Year : 2021 | Volume
: 48 | Issue : 3 | Page : 138--144
Psychosocial burdens of women in India: A narrative review
Dushad Ram1, Akash Mathew2,
1 Department of Medicine, College of Medicine, Shaqra University, Shaqra, Ar Riyadh, Saudi Arabia
2 Department of Psychology, St. Philimina College, Mysore, Karnataka, India
Dr. Dushad Ram
College of Medicine, Shaqra University, Shaqra, Ar Riyadh
Various psychosocial factors play a vital role in mental health. India's rich cultural, traditional, and social value system is well-known throughout the world. However, a considerable proportion of women are disadvantaged in these systems, and as a result, they are more likely to experience a significant psychosocial burden that affects their physical, mental, social, and spiritual well-being. These psychosocial burden also have an impact on their quality of life, personal well-being, and some fundamental human rights. In the light of the current Indian situation, this narrative review depicts the psychosocial burden that a significant proportion of Indian women are likely to face.
|How to cite this article:|
Ram D, Mathew A. Psychosocial burdens of women in India: A narrative review.J Sci Soc 2021;48:138-144
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Ram D, Mathew A. Psychosocial burdens of women in India: A narrative review. J Sci Soc [serial online] 2021 [cited 2022 Jan 26 ];48:138-144
Available from: https://www.jscisociety.com/text.asp?2021/48/3/138/333837
Mental health refers to a condition of well-being in which a person recognizes his or her own abilities, can cope with everyday challenges, work productively and fruitfully, and contribute to his or her community. It is a condition of balance that is influenced by a variety of biopsychosocial elements. The psychological burden is one of the most important variables that influence mental health. Any psychological or social event that causes severe stress is referred to as a psychosocial burden. Women in India live in a unique biopsychosocial milieu that exposes them to psychosocial burdens and is frequently accepted as a normal part of life in our socio-cultural context. There is a scarcity of research in India that specifically examines the impact of psychosocial burden on women's overall well-being. In order to explore the psychosocial burden that Indian women are likely to suffer, we conducted this narrative review. We have searched online databases with Google Scholar, Scopus, PubMed, PsycINFO, and ResearchGate for eligible articles. Google search engine was used to search for nonacademic journal-based literature and relevant articles. Literature published from 1990 to the date of this review was included. The terms inserted include women and “social factors and mental health,” “mental illness,” “psychosocial consequences and mental illness,” “mental health and reproductive health,” “quality of life,” “psychological well-being,” “burden of care,” finally “personal wellbeing,” and “human right.” Studies and articles found were collated and reviewed to extract content related to the topic of this narrative review. We have included only those studies and articles that were addressed to or relevant to the Indian population.
Social factors affecting psychological health
Poverty has a substantial link to poor mental health. Indian women are more likely to be impoverished because they are more likely to be unemployed, do unpaid domestic work, and be denied ancestral property., The second major national concern, illiteracy, particularly among women, causes a lack of awareness of healthy lifestyles, the inability to manage psychosocial problems rationally and efficiently, and a lack of mental health expertise. Poor housing and abuse (which affects up to 42% of Indian girls) have a negative impact on mental health.,, Other concerns that may have an adverse effect on mental health include gender discrimination, abortion of female fetuses, female foeticide, early marriage and childbirth, dowry practice, loss of autonomy, burden of care, poor support from in-laws, and family honor traditions.,
Common Mental Issues and Associated Psychosocial Factors
As previously mentioned, psychosocial factors have a substantial impact on mental health, and negative repercussions can be avoided.
Gender differences in utilization of mental health services
Women are more likely to obtain mental health treatments than men, and they are more likely to have various mental health issues., The treatment gap is anticipated to be greater in India due to significant stigma and a paucity of mental health services.
Significant depression affects 10%–25% of Indian women, which is ½–2 times more than men. Abuse and trauma are frequently linked to depression, as are strained relationships, a poor social standing or home environment, and their values, a lack of support system, domestic obligations, and caring for children and aging parents, etc.
Anxiety disorder, like mood disorder, affects women more than males, especially specific phobias, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Childhood abuse, physical and psychological abuse/trauma, and more anxious coping all contribute to the development of mental health problems at different stages of life.
Self-harm and suicidal behavior
Self-harm and suicidal behavior are more common among women in India than among men, notably among those who have experienced intimate partner violence, gender discrimination and bullying, stressful family and domestic life, and sexual abuse. They often do not have a support system and fewer options for dealing with stress.
Personality disorders are estimated to affect nearly half of the population, with the most frequent being borderline, histrionic, and anxious-avoidant. Unavailability of one or both parents, remarriage of the father, witnessing parental abuse by family members, and an overcontrolling child-rearing style appear to have a part in the development of personality disorder in the Indian context.
Premenstrual syndrome and postmenopausal syndrome
Premenstrual disorder affects 18%–58% of women of reproductive age. Backache, stomach bloating, sleeplessness, and widespread aches are all common symptoms. More domestic workload, tea or coffee use, early menarche, and a long menstrual cycle are all factors that may contribute to it. Menopause occurs at an average age of 45 years among Indian women, and it is connected to multipara status, substance misuse, financial issues, and a lack of support.
Perinatal mental disorders
Postpartum depression affects about 22% of women, however, patterns vary. It is the most common in the south, followed by eastern and western India. Family history of mental illness, financial issues, marital conflict, domestic violence, lack of support from spouse, female birth, and husband's alcohol usage are all common associated psychosocial factors. The prevalence of postpartum psychosis is unknown. Bipolar disorder and schizophrenia tend to be more common in those who have had a past or familial history of psychosis, or who have had psychosis during a previous pregnancy. Severe life experiences, persistent stress, and strained relationships with spouse are all common social cause.
Medically unexplained symptoms
The somatoform disorder affects about 6% of women, with those with a lower socioeconomic position and less education being more likely to be affected. Depression, anxiety disorder, and chronic fatigue syndrome are all common comorbidities. Headache, fibromyalgia, persistent pelvic pain, generalized body soreness, and exhaustion are some of the most prevalent symptoms. Women with somatoform disorder are more likely to report trauma, abuse, neglect, or violence.
Psychosocial Consequences of Mental Illness
Women with mental illnesses are more likely to be separated from society and their families, to be subjected to physical, sexual, and psychological abuse, to be neglected, and to be treated inhumanely. The majority would lose their ability to make their own decisions, and they would be denied access to health care, education, and work, as well as vocational training, career development opportunities, and community participation. Partner violence and divorce are more likely to occur in their lives.
Psychosocial Aspects of Women's Reproductive Health
During pregnancy and childbirth
During the perinatal and menstrual periods, a considerable proportion of women have a syndrome of abnormal mental health, as mentioned above. Approximately 80% of women, particularly those who have experienced abuse, have concerns and fears about their pregnancy and the challenges associated with delivering. Fears regarding maternal and infant health, childbirth pain, mode of birth, uncertainty, the future role of life, family reaction to the female child or unwanted child, pregnancy difficulties, and procedures such as cesarean section or assisted birth are all prevalent concerns. Worries, fear, and sadness may intensify in the Indian situation due to a lack of support, lack of autonomy in decision-making, insufficient antenatal care, demand for the delivery of a male baby, and a lack of proper counseling and perinatal psychological services.
Influence on fertility
Education, occupation, urban/rural residency, couple interpersonal interactions, in-law influences, preference for the child's gender, religious belief system, and family support system are all elements that mediate fertility control. In India, most choices are made by the husband, who is frequently influenced by his in-laws. Despite progress, a large percentage of pregnancies are unplanned, and women are mentally unprepared to bear a child. Women are also pressured by societal and cultural norms to have children as soon as feasible after marriage. If a woman struggles with infertility, the psychological toll can be severe. It affects roughly 8% of women and is frequently accompanied by marital conflict, abuse, a drop in sexual relationships, the need for personal adjustment, depression, anxiety, and a reduced quality of life, as well as suicidality.
About 47 abortions per 1000 women aged 15–49 years are performed. Due to stigma and socio-cultural considerations, induced pregnancy loss is more common among women who are unmarried. Another determinant of female foeticide is the desire for a male child, which is often influenced by socio-cultural variables. Almost half of women who have experienced a miscarriage suffer from posttraumatic stress disorder and depression. Most women who have experienced a miscarriage are unlikely to seek professional care for their psychological issues, and there are insufficient psychosocial resources available to them.
Aside from postmenopausal syndrome, over half of all women going through menopause have psychological issues. Irritability, anxiety, and a gloomy mood are all common psychological symptoms. Menopause is often accompanied by severe sexual dysfunction. Menopause is frequently associated with mourning for lost fertility, youth, and attractiveness, as well as a perception of being less valuable, and this is a time when women must refocus their lives. The majority of people would rarely seek psychological counseling and regard it to be a regular part of life.
Dysmenorrhea is the most frequent gynecological issue in India, affecting 50%–87.8% of women and accompanied by worry, impatience, difficulties concentrating, insomnia, forgetfulness, tension, anticipatory anxiety, and a poor quality of life. Another prevalent gynecological illness is reproductive tract infection, which affects up to 50% of all women of reproductive age. Depression, anxiety, somatoform illness, culture-bound syndrome, and sexual dysfunction are all common companions. Those with a lower socioeconomic and educational standing are more likely to have these symptoms.
Human Rights Issue that Affects Psychological Health
Gender inequality (particularly in the workplace),, gender discrimination (leading to gender-based violence, physical and sexual abuse, and low-or subordinate social status), barriers to education, and insufficient provision to use the right to health protection are all common human rights issues that women face (83% treatment gap), property rights restrictions (financial instability), no protection from unemployment (psychosomatic illness), and, most crucially, the struggle for the right to dignity (rape, restriction, acid attacks, witch hunting, domestic violence).
Factors Affecting Quality of Life
Quality of life refers to a person's perspective of their position in life in relation to their objectives, expectations, standards, and concerns, as well as the culture and value systems in which they live. It denotes the goodness of a multiple aspect of life.
According to the World Health Organization, maternal mortality is at 145 per 100000 live births, with a 70-year life expectancy. Both communicable and non-communicable diseases have a higher morbidity rate in Indian women. Malnutrition, poor maternal health, anemia, reproductive health difficulties, sexually transmitted infections, and noncommunicable illnesses are among the most common health problems encountered. Poverty, illiteracy, insufficient health care, poor environmental hygiene, social and cultural pressures, early pregnancy, early marriage, and unsafe abortion are all psychosocial variables that influence these health issues.
In India, roughly 7.5% of women suffer from severe mental problems. However, nearly half of adult females suffer from a less serious mental illness. Due to a variety of psychological issues, women have lower self-esteem and are more likely to experience negative emotions than men. Advertisements put pressure on girls regarding their beauty and appearance concerns, and nearly two-thirds of women aim to be a lower body weight than their current, which has an impact on their quality of life.
Level of independence
Indian women are less self-reliant than their counterparts in the West. They are frequently denied the freedom to leave the house, have limited social freedom, are excluded from decision-making, have little influence over money, and are less likely to seek good health care. There are enormous barriers to women joining the labor sector; the majority wish to work but end up with home responsibilities or even occupations that pay less.
Conflict in partnerships, especially when both partners work, is not unusual. Role conflict as a growing daughter, working girl, wife (homemaker), and working married woman are the key conflicts. More than half of working women have a high level of work-family conflict, and 90% of them are stressed out, owing to various roles, which can lead to strained interpersonal relationships at home or at work, as well as predispose them to psychological illness. The preference for a nuclear family diminished social support at the household level, all leaves women to fret and fight their problems alone. Good social support, on the other hand, can improve both physical and mental health.
In India, women's safety in public places is still a concern. In a public place, about half of all women are harassed, especially in isolated areas. At least 43% of women are subjected to violence, and India is ranked as the fourth most hazardous country for women in the world. Leisure, sport, and recreation are not in the vocabulary of the average Indian woman. Time and accessibility constraints, safety concerns, cultural and societal norms, inadequate support systems, and financial constraints are all common roadblocks.,,
Religious tradition, culture, and social standards appear to influence spiritual wellness. When women are in distress, they are more inclined than men to believe that it is God's will that they are left helpless rather than striving to find solutions to solve the problem. They are more inclined to accept their current living status if they do not take personal responsibility and strive for the best. This, in turn, has a negative impact on one's quality of life.
Psychological Well-being of Indian Women
Feeling good and being able to function effectively are two aspects of psychological well-being. It is a dynamic state in which a person finds contentment and happiness by balancing demanding and rewarding life events. People who are in good mental health are more likely to have better and longer lives. Homemakers are known to have low psychological well-being. Low self-efficacy (the ability to fulfill goals) and self-acceptance (a favorable attitude toward one's own life) make individuals more vulnerable to stress.,, Low autonomy (perceived level of self-determination and independence) is often associated with cultural and religious conservatism and a lack of education., Control over finance, decision-making power, and freedom of mobility are all individual variables that influence perceived autonomy. According to a government report, 57% of women do not have domestic autonomy or the flexibility to leave the house. Similarly, according to another study, 35% of women lack financial autonomy, 62% lack freedom of travel, and 72% lack household decision-making autonomy. The concept of Life's (feeling of purpose and meaning) remains ambiguous or unrealized. The majority of people aspire to play a domestic role in their lives, rather than any other aim, although this tendency is changing. Positive relationships (warm, gratifying, and trusting interactions with others) vary by socioeconomic status, but males are often assigned a role that determines the types of relationships that a woman can have. In India, romantic relationships or cross-cultural marriage are still frowned upon. Domestic violence affects about 41% of women, indicating a lack of interpersonal interactions in the home.
Burden of Care
Gendered expectations of care and societal sanction encourage women to take on the role of caregiver. Because of their unemployment status, societal, and cultural conventions, women make up between 57% and 81% of caretakers for the elderly. They have role conflict, role strain, and role overload because they play various roles such as spouses, daughters, mothers, or employees. They were more likely to have physical and mental health problems as a result of role conflict and role strain. Brinda et al. reported that when an Indian woman is caring for a common physical ailment such as cerebrovascular disease, Parkinson's disease, greater disability, urine incontinence, or insomnia, she spends on average 38 h per week caring for them and about 10% of them get depression. Leaving them apart, they also spend 15.2 h a day on routine family care duties and 8.4 h on home chores, with the latter being longer for rural women.
Personal well-being is the most desirable and best state of one's existence or life. A significant fraction, particularly in rural areas, has adapted their lives to a low standard of living. Women's poor health is a key topic that has piqued the government's interest. In the 2015–2016 National Family Health Survey, 22.4% of women were underweight, with 54.4% having anemia linked with it. According to the 2011 census, just 47% of women have access to a toilet, 46.6% have access to drinking water on the premises, 32% are uneducated females, and 24% are currently employed but the house is overcrowded. The gynecological illness affects 75.73% of women and has a negative impact on their quality of life.
What Needs to be Done
In India, more work needs to be done to alleviate women's mental burdens. The first priority should be to alter one's social status. Literacy, employment, fundamental human rights protection, friendly relationships with family and community members, and providing basic amenities and facilities should all be prioritized. There should be a universal, simple access to physical and mental health care, as well as mental health education for women. The government should promote women's empowerment measures and firmly enforce provisions for women's safety and welfare, and a zero-tolerance policy is required.
Women's education has steadily increased, from 8.9% in 1951 to over 57% in 2004. Education has improved the entire quality of life and psychological health by bringing obvious changes in social and economic standing. Women's help-seeking behavior is mediated by education, which helps them gain autonomy. It is hypothesized that changes in overall mental health knowledge and access to mental health treatments among women will occur as a result of social changes in the 21st century. Women are being empowered through constitutional provisions, government policies that allow more chances for work, and participation in nation-building efforts. The government has taken no significant steps to improve women's psychological health. Some changes in the field of mental health to provide health services are expected to be beneficial. The number of mental health experts has gradually increased over time, and the psychiatrist-to-population ratio has improved. The district mental health program is a wonderful idea for providing comprehensive mental health care to the general public, and women's mental health can be prioritized. The Indian Medical Council has included psychiatry in the MBBS curriculum, which may raise awareness of women's mental health among future medical graduates. For the first time, India's government has developed a comprehensive mental health strategy for the entire country. To address the demand on a large scale throughout India, the Indian psychiatric society has organized a Committee on Women Mental Health. Several studies and articles have been published in social media to raise awareness and underline these concerns among Indian psychiatrists. Many NGOs are striving to prevent women's abuse, which may have a role in the developing mental illness. Despite the lack of statistics, there appears to be a minor reduction in stigma as a result of increased knowledge about mental illness propagated through print and electronic media. The ease with which the educated can obtain information has revolutionized the distribution of information, and the majority of mental health-related material is accessed through media.
In India, women are subjected to enormous psychosocial burdens. The bulk of the burden stems from a variety of factors, including societal value systems, culture, tradition, illiteracy, poverty, and so on. Psychosocial burden has an impact on overall mental health. This is an issue that needs to be addressed at all levels. Mental health professionals play a vital role in identifying the hidden psychological burden and taking it into account when dealing with mental health difficulties.
The authors would like to thank Yahosha, Shamaya, Hagai, Asther, Yasuas, Marias (Divine Retreat Centre, Chalakudy, Kerala, India), Ashish, and Mini for their moral support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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