Social Pathways in the Comorbidity between Type 2 Diabetes and Mental Health Concerns in a Pilot Study of Urban Middle- and Upper-Class Indian Women

Abstract

This report describes preliminary findings about the connections between type 2 diabetes, mental health, and normative social roles among women living in Delhi, India. We conducted freelist interviews with 62 diabetic and nondiabetic women about women's roles, perceptions of diabetes, and “tension,” a common Hindi‐language idiom used to express stress. Using the freelist results, we produced and then administered a questionnaire to a pilot sample of 33 diabetic women. Among the diabetic women, physical symptoms of diabetes predicted higher biomedical anxiety and “tension,” whereas difficulties achieving gender‐specific social roles predicted higher biomedical depression. We conclude that both physical symptoms of diabetes and difficulties achieving socially important roles contribute to poor mental health among these diabetic women; further research will clarify the relationships among depression, anxiety, “tension,” and women's physically and socially mediated experiences of diabetes.

Applying Syndemics and Chronicity: Interpretations from Studies of Poverty, Depression, and Diabetes

“…Such mixed methods approaches are a growing trend among anthropologists and speak to an increasing interest across the subfield in the integrative approaches we demonstrate in previously published work (Mendenhall and Jacobs 2012;Weaver and Hadley 2011).…”

“…We use these case studies as a jumping off point in order to discuss the theoretical constructs of syndemics and chronicity in depth, and to explore the shared and complementary aspects of each analytical framework. We conducted mixed-methods research on type 2 diabetes and depression among Mexican immigrants in Chicago, USA (Mendenhall and Jacobs 2012;Mendenhall 2012), and among women in New Delhi, India (Weaver, forthcoming;Weaver and Hadley 2011). The first study was conducted in 2010 with 121 Mexican immigrant women seeking diabetes care at the largest safety-net hospital clinic in Chicago.…”

“…The CES-D has been validated for use in Spanish-speaking populations (Radloff 1977;Soler et al 1997), and a total score greater than 16 indicates clinically significant levels of distress. Weaver measured depression using the Hopkins Symptoms Checklist (HSCL), a 25-item questionnaire in which respondents are asked to score the intensity of each mood-related item in the last week (Mollica et al 2004), and which she validated for use in Hindi-speaking populations (Weaver and Hadley 2011). Responses are averaged, and a score greater than 1.75 is considered a clinically significant level of depression or anxiety symptoms.…”

Type 2 Diabetes and Anxiety Symptoms Among Women in New Delhi, India

“…12 Our scoring method produced a cutoff value of 1.3 or higher indicating clinically significant symptoms of anxiety or depression. 13 The questionnaire also included a locally derived instrument designed to measure severity of disability resulting from diabetes in 18 gender-specific tasks that women deemed important; the instrument was developed from free-listing and domain analysis exercises conducted among this population during pilot research in 2009.…”

“…13 The questionnaire also included a locally derived instrument designed to measure severity of disability resulting from diabetes in 18 gender-specific tasks that women deemed important; the instrument was developed from free-listing and domain analysis exercises conducted among this population during pilot research in 2009. 12,21 The tasks assessed were generally domestic, involving family care and household maintenance, 12 and women were asked to indicate whether their diabetes had affected their performance of each of these activities a lot, a little, or not at all. This ranking generated a simple summary score (with a possible range of 0---36) for each woman representing diabetes-related functional disability restricting performance of daily tasks.…”