Mental Illness and Pregnancy among Women in Mysore, India: Health Provider and Women’s Perspectives Open Access

Prasad, Ruhika (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/5q47rp80v?locale=en
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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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