Depression due to Poverty
In Pakistan, as in other countries, there is a constant upward creep of poverty, unemployment, displacement, and homelessness. Concomitantly, mental health is emerging as yet another major public health issue.
Few studies, however, rely on the perception of the public regarding mental health issues. This paper, therefore, aims to give a general review of mental health literacy among the Pakistani public with respect to clinical depression. It pays particular attention to the causes of the disease, its manifestations in a patient, effective measures of treatment, and help-seeking behaviors.
More than 20 million Pakistanis (10% of the country’s population) suffer from some form of mental health condition. The full gravity of this situation comes to light with the realization that Pakistan has one of the lowest psychiatrist-to-person ratios in the world. According to WHO, only 400 psychiatrists and five psychiatric hospitals exist within the entire country for a population exceeding 180 million people.
That is, low mental health literacy could be the main cause of high rates of mental illnesses. Mental health literacy has been defined by Jorm et al. as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention.” People suffering from mental illness also have to bear the prejudices associated with their condition and this stigma is prevalent amongst the Pakistani people.
Knowledge of the public’s perception of mental illness is vital towards establishing successful programs to eliminate them. This must be done along with an assessment of the norms, beliefs, and customs in the respective cultural environment. In Pakistan, beliefs in black magic, the evil eye, and possession by demons are quite rampant. Spiritual leaders have a good following and are easily accessible for a cure for all physical and mental disorders.
Materials and Methods
An anonymous self-administered questionnaire was distributed, using the method of non-probability consecutive sampling, in the areas of Clifton, Gulshan, and Saddar in Karachi, during the period from August 2018 to October 2018. The areas were selected because of their differences in social and economic infrastructure. The sample size was measured to be 385 at a 95% confidence interval.
The questionnaire was originally framed in the English language and then translated into Urdu, which is the national language of Pakistan. Males and females of all age groups, who could conveniently read either Urdu or English, were included in this study. The ethical review committee at Ziauddin Medical University approved the study, and informed written consent was taken from all respondents before their involvement in the survey.
The participants were asked to provide their demographic information in the first section of the questionnaire. The second section analyzed the general response on what depression as a mental condition is and how widespread it is in the nation. Section three addressed further questions related to depression, including signs and symptoms of the disease, causes for depression, best forms of treatment, and the primary reasons depression individuals avoid seeking help.
Section four addressed first-hand experience with clinical depression. The responses were entered and analyzed using the Statistical Package for Social Sciences 20.0 (IBM Corp, Armonk, NY, USA). Descriptive analysis was used to calculate frequencies. Associations between the demographic variables and the knowledge/attitude of depression and personal experience of depression were tested using the Chi-squared test at a significance level of p < 0.05.
Results
Out of 400 subjects, 61.5% were females and 38.5% males. The average age of the subjects was 28.53 ± 13.282 years. Most of the subjects belonged to the Muhajir community (26.6%), followed by Punjabi (21.3%) and Sindhi (20.8%). Based on qualifications, postgraduates and graduates comprised 20.5% and 32% of our subjects, respectively.
At the time of the questionnaire, 39.4% were at intermediate/A level, and 5.3% were at matriculation/O level. Most of the responses, 50.1%, were from participants with an income of less than 25,000 PKR/month, and 24.1% were greater than 100,000 PKR/month.
Whereas 45.8% of the participants correctly perceived depression to be highly prevalent and affecting one out of four people, 45.5% thought it was moderate, affecting one in fifty, while 8.3% thought it was low, affecting one in every one hundred people. Forty percent of the participants understood it as a natural feeling of sadness, 37.8% as a mental disorder, and 12.3% believed it to be an artifact of imagination.
The major reasons stated for depression were increased stress (72.2%), physical and emotional trauma (51.3%), poor physical health (36%), being overworked (36.8%), low socioeconomic status (30.5%), and family history (29.3%). Only 13.3% perceived a change of seasons to affect depression. 10.5% thought djinns and the evil eye to cause an impact, and 5.8% thought of it to be a consequence of God’s punishment.
Patterns of responses differed across gender in the case of men, they found it more common to link a lack of education and the tendency to seek attention with the depression of an individual person, while women found previous family history, depression as learned behavior, and evil eye/djinns as the most popular reasons.