Understanding psychological distress among mothers in rural Nepal: a qualitative grounded theory exploration

BMC Psychiatry

Research Article

Bhawana Thakur¹  Bhim Shrestha¹  Sonali Jha¹  Rinku Tiwari¹  Rinku Roy¹  Mamita Ghising¹  Kalpana Giri¹  Dharma Manandhar¹  Bishnu Bhandari¹  Michael King²  Meena Jha³  Jananee Magar⁴  David Osrin⁵  Anthony Costello⁵  Kelly Clarke⁵  Naomi Saville⁵  Audrey Prost⁵ 

[1] Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal;Research Department of Mental Health Sciences, University College London, Charles Bell House, 2nd Floor, 67-73 Riding House Street, W1W 7EJ, London, UK;St Albans, Hertfordshire, UK;Transcultural Psychosocial Organisation Nepal, Baluwatar, Kathmandu, Nepal;University College London Institute for Global Health, 30 Guilford Street, WC1N 1EH, London, UK;

关键词: Nepal;    South Asia;    Psychological distress;    Postnatal depression;    Perinatal common mental disorders;    Maternal mental health;    Rural health;   

DOI  :  10.1186/1471-244X-14-60

 received in 2013-09-12, accepted in 2014-02-19,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThere is a large burden of psychological distress in low and middle-income countries, and culturally relevant interventions must be developed to address it. This requires an understanding of how distress is experienced. We conducted a qualitative grounded theory study to understand how mothers experience and manage distress in Dhanusha, a low-resource setting in rural Nepal. We also explored how distressed mothers interact with their families and the wider community.MethodsParticipants were identified during a cluster-randomised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Questionnaire (GHQ-12). We conducted 22 semi-structured interviews with distressed mothers (GHQ-12 score ≥5) and one with a traditional healer (dhami), as well as 12 focus group discussions with community members. Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting.ResultsWe found that distress was termed tension by participants and mainly described in terms of physical symptoms. Key perceived causes of distress were poor health, lack of sons, and fertility problems. Tension developed in a context of limited autonomy for women and perceived duty towards the family. Distressed mothers discussed several strategies to alleviate tension, including seeking treatment for perceived physical health problems and tension from doctors or dhamis, having repeated pregnancies until a son was delivered, manipulating social circumstances in the household, and deciding to accept their fate. Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husbands for resources.ConclusionsVulnerability, as a consequence of gender and social disadvantage, manifests as psychological distress among mothers in Dhanusha. Screening tools incorporating physical symptoms of tension should be envisaged, along with interventions to address gender inequity, support marital relationships, and improve access to perinatal healthcare.

【 授权许可】

CC BY   
© Clarke et al.; licensee BioMed Central Ltd. 2014