Association of common mental disorder symptoms with health and healthcare factors among women in rural western India: results of a cross-sectional survey

Abstract

ObjectivesInformation about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.SettingSurveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.Participants700 Gujarati-speaking women between the ages of 18–45 years who resided in the Anand district of Gujarat, India, were recruited in a quasi-randomised manner.Primary and secondary outcomes measuresCMD symptoms, ascertained using WHO's Self-Reporting Questionnaire-20 (SRQ-20), were associated with self-reported (1) number of healthcare visits in the prior year; (2) health status and (3) portion of yearly income expended on healthcare.ResultsData from 658 participants were used in this analysis; 19 surveys were excluded due to incompleteness, 18 surveys were excluded because the participants were visiting hospitalised patients and 5 surveys were classified as outliers. Overall, 155 (22·8%) participants screened positive for CMD symptoms (SRQ-20 score ≥8) with most (81.9%) not previously diagnosed despite contact with healthcare provider in the prior year. On adjusted analyses, screening positive for CMD symptoms was associated with worse category in self-reported health status (cumulative OR=9.39; 95% CI 5·97 to 14·76), higher portion of household income expended on healthcare (cumulative OR=2·31; 95% CL 1·52 to 3.52) and increased healthcare visits in the prior year (incidence rate ratio=1·24; 95% CI 1·07 to 1·44).ConclusionsThe high prevalence of potential CMD among women in rural India that is unrecognised and associated with adverse health and financial indicators highlights the individual and public health burden of CMD.

Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal

“…The pattern of increased healthcare consumption by people with probable depression in Nepal reported here is consistent with observations from high-income countries, where the greatest direct healthcare costs are also attributable to general healthcare rather than specialist mental healthcare utilization [12]. Our finding that excess expenditure by people with depression was largely accounted for by outpatient service use is consistent with findings from India [21,52], Brazil [53] and other middleincome countries [22], which demonstrate 14 to 36% increases in community healthcare utilization among people with depression, and suggest that depression is a risk factor for catastrophic health expenditure [37]. This is the first study that we know of to independently report hospital admission frequency and OOP healthcare expenditures in people with symptoms of depression in LMIC, although a study from Canada also found no significant increases in health service related costs of admissions [12].…”

Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

“…The pattern of increased healthcare consumption by people with probable depression in Nepal reported here is consistent with observations from high-income countries, where the greatest direct healthcare costs are also attributable to general healthcare rather than specialist mental healthcare utilization. 12 Our finding that excess expenditure by people with depression was largely accounted for by outpatient service use is consistent with findings from India 21,52 , Brazil 53 and other middle-income countries 22 , which demonstrate 14 to 36% increases in community healthcare utilization among people with depression, and suggest that depression is a risk factor for catastrophic health expenditure. 37 This is the first study that we know of to independently report hospital admission frequency and OOP healthcare expenditures in people with symptoms of depression in LMIC, although a study from Canada also found no significant increases in health service related costs of admissions.…”

Health care use and treatment-seeking for depression symptoms in rural India: A descriptive cross-sectional analysis

“…Adults with high levels of depression symptoms are likely to be in contact with health services, but their primary complaints are rarely the depression symptoms listed in the PHQ-9. This echoes previous findings from India that depressed individuals frequently present to health services with somatic symptoms (11,12,(40)(41)(42). Therefore, the most important challenge from a public health perspective appears not to be to persuade depressed individuals to visit services, but rather to enable health workers to recognise their mental health needs during consultations about other complaints.…”