“HOW CAN WE SHARE WHEN WE DON’T GO OUT?” PSYCHOSOCIAL SUPPORT GROUPS FOR NORTH INDIAN WOMEN

Abstract

Background: Although major depression is one of the leading causes of premature death and disability in India, there is little infrastructure to provide mental health services in the rural North Indian state of Uttarakhand. The worldwide burden of depression is 50% higher in women than men, however Indian women experience the double burden of gender disadvantage and poverty which restricts their autonomy and access to social support, and increases their risk for common mental disorders (CMDs). In this low resource setting, community mental health (CMH) models of care may offer the best approach to supporting women with CMDs.

Objective: This study partnered with a local NGO in Uttarakhand to examine the factors influencing women’s participation in psychosocial support groups (PSSGs), and the groups’ impact on the women and their communities. PSSGs had been set up in the communities for a minimum of 6 months.

Methodology: Focused ethnographic research was conducted over three months in 2016, involving ten focus group discussions (FGDs) with seven unique PSSGs, representing a total of 43 women. FGDs were conducted with PSSGs that had been active a minimum of 6 months. They included both persons with psychosocial disability and their caregivers, primarily divided into separate PSSGs. FGDs were conducted across three different sites, with predominantly Muslim and Hindu populations. Additionally, eight key informant interviews were conducted with community health workers and mental health professionals. Data was translated and transcribed from Hindi to English.

Results: The principal barrier to PSSG participation was gender inequality, more specifically, women not being granted permission to leave the home to participate. In terms of impact, the women explained how learning and talking about their own depression and anxiety increased their knowledge and improved their mental health. PSSGs created safe social spaces for women to talk, which increased women’s confidence to speak freely in their community. As a result of the PSSGs, women felt that they had reimagined their roles as community members, shifting from the role of receiver of help to provider. Communities were impacted by the PSSGs as women shared their mental health (MH) knowledge widely, and referred and accompanied community members to MH services.

Discussion: These findings are significant because women in PSSGs were able to work together to improve their MH in the context of high gender inequality and mental health stigma. Greater ability to speak out and act collectively may empower women to contribute to household and community decisions, and participate economically, advancing their health and social interests. This research demonstrates how PSSGs can benefit not only the women involved but their community and its mental health. It highlights the importance of understanding models for CMH services that build on local resources and can serve as a model for other underserved communities.