Psychiatric Morbidity Among Rural And Slum Female Population-A Comparative Study

Background: Psychiahic disorders are more prevalent among women than men worldwide. The lifetime risk of depression and dysthymia are twice as cofllmon in women as men. Rural women usually undergoes more stressfrrl situations and also scores more on stress scale than that of urban and slum population. Objectives: The research objectives of this study are: 1) To find out the prevalence ofpsychiatric disorders among the study population. 2) To compare the disorders among the rural and slum female population. 3) To find out the influence of existing socio-demographic factors on psychiatric disorders. Method: This is a community-based study, which is also cross sectional and descriptive in nature. The sample for the main study constituted 366 randomly selected respondents. A two-staged screening procedure was carried in the study. First, the total population was studied by screening test * Self Reporting Questionnaire (SRQ) to divide the sample into 'screen positive' and 'screen negative' subjects. In the second stage, full assessment of a mixture of all 'screen positive' and 25Yo 'screen negative' was carried out by structured clinical interview for diagnosis (SCIDNP). Later SCID filled by the respondents was assessed by consultant psychiakists by using DSMIV in order to put exact clinical diagnosis. Stress was scored according to Presumptive Stressful Life Events Scale (PSLE). The total duration of the study was from July 2010 to June 2011. Results: Higher prevalence of psychiatric morbidity was found among rural sample Q2.8%)than slum (l).g}%)population. Regarding pattern of psychiatric disorders among rurallopulation, Depressive Disorders (46.7%), Somatoform Disorder (18.3%), and Generalized Anxiety Disorder (16.7%) showed higher prevalence rate. Among slum respondents PTSD (54.5%), Depressive Disorders (45.5%), Generalized Anxiety Disorders and Substance Misuse (18.1%) showed higher prevalence rate. Conclusion: Due attention should be given to the female population specially in rural areas regarding diagnosis and teatrnent ofmental disorders.


Introduction i
a greater degree and blame themselves for incompetence rsycnlarrc orsoroers are more prevalent among women and failure' Their passive ruminative style of coping with rnan men worrdwlde.'women are disadvanta"sed with problems' their conflicting and changing social expecta- respect to men especially when it comes to ".rtJi, diror-tionsand high rates of sexual abuse are also considered as ders lfte mood drsorder, anxiety disorder, somatofomr possible.explanationsfor high rates of depression and disorder, eating disorder and sleep disorder.2The lifetime lv]rvmia among ttrem'3 A nationwide study in Bangla-uEUil srluwEu utat ulE ccneral Drevalence oI rrsvcnlafnc nsK or qepressron ano cysthymia are twice as common in desh showed that the general prevalence of psychiatric women as men.3 Search for vurnerability to depression disorders among adult population is l6'2Yo with male showed that women invest their emotions in interiersonal female rutio l2'9: 19'0'a relationships.Another that women internalize feelings to It was also found that prevalence of psychiakic disorder is    From the study findings, we will be able to assume some differences in the pattern of psychiatric morbidtty among rural and slum female respondents.We may also assume the stressful situations they usually experiences.A two-staged screening procedure was carried for the study.First, total population was studied by screening test Self Reporting Questionnaire (SRQ)6 to divide the sample into 'screen positive' and 'screen negative' subjects.In the second stage, full assessment of a mixfure of all 'screen positive' and 25% 'screen negative' was carried out by structured clinical interview for diagnosis (SCID).7 Cases as determined in stage t was confirmed or disconfirmed by the interview in stage 2. Confirmed cases were considered as true positives.Moreover, inclusion of a random sample of 'screen negative' subjects (25%) makes it possible to determine how often the screening procedure generates false negatives.Consultant psychiatrists assessed later SCID filled by the respondents and diagnosis was assigned according to DSM IV. 8 A questionnaire for the study was also developed in order to obtain socio-demographic data and other important variables.Stress was scored according to Presumptive Stressful Life Events Scale (PSLE).e For the study, 366 respondents (206 from rural and 104 from slum) were included.About 380 respondents were contacted for inclusion and out of which 366 participated in the present study.The participation rate was 96.3%.
Households were selected according to table of random numbers and all the adult female population of that household who fulfils the inclusion criteria was interviewed.
The total duration of the study was from July 2010 to June zAIt.
l.Semi-strucfured questionnaire for obtaining socio- demographic and other import ant variables 2. The Self Reporting Questionnaire (SRQ) for screening purpose.
3. Structured Clinical Interview for Diagnosis.

DSM IV-4th edition of Diagnostic and Statistical
Manual of American Psychi atrtc Association.
5. Presumptive Stressful Life Events Scale (PSLE).PSLE was developed by Gurmeet Singh (Sing et aL.1984), which has been standardized for Indian population.

Results :
This was a cross sectional, descriptive and comparative study.The main objective of the study was to find out the prevalence of psychiatric morbidity among rural and slum female population and compare it.A total number of 366 respondents were included in the sfudy.This was a community-based study.Higher prevalence was found among rural sample (22.8%) than slum (10.90%) popula- tion" This finding is statistically significant .
The rural group also scored higher than slum ones (46.5 + I2.L) on stress scale with mean stress score 90.6 * L7 .1.
Another study also shows similar findings.' In spite of high rate of divorce (3 5.5yo), psycho-trauma in forms of domestic violence and dowry demands slum respondents could overcome and showed less prevalence of psychiat- ric disorder and scored less on stress scale.One assump- tion is that slum females cafi release their feelings, emotions easily without hesitation.They often argue for their rights, sometimes use rude language in order to show Discussion : A total of 366 respondents were included for the study.
Among them 262 was from rural background and rest 104 were from slum area.More rural population was included in the study because majority of our people reside in rural areas.Urban population is only 27% of total population.l0r49 of any diseases process will be good enough.In rural areas mental health is still ignored especially in case of females.
Medically unexplained symptoms are acommon term that remains long term maltreated, if mental illness is screened properly than the prognosis will be better.

Conclusion :
The study was conducted to find out the psychi atrtc disor- der among the females of Slum and rural areas and to compare the morbid condition between these females.Female mental health is ignored in Bangladesh and this study shows that due attention should be given to the female population specially in rural areas regarding diagnosis and treatment of mental disorders.This type of study'should be done in different districts of Bangladesh to find out the actual prevalence rate of psychiatric disor- der among female population.
The magnitude of the problem may be assessed and this may be elaborated by further intensive research.Through

Table - II
females, divorce rate was 35.5% (Table-V).Relationship of respondent's psychiatric morbidity and their husband's multiple marriage, dowry demands, and number of children they have to rear(Table-VI).Distributions of respondents according to their mean

Table - V
Distributions of respondents according to their marital their authority and control.Majorrty of them are employed as housemaid (73.0%) with reasonably good earnings.This financial independency is also important for less scoring on stress scale than rural people.Poverty, loss of crops & household animals, multiple marriages of their husbands, dowry demands, child rearing etc. were the main stress factors for rwal women.Stressors like huge loan, unemployment, loss of crops and household animals, problem with neighbor etc. were frequently present among rural sample.A11 those factors contributed to their economic crisis.Similar types of stressors were also found in rural Punj ab.eA multicentric study conducted by National Institute of Mental Health, Bangladesh in collaboration with World Health Organizationalso found more stress among ruralpopulation.2Vulnerabilityfactorsll were also more among rural people than that of slum ones.Those vulnerability factors like having the care of young children, not working outside the home, having no one to confide in also contributed in triggering a depressive episode.Health care service comprises both physical and mental health services, keeping these vulnerability factors in mind if special attention is given to the women health the outcome