title: Poor mental health in Ghana: who is at risk?
abstract: BACKGROUND
  Poor mental health is a leading cause of disability worldwide with considerable negative impacts, particularly in low-income countries. Nevertheless, empirical evidence on its national prevalence in low-income countries, particularly in Africa, is limited. Additionally, researchers and policy makers are now calling for empirical investigations of the association between empowerment and poor mental health among women. We therefore sought to estimate the national prevalence of poor mental health in Ghana, explore its correlates on a national level, and examine associations between empowerment and poor mental health among women.
  
  
  METHODS
  We conducted a cross-sectional analysis using data from a nationally representative survey conducted in Ghana in 2009-2010. Interviews were conducted face-to-face with participants (N = 9,524 for overall sample; n = 3,007 for women in relationships). We used the Kessler Psychological Distress Scale (K10) to measure psychological distress and assessed women's attitudes about their roles in decision-making, attitudes towards intimate partner violence, partner control, and partner abuse. We used weighted multivariable multinomial regression models to determine the factors independently associated with experiencing psychological distress for our overall sample and for women in relationships.
  
  
  RESULTS
  Overall, 18.7% of the sample reported either moderate (11.7%) or severe (7.0%) psychological distress. The prevalence of psychological distress was higher among women than men. Overall, the prevalence of psychological distress differed by gender, marital status, education, wealth, region, health and religion, but not by age or urban/rural location. Women who reported having experienced physical abuse, increased partner control, and who were more accepting of women's disempowerment had greater likelihoods of psychological distress (P-values < 0.05).
  
  
  CONCLUSIONS
  Psychological distress is substantial among both men and women in Ghana, with nearly 20% having moderate or severe psychological distress, an estimate higher than those found among South African (16%) or Australian (11%) adults. Women who are disempowered in the context of intimate relationships may be particularly vulnerable to psychological distress. Results identify populations to be targeted by interventions aiming to improve mental health.
authors.affiliation: Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA. Heather.sipsma@yale.edu
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.forename: Angela
authors.initials: A
authors.lastname: Ofori-Atta
authors.forename: Maureen
authors.initials: M
authors.lastname: Canavan
authors.forename: Isaac
authors.initials: I
authors.lastname: Osei-Akoto
authors.forename: Christopher
authors.initials: C
authors.lastname: Udry
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D015995:Prevalence; D036301:Qualitative Research; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D014930:Women / Q000523:psychology*
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