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Poverty And Common Mental Disorders In Developing Countries

1172 words - 5 pages

The two most striking take-home messages from this paper are: common mental disorders should be looked at on par with other diseases associated with poverty (like tuberculosis); treatment and prevention of mental diseases should involve confronting poverty and economic development, apart from the medical interventions. The rest of the paper provides a discussion of the evidence backing these points and the ways in which they can be implemented. These conclusions and the reasons why they are remarkable are discussed in this critique.
This is a review of 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries published in English-language journals since 1990 and three global mental health reports. All studies were conducted independent of each other. Although the samples surveyed do not necessarily represent the population of the country concerned, the studies have a claim to some generalizability because they have used measures validated for the local settings. A statistically significant relationship was shown in 10 of the 11 studies between prevalence of common mental disorders (median rate 20%-30%) and indicators of poverty (such as low income, lack of material possessions, lack of employment, and housing difficulties). The common mental disorders, restricted in this review to depressive and anxiety disorders (“neurotic, stress-related and somatoform disorders” and “mood disorders” (ICD-10, 1992)) were found to be most consistently related with low educational levels. The authors explore the possible mechanisms of these relationships, through factors like insecurity and hopelessness, rapid social change, risks of violence and physical ill-health. They also discuss whether poverty leads to mental disorders or vice versa, concluding instead that these two form a vicious cycle - each leading to the other and that this is a universal finding. However, they qualify this statement, maintaining that this is not a final conclusion since the review contained a small number of studies, none of them longitudinal.
The first important implication this paper emphasizes is that there is a strong need for mental diseases to be looked at on par with other diseases associated with poverty. There is no doubt today that mental disorders form a significant public health burden (WHO report, 2001). One category of mental illness – unipolar depressive disorders – is placed third among leading causes of burden of disease in terms of Disability Adjusted Life-Years (DALYs) globally (Global Burden of Disease, WHO, 2004). This is more than that for ischemic heart diseases or even HIV/AIDS. Yet, there is a big discrepancy between the magnitude of mental illness burden (especially in low- and middle-income countries) and the resources devoted to addressing it (Tomlinson, 2009). At the root of this issue is the stigma associated with mental illness. Public stigma and internalized stigma (negative ...

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