title: An approach to mental health in low and middle income countries: a case example from urban India.
abstract: Women in low and middle income countries (LMICs) facing poverty, challenging living conditions and gender inequality often express their emotional difficulties through physical health concerns and seek care at primary health facilities. However, primary care providers in LMICs only treat the physical health symptoms and lack appropriate services to address women's mental health problems. This paper, presents data from the counseling component of a multilevel, research and intervention project in a low income community in Mumbai, India whose objective was to improve sexual health and reduce HIV/STI risk among married women. Qualitative data from counselor notes shows that poor mental health, associated with negative and challenging life situations, is most often expressed by women as gynecological concerns through the culturally-based syndrome oftenshun. A path analysis was conducted on baseline quantitative data that confirmed the relationships between sources oftenshum, emotional status and symptoms of common mental disorders (CMDs). Based on these findings, the authors propose a need for culturally appropriate primary care services for LMICs that would integrate mental and physical health. This approach would reduce mental health morbidity among women through early intervention and prevention of the development of CMDs.
authors.affiliation: Centre for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai, India.
authors.forename: Shubhada
authors.initials: S
authors.lastname: Maitra
authors.affiliation: Department of Anthropology, University of Connecticut, 354 Mansfield Road, Unit 2176, Storrs, CT 06269.
authors.forename: Marie A
authors.initials: MA
authors.lastname: Brault
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Schensul
authors.affiliation: Institute for Community Research, Hartford, CT.
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Schensul
authors.affiliation: Department of Psychology, 2007 Percival Stern Hall, 6400 Freret St., Tulane University New Orleans, LA 70118.
authors.forename: Bonnie K
authors.initials: BK
authors.lastname: Nastasi
authors.affiliation: International Center for Research on Women (ICRW), C-59, South Extension Part-II, New Delhi-110049.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Verma
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Burleson
keywords: India; counseling; gynecological problems; mental health; tension
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