|Year : 2022 | Volume
| Issue : 4 | Page : 344-350
Prevalence of depression and its determinants among women of the reproductive age group in a rural area of Tamil Nadu - A community-based cross-sectional study
Sahaya Sona Thresa1, Logeswari Krishnamurthy2, T Swetha3, Karthik Shakthi Pandraveti4, S Indra Bala3
1 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai (Sri Balaji Vidyapeeth, Pondicherry), Thiruporur-Guduvanchery Main Road, Kottamedu P.O, Chengalpattu District, Tamil Nadu, India
2 Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospitals, Siruvachur, Perambalur District, Tamil Nadu, India
3 Department of Community Medicine, Sri Muthukumaran Medical College Hospital and Research Institute, Mangadu, Chennai, Tamil Nadu, India
4 Department of General Medicine, Meenakshi Medical College and Research Institute, Enathur, Kancheepuram District, Tamil Nadu, India
|Date of Submission||28-May-2022|
|Date of Acceptance||17-Oct-2022|
|Date of Web Publication||17-Mar-2023|
Dr. S Indra Bala
Department of Community Medicine, Sri Muthukumaran Medical College Hospital and Research Institute, Mangadu, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Mental health is a state of harmony between oneself and one's surrounding. According to the Indian Ministry of Health and Family Welfare, it is estimated that by 2020, depression will be the major cause of morbidity next to cardio-vascular disease in India. More than 90% of these cases remain untreated because of various factors such as social stigma, economical factors, and lack of awareness among the general public. Hence, this study was planned owing to the emerging mental health problems especially among women with an aim to estimate the prevalence of depression among women in rural areas and to identify the various determinants of depression.
Materials and Methods: A community-based cross-sectional analytical study was conducted among women of the reproductive (15–45 years) age group residing in Sembakkam village for a period of 2 years using a semi-structured validated schedule after obtaining informed consent. Becks depression inventory scale was used for estimating the prevalence of depression. Data were analyzed using the Statistical package for social sciences (SPSS) version 23.0.
Results: The prevalence of depression was found to be 17.9%. Socio-economic statuses of the respondents and religion were found to be statistically significant with depression. Among women with depression, 96.1% of them did not have any disputes with their family members, but 19.4% of their family members were alcoholics.
Conclusion: Psycho-social and socio-demographic determinants were found to be important determinants of depression. Interventions focused on tackling these determinants and maintaining a positive outlook will help in averting depression.
Keywords: Depression, reproductive age group, rural, women
|How to cite this article:|
Thresa SS, Krishnamurthy L, Swetha T, Pandraveti KS, Bala S I. Prevalence of depression and its determinants among women of the reproductive age group in a rural area of Tamil Nadu - A community-based cross-sectional study. J NTR Univ Health Sci 2022;11:344-50
|How to cite this URL:|
Thresa SS, Krishnamurthy L, Swetha T, Pandraveti KS, Bala S I. Prevalence of depression and its determinants among women of the reproductive age group in a rural area of Tamil Nadu - A community-based cross-sectional study. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Mar 21];11:344-50. Available from: https://www.jdrntruhs.org/text.asp?2022/11/4/344/371745
| Introduction|| |
Mental health includes psychological, emotional, and social well-being. It affects the way we feel, think, and act. It plays a major role in handling relationships and stress in our day-to-day life and is also important for making the right choices and wise decisions. It is very important in every walk of life.
Depressive disorder ranks first among non-fatal health loss, which is about 7.5% of all years lost in disability (YLD). The estimate in American Nations in 2015 showed that about 16.1 million adults over 18 years of age had suffered at least one episode of major depression, which is about 6.7% of the total US population. According to World Health Organization (WHO), for the African region, one in six among the African population suffers from mental illness. In the Southeast Asian region, the prevalence of depression is found to be around 23% according to WHO Global Burden of Diseases. The WHO report for India said that from 2005 to 2015, there had been 18.4% increase in the population who were suffering from depression.
According to the Indian Ministry of Health and Family Welfare, it was estimated that by 2020, depression will be the major cause of morbidity next to cardio-vascular disease in India. More than 90% of these cases remain untreated because of various factors such as social stigma, economical factors, and lack of awareness among the general public. Hence, this study was planned owing to the emerging mental health problems, especially among women, with an aim to estimate the prevalence of depression among the women residing in a rural area and also to identify the various factors contributing to depression.
| Materials and Methods|| |
A community-based analytical cross-sectional study was conducted for a duration of 2 years among women of the reproductive (15–45 years) age group in the rural field practice area of a tertiary care hospital.
Sampling technique – Multi-stage sampling
Every street in the village was covered systematically. If the house was found to be closed on three consecutive visits on three different days, then that house was excluded and the next house was selected without disturbing the sequence till the required sample size was achieved.
All women of the reproductive age group (15–45 years) and who gave an informed written consent.
Those women with other mental disorders excluding depression and not willing to give a written informed consent.
All women who satisfied the inclusion criteria were interviewed face to face with a semi-structured schedule after getting an informed written consent. If more than one woman who satisfied the inclusion criteria was residing in a house, then they were also interviewed after taking a written informed consent. The sample size was calculated based on a study conducted in Thiruvallur district, which reported the prevalence of depression to be 39.7%. by using the formula n = 4 pq/d2. Assuming 10% as non-response rate, the final sample size (n) was calculated as 670.
The data collection instrument was adopted from Becks inventory scale for depression. Based on the study objectives, a pre-tested semi-structured schedule which was originally in English was translated into Tamil and was back-translated by a third person other than the investigators to check the validity of the schedule.
The schedule consisted of two parts. The first part consisted of basic socio-demographic details such as name, age, address, occupation, religion, income of the family, number of members in the family, and their health conditions and question for pre-menstrual, post-partum mood swings, alcoholism, verbal or physical abuse, and relationship with the husband and other family members. The second part consisted of questions to rule out depression. Pilot testing was performed on 65 women, and the schedule was appropriately modified accordingly. The results of the pilot study were not included in the final analysis.
Institutional Human Ethics Committee permission for the study was obtained before the initiation of the study. Privacy and confidentiality were maintained.
Data were entered in Microsoft Excel and analyzed using the Statistical package for social sciences (SPSS) version 23.0. Descriptive statistics such as frequency and percentage were calculated. Association between various study variables was calculated using the Chi-square test, and a P value less than 0.05 was considered statistically significant.
| Results|| |
The prevalence of depression in women of the reproductive age group was found to be 17.9%.
A milder form of depression was seen in 11.64% of the respondents, whereas 4.3% and 1.9% respondents had borderline and moderate depression, respectively. Severe depression needing referral and treatment was found in only 0.1% of the participants as shown in [Figure 1].
[Table 1] shows that the median age of the study participants was 31.5 years (±8.48). The majority of the participants were residing in a pucca house (57.6%), the next majority were residing in kutcha houses (18.35%), and the rest were residing in semi-pucca houses (24.47%). It was observed that 62.5% of the women have got more than two children and 2.7% of the married women have got more than three children. In those who were having children, 37.76% had only girl children and 46.1% were having at least one male child.
|Figure 2: Prevalence of depression among the study participants (n = 670)|
Click here to view
[Table 2] shows that 37.9% of the women belonging to the 35–45 years age group were suffering from depression. 93.2% of the women who were following Hinduism were having depression manifestations. Depression was found in 32% of the women who had completed their secondary schooling. Among married women with depression, 64.1% of them were living with their husbands. While analyzing the depression and religion, it was found that religion was statistically significant with depression (p 0.04). Depression and socio-economic status of the study participants were found to be statistically significant (p < 0.01). Other than religion and socio-economic status, none of the parameters such as age, education, occupation, marital status, or type of family showed any statistical significance with depression.
|Table 2: Association between Various Socio-Demographic Parameters and Depression Among Study Participants (N = 670)|
Click here to view
[Table 3] shows the association between various psycho-social parameters. About 1.0% of the women who were suffering from depression had marital distress. 96.1% of the women who were manifesting depression were found to be having a cordial relationship with the husband and the family members, 2.9% of the women were experiencing some form of abuse either physically or verbally, and 1.9% of the women were the primary care givers for their family members with chronic illness. There was no association between psycho-social parameters such as marital distress, cordial relationship status of study participants with the family members or the husband, experiencing physical or verbal abuse, alcoholism in any of the family member, and a care taker for chronically ill family members with the presence of depression.
|Table 3: Association between Various Psycho-Social Parameters and Depression Among Study Participants|
Click here to view
| Discussion|| |
This community-based cross-sectional study was conducted to determine the prevalence of depression among the women of the reproductive age group in a rural area of Kancheepuram district, Tamil Nadu. The prevalence of depression was found to be 17.9% among the study population. The data published by WHO on “global estimates of depression and other common mental disorders” showed that the estimate of depression was found to be 27% in the South-East Asian Region. They were cumulative data of many countries; hence, the estimate might be more when compared to our study conducted in the rural area. In the same study, the estimate for India was 4.5%, which was less when compared to the present study. The high prevalence in the present study may be because of socio-demographic variations. In studies conducted in Brazil and Korea, the prevalence of depression was found to be 14% and 11%, respectively, which are less when compared to the present study., This difference reported may be because of the difference in socio-demographic pattern, the cultural practices and beliefs, and also the inclusion of both the genders as study participants.
In the present study, 37.9% of the women belonging to the 35–45 years age group were suffering from depression. In a study conducted among Korean adults, it was observed that 11.3% in the age group of 40–49 years and 9.6% in the age of 30–39 years were suffering from depression, which were less compared to our study. The difference may be attributed to the factor that the study conducted among Korean adults represents only people with definitive depressive symptoms and also includes women above 45 years. In the current study, 93.2% of the women belonging to Hindu religion and 6.8% of the women belonging to Christianity were found to have depression. The association between religion and depression was found to be statistically significant (p < 0.05). In a systematic review conducted in United States, it was found that 72.1% showed association between mental health and spirituality. However, no such association was observed in our study.
The prevalence of depression was found to be 44.7% in the skilled type of labor and 35.9% among unskilled laborers in this study. However, in a study conducted in Pennsylvania, United States, the prevalence was found to be between 6.9% and 16.2% based on the industry the respondents were employed in. This difference may be because of variation in the working environment. In a systematic review, conducted in United States, depressive symptoms and depression was found to be 28.8% among resident doctors. This difference may be because of variation in profession of the study participants.
In our study, depression was found among 64.1% of married women, 28.2% of unmarried women, 1.9% of women who were separated from their husbands, 2.9% of widows, and 2.9% of divorcees. Marital status and depression were not found to be statistically significant in my study. However, in a study conducted in Ludhiana among elderly participants, 7% of married and 12.8% of unmarried or widowed were found to have depression; here, the association between marital status and depression was found to be statistically significant. In one another study conducted in Ireland among the ageing population, not being married in the early life was found to be a contributing factor for the development of depression in the later part of life. However, this was not found to be statistically significant. On the other hand, among the people who were widows and divorcees (p < 0.001), the development of depression in the later part of life was found to be statistically significant. This difference may be because of variation in the study population as both the studies were performed among the elderly population.
In the present study conducted among women of the reproductive age group, 79.6% living in the nuclear family and 6.8% living in the joint family had depressive symptoms. However, in a study conducted in Ludhiana, Punjab, among the elderly, 18.2% belonging to the nuclear family and 7.6% belonging to the joint family had manifestations of depressive disorder. This variation may be because of the difference in the study group and background as the Ludhiana study had included both urban and rural populations. In our study, 52.4% of women belonging to the middle class, 1.0% belonging to the upper middle class, 26.2% belonging to the upper class, and 15.5% belonging to the lower middle class had depressive symptoms. In a study conducted in Europe, 25.2% of the poorest, 31.3% of poor, 19.3% of the middle class, 14.9% of rich, and 9.2% of the richest participants in Finland had depressive symptoms. In Poland, 38.2% of the poorest, 18.1% of poor, 11.1% of the middle class, 10.8% of the richer class, and 21.9% of the richest class participants had depressive symptoms. In another country, Spain, 12.4% of the poorest class, 32.5% of the poor class, 24.2% of the middle class, 18.2% of rich, and 12.7% of the richest class participants had manifestations of depression. The European study takes into account both education and income of the household to calculate the socio-economic class, but in my study, the only parameter is per capita income of the household and this might be the reason for the difference.
In our study, 16.6% of women with two children, 16.5% of women with one child, 16.5% of women without a child, and 1% of women with more than two children had depression. The association between number of children and depression in women was not found to be statistically significant. In a study conducted among post-natal mothers in rural Nepal, the association between number of children and depression was also not statistically significant.
The prevalence of depression among the respondents with diabetes was found to be 12% in this study. However, in a study conducted in Karnataka among patients of type 2 diabetes, the value was found to be 37.5%, and this difference may be because of the variation in study area as the other study involved respondents from both urban and rural areas.
In the present study, 16.7% of the participant's husbands or some other members in the family were alcoholics and had depression. In a study conducted among pregnant women whose husbands were alcoholics, 42% of them had depression. The difference may be because of variation in the study population as the second study involved wives of alcoholics.
In our study, 2.9% of the women with depression had experienced some form of verbal or physical abuse by any of the family member or by her husband. However, in a study conducted among slum dwellers in Mumbai, 35% of the participants had experienced intimate partner violence. The difference may be because of variation in community settings. The physical abuse or verbal abuse being a causative factor for depression was found in 4.9% of the women who participated in this study. A similar study conducted in Chandigarh among wives whose husbands were alcoholics showed 80% of prevalence of physical violence. The difference in the latter study may be because it was conducted among the wives of alcoholics. In the current study, 0.9% of the women who were care givers suffered from depression. In a systematic review conducted among care givers, 75.5% had depression. The difference may be because of inclusion of women who were exclusively care givers in the latter.
The strength of this study is that this is a community-based study conducted in a rural setting and focused only on women of the reproductive age group.
The study had limitations because it was a cross-sectional study conducted only in a rural set-up and the results cannot be generalized to the entire population.
| Conclusion|| |
The prevalence of depression was found to be 17.9% in women of the reproductive age group in a rural setting of Tamil Nadu. Psycho-social and socio-demographic determinants were found to be important determinants of depression. Interventions focused on tackling these determinants, and maintaining a positive outlook will help in averting depression among this vulnerable population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aminu AS, Chandrasekaran V, Nair S. Depression among patients with diabetes: A community-basedstudy in South India. J Med Sci 2017;37:237-44. [Full text]
Bansal P, Chaudhary A, Soni RK, Sharma S, Gupta VK, Kaushal P. Depression and anxiety among middle-aged women: A community-based study. J Family Med Prim Care 2015;4:576-81.
] [Full text]
Bonelli RM, Koenig HG. Mental disorders, religion and spirituality 1990 to 2010: a systematic evidence-based review. J Relig Health 2013;52:657-73.
Clarke K, Saville N, Shrestha B, Costello A, King M, Manandhar D, et al
. Predictors of psychological distress among postnatal mothers in rural Nepal: A cross-sectional community-based study. J Affect Disord 2014;156:76-86.
Dasgupta A, Battala M, Saggurti N, Nair S, Naik DD, Silverman JG, et al
. Local social support mitigates depression among women contending with spousal violence and husband's risky drinking in Mumbai slum communities. J Affect Disord 2013;145:126-9.
Freeman A, Tyrovolas S, Koyanagi A, Chatterji S, Leonardi M, Ayuso-Mateos JL, et al
. The role of socio-economic status in depression: Results from the COURAGE (aging survey in Europe). BMC Public Health 2016;16:1098.
Govindappa L, Pankajakshi S. A community study on violence among wives of alcoholics. Delhi Psychiatry J 2014;17:323-7.
Kamiya Y, Doyle M, Henretta JC, Timonen V. Depressive symptoms among older adults: The impact of early and later life circumstances and marital status. Aging Ment Health 2013;17:349-57.
Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al
. Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA 2015;314:2373-83.
Oh DH, Kim SA, Lee HY, Seo JY, Choi BY, Nam JH. Prevalence and correlates of depressive symptoms in Korean adults: Results of a 2009 Korean community health survey. J Korean Med Sci 2013;28:128-35.
Paul CM, Stanley AM, Archanalakshmi PA. A study on the prevalence of depression among women in reproductive age group (15-49 years) in a rural population. Indian J Res 2013;2:169-72.
Silva MT, Galvao TF, Martins SS, Pereira MG. Prevalence of depression morbidity among Brazilian adults: A systematic review and meta-analysis. Braz J Psychiatry 2014;36:262-70.
Van der Lee J, Bakker TJ, Duivenvoorden HJ, Dröes RM. Multivariate models of subjective caregiver burden in dementia: A systematic review. Ageing Res Rev 2014;15:76-93.
Wulsin L, Alterman T, Timothy Bushnell P, Li J, Shen R. Prevalence rates for depression by industry: A claims database analysis. Soc Psychiatry Psychiatr Epidemiol 2014;49:1805-21.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]