Building a Case for Addressing
the Issue of Mental Health in Rural Tamil Nadu

Nicholas De Vito, Amudha Panneerselvam,
Kavya Vaghul, Juhi Sutaria,
Ravikumar Chockalingam

Etiology of mental disorders

Causes of health and disease are generally a product of the interaction between biological, psychological, and socio-cultural factors. Stressful life events, affect (mood and level of arousal), personality, and gender are prominent psychological influences. Social influences include parents, socioeconomic status, racial, cultural, and religious background, and interpersonal relationships.

Genetic factors

Schizophrenia is linked strongly to genetic factors. Since 1980, 11 major family studies of schizophrenia have been reported that used blind diagnoses, control groups, personalized interviews, and operationalized diagnostic criteria. Every study showed that the risk of schizophrenia was higher in first-degree relatives of schizophrenic patients than in matched controls. The mean risk for schizophrenia in these 11 studies was 0.5% in relatives of control and 5.9% in the relatives of schizophrenics. Modern studies suggest that, on average, parents, siblings, and offspring of individuals with schizophrenia have a risk of illness about 12 times greater than that of the general population (Evans, et al., 2005).

But this does not mean that genetic factors completely fix the nature of the disorder and that psychological and social factors are unimportant. Social factors modify expression and outcome of disorders. Some mental disorders, such as post-traumatic stress disorder (PTSD), are clearly caused by exposure to an extremely stressful event, such as rape, combat, natural disaster, or concentration camp (Yehuda 1999). Yet not everyone develops PTSD after such exposure. On average, about 9 per cent do (Breslau et al., 1998), but estimates are higher for particular types of trauma. For women who are victims of crime, one study found the prevalence of PTSD in a representative sample of women to be 26 per cent (Resnick et al. 1993). The likelihood of developing PTSD is related to pretrauma vulnerability (in the form of genetic, biological, and personality factors), magnitude of the stressful event, preparedness for the event, and the quality of care after the event (Shalev, 1996). The relative roles of biological, psychological, or social factors also may vary across individuals and across stages of the life span. In some people, for example, depression arises primarily as a result of exposure to stressful life events, whereas in others the foremost cause of depression is genetic predisposition.

Social factors

Research in both developed and developing countries has shown the link between poverty and poor health status. Poverty and its associated psychosocial stressors, such as violence, unemployment, and insecurity, are correlated with the onset of adult mental disorder (GMH 2). Children born into poverty face various risk factors for mental and physical illness. Risk factors in poor children’s families and communities combine with scarcity of protective factors to increase the likelihood of mental health problems and developmental disabilities. A review of 11 community studies in six low income and middle-income countries in Africa, Asia, and Latin America, reported a consistent association between poor education and high rates of mental disorders.

Sex is also an important determinant of mental disorders, help seeking, and the need for services. In many countries, more women than men meet criteria for common mental disorders such as anxiety and depression. Patel et al. (2006) showed that nearly half of the people who attended primary care in India had common mental disorders, and that disorders were associated with poverty and female sex, after controlling for other social and demographic variables.

« Previous Section: Introduction Next Section: Classification and diagnosis of mental illness »