Mental Illness and Pregnancy among Women in Mysore, India: Health Provider and Women’s Perspectives Open Access
Prasad, Ruhika (Spring 2020)
Abstract
Global Mental Health (GMH), a subfield of the broader study in global health, examines how mental health affects populations across the world (WHO 2004). Identification and treatment of mental illness are heavily influenced by factors such as culture and society. Accounting for this diversity in global mental health requires understanding non-allopathic concepts of wellbeing and distress. To address the global diversity and wide variety of treatments, this study centers around mental illness in India.
As part of a collaboration between the Public Health Research Institute of India (PHRII), University of Oregon, and Emory University, this project studies how women’s mental illness was discussed and treated in urban Mysore, Karnataka over a three-month period in the summer of 2019. Researchers focused on the following questions: how do a spectrum of mental health providers in Mysore, South India, perceive and hear the experiences of their female patients’ mental illnesses? What terminologies do women use to describe their mental illness symptoms? To what extent does stigma pose a barrier for women to access treatment for mental illness? How do both providers and women perceive mental illnesses that occur during pregnancy, childbirth, and postpartum period?
The research team conducted semi-structured interviews with providers and women who were identified through a combination of PHRII’s existing community contacts, online research, and word of mouth. Researchers set up and conducted fifteen informational interviews with community mental health providers including psychiatrists, psychologists, spiritual healers, religious leaders, and NGO workers. Researchers asked providers about the range of pathologies and descriptions of symptoms they heard from patients. Further, researchers interviewed individual women recruited from focus group discussions to discuss mental illness specifically during pregnancy, childbirth, and the postpartum period. Analysis of transcripts from providers and women used a modified grounded theory approach focused on thematic analysis to identify motifs from interviews (Ryan 2003). Findings include mental health providers treating proportionately high numbers of female patients, and a common pattern of women seeking multiple religious healers and spiritual leaders while seeing psychiatrists or psychologists at the same time.
Table of Contents
Table of Contents
PREFACE 3
CHAPTER 1: INTRODUCTION 5
Definition of Mental Health and Mental Illness 5
The Burden of Mental Illness Around the World 6
Mental Illness in India: A Case Study 8
Framework of the Public Healthcare System in India 10
Mental Health Policy in India: A Timeline 13
Stigmatization 15
Alternative Forms of Treatment for Mental Illness 16
Caste Difference 18
Women’s Mental Illness in India 19
Women’s Mental and Maternal Needs in India 20
CHAPTER 2: METHODOLOGY 22
Site Description: Mysore, Karnataka, India 22
Study Overview 24
IRB Approval 24
Participant Recruitment 25
Consent Process 26
Research Procedure 27
Data Analysis 28
Individual Interviews with Community Health Providers 29
Individual Interviews with Women from Focus Group Discussions 31
CHAPTER 3: RESULTS 33
Providers’ Perspectives on Kannada Terminology for Mental Illness 33
Vattada (also known as Ottada) 34
Tension 34
Bejaru 35
Bhaiyya 36
Novu 37
Symptoms of Mental Illness Experienced by Women from Providers’ Perspective 38
Stress Caused by Marriage and Familial Problems 38
Depression, Sadness, Helplessness, and Loneliness 40
Anxiety 41
Taboo or Stigma and its Role in Accessing Treatment 43
CHAPTER 4: PREGNANCY, CHILDBIRTH, AND POSTPARTUM MENTAL ILLNESS FROM PROVIDER AND PATIENT PERSPECTIVES 46
Pregnancy from the Provider Perspective 46
Childbirth and Postpartum Experiences from the Provider Perspective 47
Pregnancy from the Female Perspective 49
News of Pregnancy 49
Later Stages of Pregnancy 50
Childbirth and Postpartum Experiences from the Female Perspective 51
Type of Delivery 51
Pain During Childbirth 53
Postpartum Healing 53
CHAPTER 5: DISCUSSION 55
CHAPTER 6: FUTURE DIRECTIONS 60
REFERENCES 62
APPENDIX I: INTERVIEW GUIDE FOR INDIVIDUAL INTERVIEWS WITH COMMUNITY
HEALTH PROVIDERS 68
APPENDIX II: INTERVIEW GUIDE FOR FOLLOW UP INTERVIEWS FROM FOCUS
GROUP DISCUSSION PARTICIPANTS 69
APPENDIX III: CONSENT FORM 71
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