Contextual and Social Factors That Contribute to Depression Among Women in India: A Meta-Synthesis

Background: Depression contributes most significantly to the global burden of disease and it is the most frequently encountered women’s mental health problem across the world. In India, epidemiological studies consistently report worse mental health outcomes among women as compared to men. Social determinants such as poverty, low levels of education, and gender disadvantage in the form of rigid traditional roles, interpersonal conflict and violence make Indian women more susceptible to depression. Yet, depression in India is typically addressed from a narrow biomedical standpoint. There is growing recognition that a more comprehensive biopsychosocial paradigm is needed to fully explore and understand the lives of women living with depression in India. In a male dominated society, how does culture shape women’s experiences of depression? We conducted a meta-synthesis to collate evidence from qualitative studies that explore women’s experiences of living with depression in India.

Methods: Two reviewers conducted a systematic search of three electronic data bases (PubMed, PyscINFO, ProQuest). Initial database and manual searches through reference lists produced 650 abstracts. The reviewers screened titles and abstracts to arrive at a subset of 41 papers.  In turn four reviewers screened these 41 papers for eligibility. Articles meeting the following criteria were included in the meta-synthesis: 1) study conducted in India, 2) qualitative research design, and 3) primary data included women’s firsthand accounts of depression. Eight papers met the inclusion criteria and were included in the synthesis. We used Noblit and Hare’s (1988) meta-ethnography approach to synthesize findings from the studies. This meta-ethnography approach focuses on the “translation of qualitative studies into one another” and uses the techniques of translation and reinterpretation to arrive at conceptual paradigms.

Findings: Synthesis of findings revealed that women in India express mental health problems through somatic complaints such as ‘weakness’, ‘tiredness’, ‘aches and pains’ and ‘continued feelings of hopelessness’. Women attribute the cause of their illness to ‘interpersonal conflicts’, ‘overwork’, ‘restricted freedom’, lowered status and associated physical violence, pressure to conform to social roles, economic difficulties, lack of agency and adverse reproductive events. They describe how the illness affects their daily functioning and contributes to impaired relationships. Children were a motivating factor to seek and continue treatment. Women continue to seek biomedical treatment for depression even though the causes appear to be situated in poor interpersonal experiences and socioculturally defined power differentials.

Conclusion: Indian women’s experiences with depression are deeply embedded in their social worlds. Mental health service providers in India need to reexamine their androcentric assumptions, diagnostic practices and treatment that approach women with depression from a biomedical perspective, thereby disabling and invalidating women’s context and experiences. In a country that is still deeply rooted in patriarchy, mental health practice must locate women’s lives and their illness narratives within their sociocultural contexts. Gender sensitive mental health services that can acknowledge the presence and impact of structural and interpersonal factors on women’s mental health are imperative. This will enable women to transcend deeply entrenched roles and construct identities that add meaning and quality to their lives.