title: Mental illness, poverty and stigma in India: a case-control study.
abstract: OBJECTIVE
  To assess the effect of experienced stigma on depth of multidimensional poverty of persons with severe mental illness (PSMI) in Delhi, India, controlling for gender, age and caste.
  
  
  METHODS
  Matching case (hospital)-control (population) study.
  
  
  METHODS
  University Hospital (cases) and National Capital Region (controls), India.
  
  
  METHODS
  A case-control study was conducted from November 2011 to June 2012. 647 cases diagnosed with schizophrenia or affective disorders were recruited and 647 individuals of same age, sex and location of residence were matched as controls at a ratio of 1:2:1. Individuals who refused consent or provided incomplete interview were excluded.
  
  
  METHODS
  Higher risk of poverty due to stigma among PSMI.
  
  
  RESULTS
  38.5% of PSMI compared with 22.2% of controls were found poor on six dimensions or more. The difference in multidimensional poverty index was 69% between groups with employment and income of the main contributors. Multidimensional poverty was strongly associated with stigma (OR 2.60, 95% CI 1.27 to 5.31), scheduled castes/scheduled tribes/other backward castes (2.39, 1.39 to 4.08), mental illness (2.07, 1.25 to 3.41) and female gender (1.87, 1.36 to 2.58). A significant interaction between stigma, mental illness and gender or caste indicates female PSMI or PSMI from 'lower castes' were more likely to be poor due to stigma than male controls (p<0.001) or controls from other castes (p<0.001).
  
  
  CONCLUSIONS
  Public stigma and multidimensional poverty linked to SMI are pervasive and intertwined. In particular for low caste and women, it is a strong predictor of poverty. Exclusion from employment linked to negative attitudes and lack of income are the highest contributors to multidimensional poverty, increasing the burden for the family. Mental health professionals need to be aware of and address these issues.
authors.affiliation: Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Trani
authors.affiliation: Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St Louis, Missouri, USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Bakhshi
authors.affiliation: Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Kuhlberg
authors.affiliation: Department of Psychiatry & De-addiction Services, Resource Centre for Tobacco Control, PGIMER- Dr. Ram Manohar Lohia Hospital, New Delhi, India.
authors.forename: Sreelatha S
authors.initials: SS
authors.lastname: Narayanan
authors.affiliation: Nijmegen School of Management, Radboud University, Nijmegen, Netherlands.
authors.forename: Hemalatha
authors.initials: H
authors.lastname: Venkataraman
authors.affiliation: Department of Psychiatry & De-addiction Services, Resource Centre for Tobacco Control, PGIMER- Dr. Ram Manohar Lohia Hospital, New Delhi, India.
authors.forename: Nagendra N
authors.initials: NN
authors.lastname: Mishra
authors.affiliation: Leonard Cheshire Chair, Director, Leonard Cheshire Disability & Inclusive Development Centre, Division of Epidemiology and Public Health University College London, London, UK.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Groce
authors.affiliation: UCL School of Life and Medical Sciences, University College London, London, UK.
authors.forename: Sushrut
authors.initials: S
authors.lastname: Jadhav
authors.affiliation: Department of Psychiatry & De-addiction Services, Resource Centre for Tobacco Control, PGIMER- Dr. Ram Manohar Lohia Hospital, New Delhi, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Deshpande
mesh_terms: D016022:Case-Control Studies; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D007194:India; D008297:Male; D028642:Persons with Psychiatric Disorders; D019964:Mood Disorders / Q000191:economics*; D011203:Poverty; D012424:Rural Population; D012559:Schizophrenia / Q000191:economics*; D012737:Sex Factors; D012923:Social Class; D057545:Social Stigma
keywords: MENTAL HEALTH; PUBLIC HEALTH