Mental health in the slums of Dhaka - a geoepidemiological study

Abstract

BackgroundUrban health is of global concern because the majority of the world's population lives in urban areas. Although mental health problems (e.g. depression) in developing countries are highly prevalent, such issues are not yet adequately addressed in the rapidly urbanising megacities of these countries, where a growing number of residents live in slums. Little is known about the spectrum of mental well-being in urban slums and only poor knowledge exists on health promotive socio-physical environments in these areas. Using a geo-epidemiological approach, the present study identified factors that contribute to the mental well-being in the slums of Dhaka, which currently accommodates an estimated population of more than 14 million, including 3.4 million slum dwellers.MethodsThe baseline data of a cohort study conducted in early 2009 in nine slums of Dhaka were used. Data were collected from 1,938 adults (≥ 15 years). All respondents were geographically marked based on their households using global positioning systems (GPS). Very high-resolution land cover information was processed in a Geographic Information System (GIS) to obtain additional exposure information. We used a factor analysis to reduce the socio-physical explanatory variables to a fewer set of uncorrelated linear combinations of variables. We then regressed these factors on the WHO-5 Well-being Index that was used as a proxy for self-rated mental well-being.ResultsMental well-being was significantly associated with various factors such as selected features of the natural environment, flood risk, sanitation, housing quality, sufficiency and durability. We further identified associations with population density, job satisfaction, and income generation while controlling for individual factors such as age, gender, and diseases.ConclusionsFactors determining mental well-being were related to the socio-physical environment and individual level characteristics. Given that mental well-being is associated with physiological well-being, our study may provide crucial information for developing better health care and disease prevention programmes in slums of Dhaka and other comparable settings.

The psychological toll of slum living in Mumbai, India: A mixed methods study

“…Other studies have come to similar conclusions regarding the importance of slum characteristics, independent of income, specifically with regard to understanding environmental living standards (Swaminathan, 1995), maternal and child health outcomes (Osrin et al, 2011), and self-rated well-being (Gruebner et al, 2012) in slums. Collectively, these studies, combined with the findings in this paper, support the use of broad definitions of poverty, such as the capabilities approach, which attempt to define poverty using a wide variety of indicators of deprivation, of which income is but one (Sen, 1999).…”

How community physical, structural, and social stressors relate to mental health in the urban slums of Accra, Ghana

“…A handful of studies in developing countries have examined the relationship between slum residence and mental health. However, they rarely focus on sub-Saharan Africa or examine how specific facets of the social and structural environment (e.g., crime, disorder, joblessness, social capital) influence mental health (Ezpeleta et al, 2007;Gruebner et al, 2012;Izutsu et al, 2006;Parkar et al, 2012;Puertas et al, 2006;. There are significant regional variations in the cultural meanings of mental health, comfort about expressing symptoms indicative of mental health disorders, and stigma surrounding mental health disorders (Abas and Broadhead, 1997;Barke et al, 2011;Bass et al, 2007;de Menil et al, 2012;.…”

“…Existing research on mental health in sub-Saharan Africa has primarily focused on individual and household risk factors, including poverty, unemployment, inadequate housing, food insecurity, gender, age, marital status, education, intimate partner violence, and HIV status (Bove and Veleggia, 2009;Cole and Tembo, 2011;de Menil et al, 2012;Dewing et al, 2013;Gruebner et al, 2012;Khumalo et al, 2012;Kuo et al, 2012;Patel and Kleinman, 2003;Myer et al, 2008;Olagunju et al, 2012;Patel et al, 2006;Pillay and Kriel, 2006;Pitpitan et al, 2012;Sipsma et al, 2013). To date there is scant population-based research on how the structural, institutional, and social dynamics in disadvantaged urban settings can contribute to mental health outcomes.…”

Socioeconomic Inequalities in Mental Health of Adult Population: Serbian National Health Survey

“…Being a female was also a significant predictor of chronic medical illness and psychiatric multi morbidity in Australia (24), Finland (25), Sweden (26), Bangladesh (28), and Southeast Brazil (29), perhaps because of higher workload, low position in some cultures and higher level of stress hormones (25,30). Although female roles changed with the time, the odds ratios remained relatively stable for more than half a century (23).…”

“…Although female roles changed with the time, the odds ratios remained relatively stable for more than half a century (23). Noteworthy evidence implies that the mental health of females and males is equally endangered by unsatisfactory basic life conditions (28).…”