title: Education Mitigates the Relationship of Stress and Mental Disorders Among Rural Indian Women.
abstract: Common mental disorders (CMD) are a constellation of mental health conditions that include depression, anxiety, and other related nonpsychotic affective disorders. Qualitative explanatory models of mental health among reproductive-aged women in India reveal that distress is strongly associated with CMD. The relationship of perceived stress and CMD might be attenuated or exacerbated based on an individual's sociodemographic characteristics.
  
  
  
  To screen for Common Mental Disorders (CMD) among reproductive-aged women from rural western India and explore how the relationship between perceived stress and CMD screening status varies by sociodemographic characteristics.
  
  
  
  Cross-sectional survey of 700 women from rural Gujarat, India. CMD screening status was assessed using Self-Reported Questionnaire 20 (SRQ-20). Factors associated with CMD screening status were evaluated using multivariable logistic regression. Effect modification for the relationship of perceived stress and CMD screening status was assessed using interaction terms and interpreted in terms of predicted probabilities.
  
  
  
  The analytic cohort included 663 women, with roughly 1 in 4 screening positive for CMD (157, 23.7%). Poor income, low education, food insecurity, and recurrent thoughts after traumatic events were associated with increased risk of positive CMD screen. Perceived stress was closely associated with CMD screening status. Higher education attenuated the relationship between high levels of stress and CMD screening status (82.3%, 88.8%, 32.9%; P value for trend: 0.03). Increasing income and age attenuated the link between moderate stress and CMD.
  
  
  
  Our findings suggest a high burden of possible CMD among reproductive-aged women from rural western India. Higher education might mitigate the association between elevated stress and CMD. Future efforts to improve mental health in rural India should focus on preventing CMD by enhancing rural women's self-efficacy and problem-solving capabilities to overcome challenging life events and stressors, thereby reducing the risk of CMD.
authors.affiliation: Des Moines University, Des Moines, IA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Fahey
authors.affiliation: University of Massachusetts, Worcester, MA. Electronic address: Apurv.Soni@umassmed.edu.
authors.forename: Apurv
authors.initials: A
authors.lastname: Soni
authors.affiliation: University of Massachusetts, Worcester, MA.
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.affiliation: Pramukhswami Medical College, Gujarat, India.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Vankar
authors.affiliation: Pramukhswami Medical College, Gujarat, India.
authors.forename: Anusha
authors.initials: A
authors.lastname: Prabhakaran
authors.affiliation: University of Massachusetts, Worcester, MA.
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Moore Simas
authors.affiliation: University of Massachusetts, Worcester, MA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Byatt
authors.affiliation: Pramukhswami Medical College, Gujarat, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Phatak
authors.affiliation: Boston University, Boston, MA.
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Keefe
authors.affiliation: Pramukhswami Medical College, Gujarat, India.
authors.forename: Somashekhar
authors.initials: S
authors.lastname: Nimbalkar
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005523:Food Supply; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D008403:Mass Screening; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008603:Mental Health; D012424:Rural Population / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: SRQ-20; common mental disorders; epidemiology; perceived stress; rural India; women's health