International Journal of Women's Health (Mar 2023)
Factors Predicting Mental Health Among Women in Low-Income Communities of a Changing Society: A Mixed-Methods Study
Abstract
Lisa R Roberts,1 Vathsala Sadan,2 Rajeswari Siva,2 Manoranjitham Sathiyaseelan,2 Sara Emma Rosalind,2 Prema Suresh,2 Susanne B Montgomery3 1Loma Linda University School of Nursing, Loma Linda, CA, USA; 2Christian Medical College-Vellore, College of Nursing, Vellore, Tamil Nadu, India; 3Loma Linda University School of Behavioral Health, Loma Linda, CA, USACorrespondence: Lisa R Roberts, Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA, 92350, USA, Tel +1 909 558 1000, Fax +1 909 558 0719, Email [email protected]: To explore women’s mental health in India’s rapidly changing society.Participants and Methods: A convenience sample of low-income women (N = 286) in a medium-sized city in South-India participated in a mixed-methods, exploratory study in 2022. Institutional Review Board (IRB) approval was received from Loma Linda University in the US, and Christian Medical College-Vellore in India, in accordance with the declaration of Helsinki, prior to data collection. All study materials were forward and back translated for Tamil, the local language. Phase 1(n = 25) involved audio recorded key-informant interviews and focus groups. Verbatim transcripts were inductively coded, and emerging themes identified. Phase 2 (n = 261) entailed a quantitative survey including demographics, health history, and validated scales measuring mental health symptoms, coping strategies, social support, living situation, and life satisfaction. Data collectors were gender and language matched, research trained, community health nurses.Results: Qualitative themes included: 1) benefits of living in the city, 2) double duty for women doing household work and paid work, 3) challenges of living in the urban environment, 4) advantages of living in the village, 5) struggles associated with village life. Quantitative results: the average Hopkins Symptoms Checklist (HSCL) score of 1.82 (SD = 0.70) exceeded the 1.65 cut-off score for anxiety and depression symptomology. Among participants with elevated HSCL scores (n = 129) the average was markedly elevated (M = 2.39, SD = 0.56). These women were more likely to rely on wishful thinking, religious coping, and reported more post-migration living difficulties, less social support, and less satisfaction with life. Regression analysis further explored variables associated with participant HSCL scores.Conclusion: In this sample of low-income urban-dwelling women depression and anxiety symptomology was elevated. Given the limited mental health workforce and cultural stigmatization of mental health issues, further attention is required.Keywords: India, urban women, post-migration, social support, coping
