Ever-Married Women's Enabling Resources and Generalized Anxiety in Minya, Egypt Open Access

Abstract

Gender disparities in mental health are evident across the globe, with women experiencing
higher rates of depression, anxiety disorders, and suicide attempts in comparison to men.
Women's low social status is thought to underlie some of these disparities in mental health, yet
empirical evidence in Arab and Middle Eastern settings is limited. In this study, we explore the
relationship between ever-married women's acquired patriarchal and human and economic
enabling resources and their generalized anxiety in Minya, Egypt. We hypothesize that both
types of enabling resources are associated with lower generalized anxiety. We conceptualize two
pathways through which women may achieve better mental health: empowerment and strategic
conformity to local systems of patriarchy. We hypothesize that women's agency and exposure to
intimate partner violence (IPV) mediate the relationship between enabling resources and
generalized anxiety. Using secondary data from the 2005 Egyptian Demographic Health Survey
(EDHS) and a 2012 follow-up survey, we performed bivariate and linear regressions to assess
the associations between women's enabling resources, agency, and exposure to IPV at their time
of marriage and their generalized anxiety at the 2012 follow-up.

Women's work before marriage, schooling, and proximity to natal family are significantly
associated with lower generalized anxiety. Women's agency and IPV status do not mediate the
relationship between women's enabling resources and generalized anxiety. Women's agency has
mixed associations with generalized anxiety, and exposure to IPV is associated with higher
generalized anxiety. Women's empowerment is the primary pathway through which women
achieve lower generalized anxiety. There is not sufficient evidence to support the strategic
conformity to patriarchy pathway. Women's access to social support, education, and work before
marriage are imperative to their mental health and generalized anxiety specifically. Our results
can prompt gender-equity development projects to focus on increasing women's access to these
enabling resources. Empowerment projects should continue to focus on women's schooling and
entering women into the workplace. More emphasis should be made on building women's social
support networks, particularly between the woman and her natal family.

Table of Contents

Table of Contents
Introduction ................................................................................................................................... 1
Rationale………………………………………………………………………………………..1
Problem statement……………………………………………………………………………...1
Purpose statement………………………………………………………………………………3
Research hypotheses……………………………………………………………………………4
Significance statement………………………………………………………………………….4
Comprehensive Review of the Literature ................................................................................... 6
Women's empowerment pathway………………………………………………………………6
Human and economic enabling resources……………………………………………………...7
Strategic conformity pathway………………………………………………………………...10
Patriarchal resources………………………………………………………………………….12
Women's agency………………………………………………………………………………15
Intimate partner violence……………………………………………………………………...16
Confounders…………………………………………………………………………………..17
Manuscript……………………………………………………………………...……………….19
Title page………………………………………………………………………………………19
Contribution of student .............................................................................................................. 20
Abstract ..................................................................................................................................... 21
Introduction ............................................................................................................................... 22
Background ............................................................................................................................... 23
Women's mental health…………………………………………………………………..23
Women's empowerment pathway………………………………………………………..24
Human and economic enabling resources………………………………………………..24
Strategic conformity pathway……………………………………………………………26
Patriarchal resources……………………………………………………………………..27
Women's agency…………………………………………………………………………29
Intimate partner violence………………………………………………………………...29
Confounders……………………………………………………………………………..30
Research hypotheses…………………………………………………………………….30
Methods ..................................................................................................................................... 32
Setting……………………………………………………………………………………32
Sample……………………………………………………………………………………32
Data collected…………………………………………………………………………….33
Variables…………………………………………………………………………………35
Analysis………………………………………………………………………………….37
Results ....................................................................................................................................... 39
Characteristics of the sample…………………………………………………………….39
Bivariate results………………………………………………………………………….39
Multivariate results………………………………………………………………………40
Discussion ................................................................................................................................. 42
Summary…………………………………………………………………………………42
Limitations……………………………………………………………………………….44
Conclusion……………………………………………………………………………….45
References ................................................................................................................................. 47
Tables and Figures .................................................................................................................... 53
Conclusion and Recommendations ........................................................................................... 57
Summary……………………………………………………………………………………….57
Recommendations for future research…………………………………………………………59
Policy implications……………………………………………………………………………..60
References .................................................................................................................................... 61
List of Tables and Figures
Figure 1: Resources, Agency, and Women's Mental Health……………………………………53
Table 1: Descriptive statistics, 539 Ever-Married Women Aged 22-65 Years
in Minya, Egypt………………………………………………………………...............54
Table 2: Bivariate associations between generalized anxiety and enabling
resources, agency, and IPV, 539 Ever-Married Women Aged 22-65
Years in Minya, Egypt………………………………………………………………….55
Table 3: Linear models of the relationship between enabling resources, agency,
IPV, and generalized anxiety, 539 Ever-Married Women Aged 22-65
Years in Minya, Egypt………………………………………………………………….56

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General Health Sciences, Mental Health
Keyword	empowerment enabling resources generalized anxiety mental health
Committee Chair / Thesis Advisor	Yount, Kathryn, Emory University
Committee Members	Zureick Brown, Sarah M, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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