According to WHO, mental health is “a state of well-being in which every individual realizes his
or her own potential, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to her or his
community.”As is evident from
the above, mental health disorders are also becoming an increasingly important public
health problem in the low-income countries, thanks to the fall-outs from the very
competitive globalized economy as well as the socio-politcal instability which
is a spin off from the former. The magnitude of the problem is reflected in the
Call by WHO (2014) for... ‘the promotion, protection and restoration’ of mental
health so that we can ‘think, emote, interactwith each other, earn a living and
enjoy life.’
Besides biological and psychological factors, various social,economic and
environmental factors (‘conditions in which
people are born, grow, live, work, and age’) also come into play to determine mental health status, together
called the ‘social determinant of mental health’. These determinants act
throughout the life-cycle starting from in-utero to old age. These determinants
or risk factors for disorder(s) of mental health include poverty and exclusion,
education, gender and violence, employment status, work and living environment,
and social capital.
Poverty, exclusion, education and mental health
In low-(and middle-)income
countries [henceforth, LAMICs], poverty and exclusion is intimately associated
with common mental health disorders such as anxiety and depression. Poverty
results in economic deprivation, income in-equalities, and poor level of
education; and thus, low probability of gainful employment and high probability
of indebtedness, ultimately leading to mental disorders. These two are related
in a vicious circle: poverty perpetuates mental disorders and the latter interferes
with engagement in productive activities and income-earning, therefore
exacerbating poverty.
Unemployment and mental health
Unemployment is both a
consequence and a cause of illness, including mental illness. Unemployment
leads to deterioration of both physical and mental health, more of the latter
including suicide,and long-term unemployment causes a higher burden of mental
illnesses compared to short-term unemployment, the burden of illness increasing
with the duration of unemployment. It has been found that
unemployment leaves a long-term “scarring effect” on mental health of the
individual. This deleterious effect of unemployment on mental health
is especially prominent in countries with low level of economic development
including absence of appropriate safety net for the unemployed.
Work environment and mental health
Work
or engagement in gainful activities can be beneficial for an individual’s
overall well-being including mental wellbeing, especially if the work
environment is favourable and the supervision is good. It is also identified
with providing one with sense of purpose and social identity, and opportunities
for personal development, which again, is crucial for mental well-being. In organizational environment, issues such as ‘overwork,
lack of clear instructions, unrealistic deadlines, lack of decision-making, job
insecurity, isolated working conditions, surveillance, and inadequate child-care
arrangements’ produce job stress, and consequent common mental disorders and
reduced productivity, especially in low-income settings.
Living environment and mental health
A healthy environment and
living arrangement is essential for better health including mental health.
External environment may determine exposure to various physical,
biological or chemical pollutants, producing health effects such as accidents/injury
(direct)and bronchial asthma from air pollution (indirect). Housing
or built environment has effects on mental health, either directly (e.g.,
increasing psychological distress) or indirectly (e.g., altering psychosocial
processes with known mental health affects), through elevating the stress level
and its consequences.
Gender, violence and mental health
Women’s
experiences of social, economic and environmental factors are different from
men including the level of stress of everyday life, and as such, they tend to
have higher levels of common mental disorders (e.g., depression) compared to
men, at every level of household income. Also, society’s negative
attitude towards mental disorders e.g., stigma, is more dominant in case of
women which interferes with their connectivity with the society at large.
Depression
during pregnancy, both ante-partum and post-partum, is very common in women in
low income countries and affects infant and child growth and nutritional status.
Violence/intimate partner violence has been implicated for all forms of mental
disorders (anxiety, depression, suicide attempts and post-traumatic stress
syndrome) in low-income countries like Bangladesh Rwanda, Ghana, India.
Social capital and mental health
Social capital plays a
significant role for people’s health and well-being in resource-poor settings,
e.g., in LMICs. It works both as a source of health information in
times of need and also, as a safety net in absence of formal financial
resources. There is an inverse relationship between levels of social
capital and occurrence of common mental disorders in times of peace, and
disaster. Individual level of social capital (e.g., level of trust
and harmony in the society) in women and men has been shown to be inversely associated
with common mental disorders in diverse low-income settings such as Peru,
Ethiopia, Vietnam, and Andhra Pradesh of India, Bangladesh, and Vietnam.
Conclusions
For
people of low-income countries, poverty is all pervasive and affects physical
as well as mental health in various ways. Any attempt to ameliorate mental illnesses
calls for attention to these important social determinants and take appropriate
measures to overcome adverse conditions.
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