title: The psychological toll of slum living in Mumbai, India: a mixed methods study.
abstract: In India, "non-notified" slums are not officially recognized by city governments; they suffer from insecure tenure and poorer access to basic services than "notified" (government-recognized) slums. We conducted a study in a non-notified slum of about 12,000 people in Mumbai to determine the prevalence of individuals at high risk for having a common mental disorder (i.e., depression and anxiety), to ascertain the impact of mental health on the burden of functional impairment, and to assess the influence of the slum environment on mental health. We gathered qualitative data (six focus group discussions and 40 individual interviews in July-November 2011), with purposively sampled participants, and quantitative data (521 structured surveys in February 2012), with respondents selected using community-level random sampling. For the surveys, we administered the General Health Questionnaire-12 (GHQ) to screen for common mental disorders (CMDs), the WHO Disability Assessment Schedule 2.0 (WHO DAS) to screen for functional impairment, and a slum adversity questionnaire, which we used to create a composite Slum Adversity Index (SAI) score. Twenty-three percent of individuals have a GHQ score≥5, suggesting they are at high risk for having a CMD. Psychological distress is a major contributor to the slum's overall burden of functional impairment. In a multivariable logistic regression model, household income, poverty-related factors, and the SAI score all have strong independent associations with CMD risk. The qualitative findings suggest that non-notified status plays a central role in creating psychological distress-by creating and exacerbating deprivations that serve as sources of stress, by placing slum residents in an inherently antagonistic relationship with the government through the criminalization of basic needs, and by shaping a community identity built on a feeling of social exclusion from the rest of the city.
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, Maharashtra, India; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: ramnath.sub@gmail.com.
authors.forename: Ramnath
authors.initials: R
authors.lastname: Subbaraman
authors.affiliation: Office of Population Research, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Nolan
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, Maharashtra, India.
authors.forename: Tejal
authors.initials: T
authors.lastname: Shitole
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, Maharashtra, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Sawant
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, Maharashtra, India.
authors.forename: Shrutika
authors.initials: S
authors.lastname: Shitole
authors.affiliation: University of California at San Francisco Global Health Sciences, San Francisco, CA, USA.
authors.forename: Kunal
authors.initials: K
authors.lastname: Sood
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, Maharashtra, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Nanarkar
authors.affiliation: University of California at San Francisco Global Health Sciences, San Francisco, CA, USA; Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Jess
authors.initials: J
authors.lastname: Ghannam
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Bloom
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, Maharashtra, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Patil-Deshmukh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D006304:Health Status; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011204:Poverty Areas; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Common mental disorders; Depression; India; Informal settlements; Mental health; Poverty; Slums; Urban