposed on west African health infrastructure. In short, it was felt that to talk about ethics and Ebola without focusing on structural inequalities and neocolonial policies at the root of this public health disaster would be unethical.Interpretation During an outbreak of incredible proportion, the need to debate short-term, individual-focused bioethical dilemmas must be balanced with a long-term focus at the community and health-system level. Debates in global bioethics have a responsibility to keep uppermost in their analyses local bioethical paradigms and incorporate an understanding of global economic consequences on health infrastructure and trust building. To move forward, global health ethics needs to prioritise building trustworthy systems that embody solidarity and global justice.Funding R2HC: an ELRHA (Wellcome Trust/DFID/Save the Children) programme.

Background: Antenatal depression is a condition from which 8-29% of women suffers worldwide, and may be more prevalent in obese women and women of low socioeconomic status. Counties Manukau is a region of New Zealand that has a high prevalence of obesity and socioeconomic deprivation amongst its population. There are limited data concerning the issue of depression in pregnant women in this population. Additionally, the relationship between demographic characteristics and rates of depression in this population is unexplored.Methods: Depression was assessed amongst obese pregnant women at recruitment to the Healthy Mums and Babies (HUMBA) trial (between 12-18 weeks of pregnancy) using the Edinburgh Postnatal Depression Scale (EPDS). These scores were analyzed to determine the prevalence of depression in the study cohort, defined as EPDS score > 13. Additionally, socioeconomic status was evaluated using New Zealand's Deprivation Index. Demographic factors were self-reported by study participants using questionnaires administered by HUMBA research midwives. Statistical analysis was done using logistic regression and chi square tests. At present, 65% of the study cohort has been recruited.Findings: One hundred and thirty seven women were included in the current analysis of whom 19 (13.9%) met the criteria for depression. Deprivation index was not associated with depression. Women who did not complete secondary school were more likely to be depressed than women who had a secondary school qualification or completed some form of tertiary education (OR: 4.81, CI: 1. 63-14.19). BMI grouping did not have a significant overall effect on EPDS score. Comparisons between categorical groups showed that the BMI group of 30-35 was associated with a higher rate of depression compared to the other BMI groups (OR: 3.90, CI: 1.02-14.89). When level of education was adjusted for in a multivariate model, BMI group of 30-35 no longer had a significant relationship with depression.Interpretation: The rate of depression in this obese cohort of pregnant women is similar to rates reported in other settings. Women with lower levels of education appeared to be more likely to be depressed than their more educated counterparts. If this finding is confirmed in results from the full cohort, women with lower educational attainment should be considered for EPDS screening during pregnancy. Source of Funding: None.Abstract #: 1.017_WOM