title: Gender inequality and structural violence among depressed women in South India.
abstract: OBJECTIVE
  While exploring experiences of psychological distress among psychiatric outpatients in Southern India, we set out to further understand interpersonal and socio-cultural factors that are associated with depressive symptoms.
  
  
  METHODS
  Using a grounded theory framework, we thematically coded narrative accounts of the women who sought treatment at the psychiatric clinic. In addition, we included author notes from participant observation and field work experiences in the South Indian psychiatric clinic.
  
  
  RESULTS
  Of the 32 women who participated in the study, 75 % qualified for a diagnosis of a current major depressive episode. Depressive symptoms were associated with experiences of domestic violence and, in Farmer's terms, structural violence. Although only a partial response to gender-based suffering, allopathic psychiatric treatment seemed the best available means of coping with their circumstances.
  
  
  CONCLUSIONS
  The paper moves beyond a medicalized model of disease and behavior to explore social and contextual factors that enabled these women to brave additional stigmas surrounding psychiatric treatment and seek a better outcome for themselves. It concludes by discussing the need for a multi-layered approach to addressing the suffering that women in South India experience.
authors.affiliation: Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, WA 98104, USA. deeparao@uw.edu
authors.forename: Deepa
authors.initials: D
authors.lastname: Rao
authors.forename: Randall
authors.initials: R
authors.lastname: Horton
authors.forename: R
authors.initials: R
authors.lastname: Raguram
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D003863:Depression / Q000208:ethnology / Q000523:psychology*; D017579:Domestic Violence / Q000208:ethnology / Q000523:psychology*; D005260:Female; D005783:Gender Identity; D006801:Humans; D007194:India; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008875:Middle Aged; D036301:Qualitative Research; D012737:Sex Factors; D057545:Social Stigma; D012959:Socioeconomic Factors