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Mehra A, Kathirvel S, Gainder S, Avasthi A, Grover S. Female Dhat syndrome in primary care setting. Ind Psychiatry J 2021; 30:278-284. [PMID: 35017812 PMCID: PMC8709513 DOI: 10.4103/ipj.ipj_76_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/11/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
AIM The study aimed to evaluate the females presenting with the complaint of nonpathological vaginal discharge to a general gynecology outpatient service in a rural community clinic from the perspective of female Dhat syndrome. METHODOLOGY Sixty-nine females considered to have nonpathological vaginal discharge after detailed gynecological evaluation, including required investigations, attending a rural community clinic were assessed for their belief about the vaginal discharge. The study subjects were also evaluated on the proposed criteria of female Dhat syndrome by using a semi-structured interview. RESULTS The mean age of onset of vaginal discharge was 36.1 (standard deviation - 8.5) years. Most of the females considered the loss of vaginal fluid as loss of a vital fluid from the body. Consumption of warm foods and drinks (75.8%) was the most common reason reported for vaginal discharge followed by eating unbalanced food/inappropriate food (73.5%). A majorty of the subjects considered vaginal discharge responsible for bodily weakness (87.0%), backache (71.0%) and stomache (66.7%). About two-third of the participants considered the taking energizing medications like vitamins/tonics/tablets and treatment from a gynecologist the treatment for vaginal discharge. CONCLUSIONS Significant proportion of females with non-pathological vaginal discharge have a belief that they are losing a vital fluid of the body. The subject attributes their symptoms to factors such as consumption of warm foods and drinks, and eating unbalanced food/inappropriate food. Accordingly, assessment and management of women with Dhat syndrome require addressing these important issues.
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Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Soundappan Kathirvel
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Varley E. Weeping wombs: Leucorrhea and the chronicity of distress in Gilgit-Baltistan. Anthropol Med 2021:1-17. [PMID: 34169798 DOI: 10.1080/13648470.2020.1865037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In Gilgit, capital of the Gilgit-Baltistan region in northern Pakistan, leucorrhea - vaginal discharge known in the vernacular as safaid pani, or 'white water' - serves as both a medical diagnosis and signifier of the chronicity of the reproductive, social, and emotional burdens endured by women. While ethnomedical providers explained safaid pani as resulting from relatively benign forms of 'weakness', which required minimal dietary or ethno-botanical recourse, allopathic physicians approached discharge as evidence of numerous pathologies that necessitated protracted and sometimes also expensive treatments. Physicians' clinical assessments were not solely biomedical, but also integrated informal folk and formal ethnomedical theories of causation. Clinical diagnoses that affirmed leucorrhea as a pathophysiology substantiated women's belief that it was proof of the destructive effects of sustained social inequity, peril, and distress on the body, and the uterus in particular. Women and their treating providers recognized the power of the (dys)functional uterus to not only threaten women's reproductive wellness but also their social, marital, and familial status, which hinged on their ability to become pregnant and give birth, to sons especially. Because of the ailing uterus's expansive importance, weeping wombs served as a potent source for women's claims making and calls for attention and care.
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Affiliation(s)
- Emma Varley
- Anthropology, Brandon University, Brandon, Canada
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Roy Chowdhury S, Bohara AK, Drope J. Comparison of mental burden across different types of cancer patients in Nepal: a special focus on cervical cancer patients. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-01-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of the study is to assess the differential impact of gender and cancer sites on mental burden across different types of cancer and control patients.
Design/methodology/approach
The paper is based on a primary survey undertaken in 2015–2016 of 600 cancer and 200 control patients across five hospitals of Nepal. The data was analyzed using propensity score matching methods and treatment effect weighting estimators.
Findings
The authors find that of all the types of patients covered under this study, cervical cancer patients suffered from a greater intensity of anxiety and lack of functional wellbeing. On an average, all other female, male cancer patients, and control patients experience significantly lower intensity of mental burden in the range of 1.83, 2.63 and 3.31, respectively when compared to patients of cervical cancer. The results are robust across all the four treatment effect estimators and through all the measures of mental burden. The implications of suffering from cervical cancer, as a unique gynecological cancer was studied in-depth. An effect size analysis pointed out to the dysfunctional familial relationship as additional causes of concern for cervical cancer patients.
Originality/value
An important finding that emerged is that female cancer patients especially those who have cervical cancer should be given special attention because they appear to be the most vulnerable group. Further work is needed to delineate the reasons behind a cervical cancer patient facing higher amount of stress.
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Desai S, Pandey N, Singh RJ, Bhasin S. Gender inequities in treatment-seeking for sexual and reproductive health amongst adolescents: Findings from a cross-sectional survey in India. SSM Popul Health 2021; 14:100777. [PMID: 33997240 PMCID: PMC8095180 DOI: 10.1016/j.ssmph.2021.100777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
CONTEXT India's adolescent health policy aims to improve sexual and reproductive health, especially amongst the most vulnerable. There is limited evidence on how gender influences treatment-seeking patterns amongst unmarried adolescents. METHODS We analyzed data from 11,651 unmarried adolescent boys and girls aged 15-19 from a cross-sectional survey conducted in two large states of India. We conducted sex-disaggregated analyses to estimate the prevalence of symptoms of genital infections and compare treatment-seeking patterns. We identified correlates through multivariable regression and used a conceptual framework to explore structural, household, social and individual factors that influence gender inequities in adolescent sexual and reproductive health. RESULTS One in five unmarried adolescents reported symptoms of genital infections, such as burning or discharge, in the past three months. Factors associated with reporting symptoms varied between boys and girls, except for a common correlation with symptoms of depression. At least two-thirds of boys sought treatment, compared to approximately one in four girls (rural: 66.2% boys, 23.1% girls; urban: 69.4% boys, 30.7% girls). Boys primarily sought care from medical shops or private facilities, while girls used both private and government services. Amongst boys, having friends and being in school was associated with seeking treatment (aOR: 11.47; 95% CI: 2.75, 47.87; aOR: 1.95; 95% CI: 1.24, 3.07, respectively). Odds of seeking treatment were higher amongst girls with exposure to any mass media (aOR: 1.93; 95% CI: 1.25, 2.99) and who had discussed puberty with a parent (aOR: 1.98; 95% CI: 1.32, 2.98). CONCLUSION Stark sex differentials in factors associated with symptoms and in treatment-seeking illustrate how structural gender inequities, such as access to economic resources and education, influence sexual and reproductive health amongst adolescents. Along with health system interventions, addressing gender inequities calls for strategies to strengthen parental engagement, social support and girls' access to resources.
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Khanna T, Garg P, Akhtar F, Mehra S. Association between gender disadvantage factors and postnatal psychological distress among young women: A community-based study in rural India. Glob Public Health 2020; 16:1068-1078. [PMID: 32928069 DOI: 10.1080/17441692.2020.1820066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Common mental health disorders are studied extensively among adult women globally. However, they remain under-researched among young women. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average. A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in the last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. Psychological distress was found among 50 respondents (21.9%). Young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors. Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress, is imperative, along with addressing gender inequitable practices.
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Affiliation(s)
- Tina Khanna
- MAMTA Health Institute for Mother and Child, Delhi, India.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Priyanka Garg
- MAMTA Health Institute for Mother and Child, Delhi, India
| | - Faiyaz Akhtar
- MAMTA Health Institute for Mother and Child, Delhi, India
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, Delhi, India
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Molenaar J, Hanlon C, Alem A, Wondimagegn D, Medhin G, Prince M, Stevenson EGJ. Perinatal mental distress in a rural Ethiopian community: a critical examination of psychiatric labels. BMC Psychiatry 2020; 20:223. [PMID: 32398030 PMCID: PMC7216512 DOI: 10.1186/s12888-020-02646-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/03/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Perinatal mental distress poses a heavy burden in low- and middle-income countries (LMICs). This study investigated perceptions and experiences of perinatal mental distress among women in a rural Ethiopian community, in an effort to advance understanding of cross-cultural experiences of perinatal mental distress. METHODS We employed a sequential explanatory study design. From a population-based cohort study of 1065 perinatal women in the Butajira Health and Demographic Surveillance Site, we purposively selected 22 women according to their scores on a culturally validated assessment of perinatal mental distress (the Self-Reporting Questionnaire). We examined concordance and discordance between qualitative semi-structured interview data ('emic' perspective) and the layperson-administered fully-structured questionnaire data ('etic' perspective) of perinatal mental distress. We analysed the questionnaire data using summary statistics and we carried out a thematic analysis of the qualitative data. RESULTS Most women in this setting recognised the existence of perinatal mental distress states, but did not typically label such distress as a discrete illness. Instead, perinatal mental distress states were mostly seen as non-pathological reactions to difficult circumstances. The dominant explanatory model of perinatal mental distress was as a response to poverty, associated with inadequate food, isolation, and hopelessness. Support from family and friends, both emotional and instrumental support, was regarded as vital in protecting against mental distress. Although some women considered their distress amenable to biomedical solution, many thought medical help-seeking was inappropriate. Integration of perspectives from the questionnaire and semi-structured interviews highlighted the important role of somatic symptoms and nutritional status. It also demonstrated the differential likelihood of endorsement of symptoms when screening tools versus in-depth interviews are used. CONCLUSIONS This study highlights the importance of the wider social context within which mental health problems are situated, specificially the inseparability of mental health from gender disadvantage, physical health and poverty. This implies that public health prevention strategies, assessments and interventions for perinatal distress should be developed from the bottom-up, taking account of local contexts and explanatory frameworks.
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Affiliation(s)
- Jil Molenaar
- School of Global Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen, Denmark
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
| | - Dawit Wondimagegn
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity Building, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Sifra Selam, Addis Ababa, Ethiopia
| | - Martin Prince
- King’s College London, King’s Global Health Institute, Room 1.49, Franklin Wilkins Building, 127, Stamford Street, London, UK
| | - Edward G. J. Stevenson
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE UK
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Patel V. The Stree Arogya Shodh: investigating gynaecological morbidities and women's mental health in India. Int Psychiatry 2018. [DOI: 10.1192/s1749367600000758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gynaecological complaints have long been associated with poor mental health, in particular depression and anxiety, in higher-income countries. Lower abdominal pain (both menstrual and non-menstrual) and pelvic pain are considered the hallmark gynaecological symptoms associated with somatoform, stress-related and neurotic disorders (the ‘common mental disorders', CMDs). Cultural and social factors heavily influence the expression of somatic symptoms and metaphors for emotional distress, but little is known about gynaecological psychosomatic clinical syndromes in non-Western cultures, despite the enormous global health significance of gynaecological symptoms. This paper considers the specific example of the syndrome of abnormal vaginal discharge (AVD) in India.
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Nasreen HE, Alam MA, Edhborg M. Prevalence and Associated Factors of Depressive Symptoms Among Disadvantaged Adolescents: Results from a Population-Based Study in Bangladesh. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:135-44. [DOI: 10.1111/jcap.12150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hashima E. Nasreen
- Assistant Professor, Department of Community Medicine, Faculty of Medicine; International Islamic University Malaysia; Kuantan Pahang Malaysia
| | - Mohammad Ariful Alam
- Programme Head, Health, Nutrition and Population Programme; BRAC; Dhaka Bangladesh
| | - Maigun Edhborg
- Senior Lecturer, Department of Neurobiology, Care Science and Society; Karolinska Institute; Stockholm Sweden
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Amin A, Bentley ME. The Influence of Gender on Rural Women's Illness Experiences and Health-seeking Strategies for Gynaecological Symptoms. JOURNAL OF HEALTH MANAGEMENT 2016. [DOI: 10.1177/097206340200400209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community-based research on reproductive tract infections (R TI) has shown that many women in India suffer a significant burden of morbidity from gynaecological symptoms, accept these as normal and delay seeking treatment. This paper describes how gender inequalities influence women's experiences of gynaecological morbidity and health-seeking strategies. Data for this paper are obtained from three villages in Gujarat, India, through in-depth interviews with 18 women who reported symptoms of R TI. The sample was selected form women participating in savings groups operated by the collaborating non-governmental organisation. Women describe how they give priority to fulfilling their work responsibilities over their discomfort. They explain normative pressures to remain with the husband and produce children with two years of marriage. Women exposed to violence report that they did not reveal their symptoms to their husbands. Where there is a better marital communication, they describe their strategies to refuse sex in relation to their symptoms. Women also express helplessness with their social and health situations in context of seeking treatment. We conclude that gender inequalities, manifested through fertility, marriage and work norms, violence in marital relationships and poor psychological health, have resulted in rural Indian women accepting high thresholds of suffering, and not seeking treatment for their symptoms. We recommend that RTI prevention and treatment efforts be part of a larger process of empowering women and men in which there is a discussion of reproductive, sexual and health rights. 1. The study was conducted as part of a doctoral research on women's perceived morbidity and treatment-seeking behaviours for gynaecological symptoms. The results describing perceived morbidity and treatment-seeking behaviours are reported in forthcoming papers. 2. The terms 'morbidity' and 'symptoms' refer to medically defined categories that were used to identify women reporting gynaecological disease. In this paper we focus on 'illness', which refers to the meanings women give to health, experiences and perceptions of gynaecological symptoms (Zurayk et al. 1993). 3. Other than urban and rural population statistics, 2001 census data are not available for any other parameters, including tribal population and development indices. Therefore, we have used 1991 census data for these statistics. 4. The women's health programme has trained local women as traditional birth attendants and as barefoot gynaecologists who can use speculums, conduct pelvic examinations and provide treatment with validated local plant-based medicines. 5. Women who perceived infertility were included in the sample regardless of whether they had biomedically defined infertility or were trying to get pregnant soon after marriage. This selection criteria for infertility is based on women's perceptions because, based on previous research in this community, we felt that it was an im portant concern for women, impacting all other health-seeking behaviours related to gynaecological symptoms and, therefore, should be defined as such. 6. The sect known by the name of gayatri parivar has followers from several villages in the area. We are not aware of its reach in other parts of the state. Several women mentioned books published by the sect with guidelines on dietary and sexual practices. Three respondents explained sexual practices and drinking alcohol of their husbands based on the teachings of this sect.
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Affiliation(s)
- Avni Amin
- Centre for Health and Gender Equity, 6930 Carroll Avenue, Suite 910, Takoma Park, MD 20912, USA
| | - Margaret E. Bentley
- Department of Nutrition, Fellow, Carolina Population Centre, 123 W. Franklin Street, Suite 308B, University of North Carolina, Chapel Hill, NC 27516, USA
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Grover S, Avasthi A, Gupta S, Hazari N, Malhotra N. Do female patients with nonpathological vaginal discharge need the same evaluation as for Dhat syndrome in males? Indian J Psychiatry 2016; 58:61-9. [PMID: 26985107 PMCID: PMC4776585 DOI: 10.4103/0019-5545.174376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM The aim of this study was to evaluate the concept of female Dhat syndrome characterized by the complaint of nonpathological vaginal discharge in association with somatic, anxiety, and depressive symptoms. MATERIALS AND METHODS A total of 26 female subjects with nonpathological vaginal discharge along with depressive and somatic complaints were assessed on a self-rated questionnaire modified from Comprehensive Questionnaire for Assessment of Dhat Syndrome designed for males. They were also assessed for psychiatric comorbidity as per ICD-10. RESULTS All female subjects received an ICD-10 psychiatric diagnosis, with somatoform/dissociative disorder (57.7%) being the most common. The mean age of onset of vaginal discharge was 24.6 (standard deviation - 7.0) years, noted every day or for 2-3 times per week by more than two-third of the participants. Two-fifth (61.5%) of the women described it as a milky discharge. The most common reason reported for passage of vaginal discharge was that of urinary infection or problems of urinary tract infections (42.3%) followed by vaginal infection/disease (34.6%). More than half (53.8%) of the subjects considered vaginal discharge to be responsible for weakness in the body, weakness in stamina and thinness of physique, while slightly more than two-third (69.2%) of them reported bodily weakness and sleep disturbances. Overall the clinical picture in females was similar to male patients with Dhat syndrome on most of the account. CONCLUSIONS Subgroup of patients with vaginal discharge attribute their somatic and mental symptoms to the passage of whitish vaginal discharge and are distressed due to the same. The clinical picture is similar to Dhat syndrome in males. There is a need to recognize female variant of Dhat syndrome as a culture-bound syndrome. Identification of the same may help in managing this subgroup of patients seeking help from the gynecologists for their nonpathological vaginal discharge or from mental health professionals for their symptoms of common mental disorders.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Gupta
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Hazari
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sami N, Ali TS, Osama M. Quality of life among women with symptoms of gynecological morbidities: results of a cross-sectional study in Karachi, Pakistan. J Obstet Gynaecol Res 2014; 41:608-14. [PMID: 25492624 DOI: 10.1111/jog.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
AIMS A population-based cross-sectional study design was used to study the effects of symptoms of various gynecological morbidities (GM) on health-related quality of life (HRQoL) of women, residents of squatter settlements of Karachi, Pakistan. MATERIAL AND METHODS This cross-sectional study was conducted in squatter settlements of Karachi from September 2012 to August 2013, with 1002 married, non-pregnant women. After obtaining written informed consent from every participant, a structured questionnaire was used to collect information about symptoms of GM and their effect on four domains of HRQoL (physical, social, functional and financial domains). RESULTS Of 1002 women who participated in the study, 578 reported suffering from one or more symptoms of GM. The most commonly reported symptoms were foul-smelling vaginal discharge, dysmenorrhea and uterovaginal prolapse while the least reported symptom was post-coital bleeding. Symptoms of GM were found to have a negative impact on HRQoL. Approximately one-third of women with the symptoms of GM reported having negative influences on the physical, financial and functional domains of HRQoL with social domain being comparatively less affected. Compared to other symptoms, dysmenorrhea and uterovaginal prolapse were reported to be mostly associated with poor HRQoL of women. CONCLUSION The concept of HRQoL has been kept marginal and inconspicuous by clinicians. In order to achieve the psychosocial satisfaction of the patient, the focus needs to be diverted to all domains of HRQoL.
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Grover S, Kate N, Avasthi A, Rajpal N, Umamaheswari V. Females too suffer from Dhat syndrome: A case series and revisit of the concept. Indian J Psychiatry 2014; 56:388-92. [PMID: 25568483 PMCID: PMC4279300 DOI: 10.4103/0019-5545.146537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Dhat syndrome as a clinical entity has been rarely described in females. Ethnographic studies suggest that as in males, whitish vaginal discharge in females is also associated with depressive and somatic symptoms and many women with symptoms of whitish discharge attribute their depressive and somatic symptoms to the whitish discharge. In this report, we describe two female patients who presented with psychiatric manifestations also with somatic symptoms and attributed their somatic complaints to whitish vaginal discharge. In this background, we discuss whether this entity requires nosological attention and what criteria can be used to define the same.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Natasha Kate
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Rajpal
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Umamaheswari
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Moonzwe Davis L, Schensul SL, Schensul JJ, Verma RK, Nastasi BK, Singh R. Women's empowerment and its differential impact on health in low-income communities in Mumbai, India. Glob Public Health 2014; 9:481-94. [PMID: 24766149 DOI: 10.1080/17441692.2014.904919] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy-related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined.
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Stephenson R, Winter A, Hindin M. Frequency of intimate partner violence and rural women's mental health in four Indian states. Violence Against Women 2014; 19:1133-50. [PMID: 24142954 DOI: 10.1177/1077801213501898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the association between self-reported frequency of verbal, physical, and sexual intimate partner violence (IPV) and mental health among 6,303 rural married women (age 15-49), in four Indian states: Bihar, Jharkhand, Maharashtra, and Tamil Nadu. Data are taken from the 2002-2003 National Family Health Survey-2 Follow-Up Survey. The results indicate that experiencing physical, verbal, or sexual IPV is associated with an increased risk of adverse mental health outcomes. Our results provide support for the importance of screening for IPV in mental health settings, especially in resource-poor settings where both IPV and mental health are often overlooked.
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Intimate partner violence and symptoms of reproductive tract infections among married Indian women. Int J Gynaecol Obstet 2013; 121:218-23. [PMID: 23497750 DOI: 10.1016/j.ijgo.2012.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/14/2012] [Accepted: 02/20/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the association of 3 types of intimate partner violence (IPV)-verbal, physical, and sexual-with self-reported symptoms of reproductive tract infections (RTIs) among married Indian women. METHODS A cross-sectional analysis of population-based data from the 2005-2006 Indian National Family Health Survey-3 was conducted. The sample comprised 65610 married Indian women of reproductive age (15-49years). RESULTS Overall, 23.9% of women experienced at least 1 type of IPV, and 9.6% reported at least 1 RTI symptom in the year preceding the survey. Verbal, physical, and sexual IPV each demonstrated a significant independent effect on the reporting of genital sores and abnormal genital discharge. Additionally, the more types of IPV a woman experienced, the higher her odds of also reporting genital sores and abnormal genital discharge. CONCLUSION No single type of IPV explains women's risk of RTIs; rather, there are multiple pathways by which women's experience of IPV can result in RTIs. Sexual and reproductive healthcare that incorporates IPV support services is needed to meet the special needs of abused women. Additionally, RTI screening should be considered by non-governmental organizations providing care for women who have experienced IPV, especially those who report multiple types of violence.
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Kobeissi L, Mahfoud Z, Khoury B, El Kak F, Ghantous Z, Khawaja M, Nakkash R, Ramia S, Zurayk H, Araya R, Peters TJ. The Relaxation Exercise and Social Support Trial (RESST): a community-based randomized controlled trial to alleviate medically unexplained vaginal discharge symptoms. BMC Psychiatry 2012; 12:195. [PMID: 23140480 PMCID: PMC3534445 DOI: 10.1186/1471-244x-12-195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms such as medically unexplained vaginal discharge (MUVD) are common and bothersome, leading to potentially unnecessary use of resources. METHODS A community-based individually randomized controlled trial to assess the effectiveness of a relatively simple, culturally appropriate multi-component intervention on reducing reported MUVD, among women suffering from low-moderate levels of common mental distress. The setting was a socio-economically deprived, informal settlement in the southern suburbs of Beirut, Lebanon. The intervention comprised up to 12 group sessions implemented over a six-week period, each divided into a psychosocial and a relaxation exercise component. The primary outcome was self-reported MUVD, which was defined as a complaint of vaginal discharge upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Blinding on the intervention status was not possible for both logistic and ethical reasons, especially as knowledge of involvement in the intervention was integral to its delivery. Intent to treat analysis was used. RESULTS Of 75 women randomized to the intervention, 48% reported MUVD at 6 months compared with 63% of 73 in the control group (difference of -15%, 95% confidence interval (CI) -31%, 0%, p=0.067). Adjustments for baseline imbalances and any factors relating to consent had no appreciable effect on these results. The risk of MUVD was reduced in absolute terms by 2.4% for each intervention session attended (95% CI -4.9%, 0.0%, p=0.049). While there was also marginal evidence of a beneficial effect on anxiety, there was no evidence of mediation of the effect on MUVD through measures of common mental disorders. CONCLUSION This study confirms that MUVD is an important public health problem. While the benefits of this intervention may appear modest, the intervention offers an opportunity for women to enhance their problem-solving skills as well as use physical relaxation techniques that can help them deal with stressful in their lives. Further research is needed in a variety of contexts, for different populations and preferably involving larger randomized trials of such an intervention. TRIAL REGISTRATION * Title of trial: The Relaxation Exercise and Social Support Trial ISRCTN assigned: ISRCTN98441241 Date of assignation: 10/09/2010 Link: http://www.controlled-trials.com/ISRCTN98441241* Also registered at the Wellcome Trust register:http://www.controlled-trials.com/mrct/trial/469943/98441241.
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Affiliation(s)
- Loulou Kobeissi
- Epidemiology and Biostatistics Division, Center for Middle Eastern Studies, University of Arizona, Tucson, Arizona, USA,Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ziyad Mahfoud
- Department of Public Health, Weill Cornell Medical College, Doha, Qatar
| | - Brigitte Khoury
- Department of Psychiatry-Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fayssal El Kak
- Department of Health Promotion and Community Health Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeina Ghantous
- Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marwan Khawaja
- Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima Nakkash
- Center for Research on Population and Health Department of Health Promotion and Community Health Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sami Ramia
- Medical Lab Sciences Program Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Huda Zurayk
- Center for Research on Population and Health Epidemiology and Population Health Department Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ricardo Araya
- Academic Unit of Psychiatry School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
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Khan N, Kausar R, Flach C, Howard L. Psychological and gynecological morbidity in women presenting with vaginal discharge in Pakistan. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17542863.2011.579710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The mental health gender-gap in urban India: Patterns and narratives. Soc Sci Med 2012; 75:1660-72. [DOI: 10.1016/j.socscimed.2012.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 06/11/2012] [Accepted: 06/19/2012] [Indexed: 11/21/2022]
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Sheikh S, Furnham A. The relationship between somatic expression, psychological distress and GP consultation in two cultural groups. COUNSELLING PSYCHOLOGY QUARTERLY 2012. [DOI: 10.1080/09515070.2012.735860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Shaheen Sheikh
- a Research Department of Clinical , Educational and Health Psychology, University College London , London , UK
| | - Adrian Furnham
- a Research Department of Clinical , Educational and Health Psychology, University College London , London , UK
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Youth-friendly services in two rural districts of West Bengal and Jharkhand, India: definite progress, a long way to go. REPRODUCTIVE HEALTH MATTERS 2011; 19:174-83. [PMID: 21555098 DOI: 10.1016/s0968-8080(11)37557-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
It is a continuing challenge to reach rural youth in India with sexual and reproductive health services. Drawing on a large survey among 6,572 young people aged 15-24 and 264 rural health providers accessed by them in rural West Bengal and Jharkhand, we witnessed a long-awaited response to national efforts to promote birth spacing. That 31% of young, married women without children were using contraception to delay a first birth was evidence of cracks in the persistent tradition of demonstrating fertility soon after marriage. The coverage of public sector services for reproductive and sexual health is highly variable and the scope largely restricted to married women, with unmarried young women and men relying mainly on the informal private sector, and seriously underserved. Strong social norms proscribing pre-marital sexual relationships perpetuate barriers in meeting their needs. Access to contraception is affected by negative provider attitudes and reluctance to report having sex underestimates the real scale of unmet need. Yet, 30% of providers reported unmarried young women seeking abortion services. To address the needs of all rural youth, the public sector needs to expand its remit or engage with informal providers, train them to deliver youth-friendly services and give them a recognised role in abortion referral.
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Kobeissi L, Araya R, Kak FE, Ghantous Z, Khawaja M, Khoury B, Mahfoud Z, Nakkash R, Peters TJ, Ramia S, Zurayk H. The relaxation exercise and social support trial-resst: study protocol for a randomized community based trial. BMC Psychiatry 2011; 11:142. [PMID: 21864414 PMCID: PMC3184263 DOI: 10.1186/1471-244x-11-142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies suggests a possible link between vaginal discharge and common mental distress, as well as highlight the implications of the subjective burden of disease and its link with mental health. METHODS/DESIGN This is a community-based intervention trial that aims to evaluate the impact of a psycho-social intervention on medically unexplained vaginal discharge (MUVD) in a group of married, low-income Lebanese women, aged 18-49, and suffering from low to moderate levels of anxiety and/or depression. The intervention consisted of 12 sessions of structured social support, problem solving techniques, group discussions and trainer-supervised relaxation exercises (twice per week over six weeks). Women were recruited from Hey el Selloum, a southern disadvantaged suburb of Beirut, Lebanon, during an open recruitment campaign. The primary outcome was self-reported MUVD, upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Intent to treat analysis will be used. DISCUSSION The results will indicate whether the proposed psychosocial intervention was effective in reducing MUVD (possibly mediated by common mental distress). TRIAL REGISTRATION The trial is registered at the Wellcome Trust Registry, ISRCTN assigned: ISRCTN: ISRCTN98441241.
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Affiliation(s)
- Loulou Kobeissi
- UCLA, School of Public Health, Community Health Sciences Department, Los Angeles, California 90095, USA.
| | - Ricardo Araya
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Fayssal El Kak
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeina Ghantous
- Center for Research on Population and Health, Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marwan Khawaja
- Center for Research on Population and Health, Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Brigitte Khoury
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ziyad Mahfoud
- Department of Public Health, Weill Cornell Medical College, Doha, Qatar
| | - Rima Nakkash
- Center for Research on Population and Health, Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Sami Ramia
- Medical Lab Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Huda Zurayk
- Center for Research on Population and Health, Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Kostick KM, Schensul SL, Jadhav K, Singh R, Bavadekar A, Saggurti N. Treatment seeking, vaginal discharge and psychosocial distress among women in urban Mumbai. Cult Med Psychiatry 2010; 34:529-47. [PMID: 20533080 DOI: 10.1007/s11013-010-9185-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vaginal discharge (safed pani in Hindi, meaning "white water") is one of the leading symptoms for which women in India seek care. Treatment-seeking for safed pani is disproportionately high among poor women, representing a physical, emotional and financial burden for low-income families. Safed pani is only rarely indicative of a reproductive tract or sexually transmitted infection. The discrepancy between symptom reports and observed pathology has led some researchers to characterize safed pani as a culturally based expression of more generalized negative life situation. Data are drawn from two prevention intervention studies (2002-2006 and 2007-2012) conducted in economically marginal communities in Mumbai. Results show that husbands as problem generators and spousal abusers and women's greater perceived empowerment and reported tension are significantly associated with safed pani. These results provide the basis for identifying women at greater risk for psychosocial distress and providing supports at the locations at which they seek treatment.
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Affiliation(s)
- Kristin M Kostick
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-1912, USA.
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Symptoms of Reproductive Tract Infections and Mental Distress among Women in Low-Income Urban Neighborhoods of Beirut, Lebanon. J Womens Health (Larchmt) 2009; 18:1701-8. [DOI: 10.1089/jwh.2008.0962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kermode M, Bowen K, Arole S, Joag K, Jorm AF. Community beliefs about treatments and outcomes of mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Public Health 2009; 123:476-83. [PMID: 19608211 DOI: 10.1016/j.puhe.2009.06.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/16/2009] [Accepted: 06/08/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mental health remains a neglected issue in most developing countries, especially in rural areas where access to effective mental health services is limited. The integration of mental health into primary health care is being promoted as a strategy to address this problem. Consequently, there is an urgent need to enhance mental health awareness among communities, and to provide mental health training for primary healthcare staff. In order to do this effectively, it is important to understand and take account of local views on mental health and illness. As such, a mental health literacy (MHL) assessment was undertaken in a poor, rural area of Maharashtra, India to inform the development of a mental health training programme. STUDY DESIGN A cross-sectional MHL survey was undertaken in late 2007. METHODS Data were collected from 240 systematically sampled community members and 60 purposively sampled village health workers (VHWs) using an interviewer-administered questionnaire. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked to name the problems, and to identify the treatments and people that were most likely to be helpful (or otherwise), and the likely outcomes for people with such problems. RESULTS Most participants recognized that the people in the vignettes were experiencing a mental health problem. 'Depression' was the most common label for the problems experienced in the depression vignette, and 'a mind/brain problem' was the most common label in the case of the psychosis vignette. Socio-economic interventions provided by family, friends and neighbours were considered to be most helpful. Local VHWs and doctors were also viewed as potentially helpful, but psychiatrists less so. Approximately half of the sample thought that dealing with the problem alone would be helpful. Special diets, tonics, appetite stimulants and sleeping pills were also strongly endorsed, but awareness of psychiatric medications was negligible. CONCLUSION The findings from this study highlight the need to enhance MHL in this community. Additionally, there is a need to build the capacity of the primary healthcare staff, including the VHWs, so that they are equipped to provide an effective local response for people experiencing mental health problems.
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Affiliation(s)
- M Kermode
- Nossal Institute for Global Health, University of Melbourne, Alan Gilbert Building, Carlton, Victoria 3010, Australia.
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Patel V, Andrew G, Pelto PJ. The psychological and social contexts of complaints of abnormal vaginal discharge: a study of illness narratives in India. J Psychosom Res 2008; 64:255-62; discussion 263-4. [PMID: 18291239 DOI: 10.1016/j.jpsychores.2007.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/10/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Epidemiological studies have reported strong associations between psychosocial adversity and complaints of abnormal vaginal discharge (AVD) in South Asia. We aimed to explore the mechanism of these associations through qualitative research. METHOD We carried out serial in-depth interviews with 42 married women with the complaint of AVD who were purposively selected from a sample of 2494 women recruited into a population-based cohort study in Goa, India. The interviews elicited illness narratives of their complaint, focusing on causal attributions and help-seeking behaviors. RESULTS Women explicitly link their personal experiences of social adversity and stress (such as marital problems and heavy workloads) with their complaints of AVD. The complaint of tiredness, a core feature of depressive and somatoform disorders, and complaint of "tension" were commonly associated with AVD through bidirectional causal interpretations. Reproductive events, particularly related to the menstrual cycle and contraception, comprise another set of causal attributions. Many women hold multiple causal attributions. Most women sought health care, both biomedical and traditional, and their narratives indicate reinforcement of their causal attributions by health care providers. However, treatments were often discontinued or changed due to lack of symptomatic relief, side effects, or costs. CONCLUSIONS Reproductive health policy and practice must explicitly acknowledge and integrate research findings on psychosocial associations of AVD to promote a holistic and evidence-based approach for this common complaint in women in South Asia.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Rashid SF. Durbolota (weakness), chinta rog (worry illness), and poverty: explanations of white discharge among married adolescent women in an urban slum in Dhaka, Bangladesh. Med Anthropol Q 2007; 21:108-32. [PMID: 17405700 DOI: 10.1525/maq.2007.21.1.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
I carried out ethnographic fieldwork among 153 married adolescent girls, aged 15-19, in a Dhaka slum from December 2001 to January 2003, including 50 in-depth interviews and eight case studies. I also held discussions with family and community members. In this article, I focus on popular understandings of vaginal discharge being caused by durbolota (weakness) and chinta rog (worry illness), as mentioned by young women. Eighty-eight young women reported that they had experienced white discharge, blaming it on a number of factors such as stress and financial hardships, tensions in the household, marital instability, hunger anxiety, and reproductive burdens. For married adolescent women in the urban slum, white discharge has many levels of meaning linked to the broader social, political, and material inequalities in their everyday lives.
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Affiliation(s)
- Sabina Faiz Rashid
- Social and Medical Anthropology, James P. Grant School of Public Health, BRAC University, Bangladesh
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Patel V, Kirkwood BR, Pednekar S, Weiss H, Mabey D. Risk factors for common mental disorders in women. Population-based longitudinal study. Br J Psychiatry 2006; 189:547-55. [PMID: 17139040 DOI: 10.1192/bjp.bp.106.022558] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The determinants of common mental disorders in women have not been described in longitudinal studies from a low-income country. METHOD Population-based cohort study of 2494 women aged 18 to 50 years, in India. The Revised Clinical Interview Schedule was used for the detection of common mental disorders. RESULTS There were 39 incident cases of common mental disorder in 2166 participants eligible for analysis (12-month rate 1.8%, 95% CI 1.3-2.4%). The following baseline factors were independently associated with the risk for common mental disorder: poverty (low income and having difficulty making ends meet); being married as compared with being single; use of tobacco; experiencing abnormal vaginal discharge; reporting a chronic physical illness; and having higher psychological symptom scores at baseline. CONCLUSIONS Programmes to reduce the burden of common mental disorder in women should target poorer women, women with chronic physical illness and who have gynaecological symptoms, and women who use tobacco.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene and Tropical Medicine, London, UK.
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Patel V, Weiss HA, Kirkwood BR, Pednekar S, Nevrekar P, Gupte S, Mabey D. Common genital complaints in women: the contribution of psychosocial and infectious factors in a population-based cohort study in Goa, India. Int J Epidemiol 2006; 35:1478-85. [PMID: 16997847 DOI: 10.1093/ije/dyl219] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The genital complaint of abnormal vaginal discharge is common in South Asia. We describe the risk factors for the incidence of the complaint in women of reproductive age. Method Population-based cohort study in Goa, India. Out of 3000 randomly selected women, 2494 women participated. The outcome was an incident case of the complaint of abnormal vaginal discharge at 6 months (T1) and 12 months (T2) review. RESULTS In total 71 (3.6%, 95% CI 2.8-4.5%) of the 2000 eligible women reviewed at T1 reported the complaint; and 80 (4.0%, CI 3.2-5.0%) of the 1999 women who did not complain of abnormal vaginal discharge at T1 reported it at T2. Multivariate logistic regression analysis identified the following factors as associated with the complaint: younger age (OR 0.26, CI 0.1-0.5 for women aged 40-49 years compared with women aged 18-24 years); illiteracy (OR 1.48, CI 0.9-2.4); religion (Muslim women OR 3.15, CI 1.7-6.0 compared with Hindu women); women's concerns regarding their spouse's extramarital relationships (OR 3.46, CI 1.2-10.0); current BV infection (OR 1.87, CI 1.2-2.9); somatoform complaints (OR 3.30, CI 1.7-6.5 for the highest somatoform score quartile compared with the lowest); and depression and anxiety (OR 1.55, CI 0.9-2.6 for the highest mental health score quartile compared with the lowest). CONCLUSIONS Reproductive and sexual health programmes must strengthen the capacity of practitioners to assess and treat bacterial vaginosis and psychosocial problems in women with complaints of abnormal vaginal discharge.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
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Jejeebhoy S. Commentary: Vaginal discharge and stress: a commentary on directions of influence. Int J Epidemiol 2005; 34:862-3. [PMID: 15964907 DOI: 10.1093/ije/dyi128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shireen Jejeebhoy
- Population Council, Indian Habitat Centre, Lodi Road, New Delhi 110003, India.
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Patel V, Pednekar S, Weiss H, Rodrigues M, Barros P, Nayak B, Tanksale V, West B, Nevrekar P, Kirkwood BR, Mabey D. Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community. Int J Epidemiol 2005; 34:853-62. [PMID: 15833795 DOI: 10.1093/ije/dyi072] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaginal discharge is a common complaint, particularly among women in Asia. Although presumed to be caused by reproductive tract infections (RTIs), the association between the complaint and the presence of RTIs is weak. This study aimed to investigate the risk factors of the complaint of vaginal discharge. METHODS We conducted a community-based survey of 3000 women aged 18-50 years, randomly sampled from a population in Goa, India. Women who gave informed consent were invited to participate in a structured interview, which elicited data on the primary outcome (the experience of current abnormal vaginal discharge) and psychosocial exposures: gender adversity; symptoms of somatoform disorders; and common mental disorders (CMD). All women were required to provide vaginal and/or urine samples for diagnosis of RTIs using gold standard laboratory tests. Risk factors were analysed using logistic regression with the binary outcome of the complaint of vaginal discharge. RESULTS Of the 2494 women (83%) who agreed to participate, 14.5% complained of having an abnormal vaginal discharge. Stress was the most common causal attribution for the complaint. The final multivariate model found that high scores for CMD (OR 2.16, 1.4-3.2) and somatoform disorders (6.23, 4.0-9.7) and the use of an intrauterine contraceptive device (1.86, 1.0-3.4) were independently associated with the complaint. Low literacy (0.54, 0.4-0.8) and age >40 years (0.29, 0.2-0.4) were associated with a reduced risk. RTI were not associated with the complaint (1.24, 0.9-1.6). CONCLUSIONS Psychosocial factors have the strongest association with the complaint of vaginal discharge. Syndromic management algorithms need refinement so that women with complaints that are non-infectious in aetiology are offered psychosocial interventions.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Abstract
India is a country with a population of over 1 billion, and immense diversity in the languages spoken, levels of literacy, and social and cultural practices. Organising mental health services for this predominantly rural population is indeed a daunting task. Compounding this problem are low budgetary resources, the presence of competing and conflicting healing systems, scarcity of mental health personnel, ‘brain drain’, and the stigma of seeking help for problems related to the mind. This paper looks at the mental health scene in India with respect to services and research. It deals with conditions such as schizophrenia, acute psychoses, minor mental morbidity and drug misuse, highlighting aspects unique to the Indian scene. Indian families exhibit great tenacity in caring for relatives who are ill, and are a great resource in treatment and rehabilitation.
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Affiliation(s)
- R Thara
- Schizophrenia Research Foundation, Anna Nagar (West Extension), Chennai, India.
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Andrew G, Patel V, Ramakrishna J. Sex, studies or strife? What to integrate in adolescent health services. REPRODUCTIVE HEALTH MATTERS 2003; 11:120-9. [PMID: 12800709 DOI: 10.1016/s0968-8080(03)02167-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
If health services for adolescents are to be successfully integrated into the existing health care system, they will need to reach out to meet the needs that adolescents themselves perceive as salient. This paper describes a study aiming to elicit the needs of adolescents in higher secondary schools in Goa, India, in 1999-2000. The objective was to generate information which could guide the development of adolescent-friendly health services by integrating the health needs identified by adolescents themselves. The study began with free-listing, followed by focus group discussions and in-depth interviews to elicit areas of concern. Then, a survey of 811 students with a self-report questionnaire was carried out. The findings demonstrate that there is clearly an unmet need for information about sexual and reproductive health, but also a large, unmet need for psychosocial support for health issues ranging from violence in schools to poor relationships with parents, stress-related health complaints and educational difficulties, which are often perceived by adolescents to be of primary importance. Integrating these issues into programmes is likely to be an essential element in developing health services and programmes which can reach out to the majority of adolescents in school settings in India.
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Affiliation(s)
- Gracy Andrew
- Sangath Society for Child Development and Family Guidance, Goa, India
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Abstract
In this article, the author explores how gender inequity is manifested in poor reproductive and mental health outcomes, including unwanted pregnancy, unsafe abortion, maternal mortality, sexually transmitted infections, depression, and psychosomatic symptoms. Briefly described is a landmark 1994 United Nations conference emphasizing that gender inequity adversely affects women's reproductive health, particularly in developing countries, and the implementation of its recommendations is tracked. Although there is increased recognition of oppression's toll on women's physical and emotional health as well as their intellectual and social potential, progress toward equity goals is uneven and slow. Psychologists as a group play many roles--for example, in research, education, policy, law, communications, industry, international development, and private practice--through which they can make professional contributions to gender equity as a focus or underlying principle.
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Affiliation(s)
- Elaine M Murphy
- Department of Global Health, George Washington University School of Public Health, 2175 K Street, NW, #810, Washington, DC 20037, USA.
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Lakhani A, Gandhi K, Collumbien M. Addressing semen loss concerns: towards culturally appropriate HIV/AIDS interventions in Gujarat, India. REPRODUCTIVE HEALTH MATTERS 2001; 9:49-59. [PMID: 11765399 DOI: 10.1016/s0968-8080(01)90090-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A situation analysis of sexual networking and sexual health in an industrial area of Gujarat, India, identified anxiety about masturbation and other semen loss concerns as major preoccupations among young men. This paper describes how the Deepak Charitable Trust addressed these concerns in their HIV prevention programme for young men aged 15 to 30. Flowcharts were used as participatory learning tools and to obtain data on the perceived consequences of masturbation, both before and after intervention activities. Research was also done on the relation between semen-related anxieties and sexual risk behaviour by DCT and two other NGOs among young men engaging in unsafe sexual behaviour. DCT advocates addressing masturbation and other semen loss concerns in all sexual health campaigns in South Asia, based on the magnitude of these concerns, their potential to confound syndromic management of STIs and their significance as an idiom of psychosocial distress. Masturbation and associated anxieties about sexual performance are seen as health issues and discussed as such by the programme. There is immediate identification among young men, whether or not they are already sexually active, and it provides an excellent entry point for sexual health and safer sex education. The community response to these efforts has been entirely positive.
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Affiliation(s)
- A Lakhani
- Deepak Charitable Trust, 9-10 Kunj Society, Alkapuri, Vadodara 390 007, India.
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Trollope-Kumar K. Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women. Trop Med Int Health 2001; 6:260-6. [PMID: 11348516 DOI: 10.1046/j.1365-3156.2001.00699.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Among women in South Asia, the complaint of vaginal discharge (often called leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of vaginal discharge. An anthropological perspective on the cultural meanings of leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. Many South Asian women who complain of vaginal discharge also report a variety of somatic symptoms such as dizziness, backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia. Leukorrhea may represent a culturally shaped "bodily idiom of distress", in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of sexually transmitted infections (STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of infection. A recent evaluation of this approach demonstrates that many women who complain of vaginal discharge do not have RTI, and are inappropriately treated with antibiotics. It seems likely that women are over-reporting vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework.
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Affiliation(s)
- K Trollope-Kumar
- West End Health Associates, 1827 Main Street W., Hamilton, Ontario, Canada L8S 1H6.
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