Depressive symptomatology among women in Punjab: An exploration of psychological vulnerabilities, defenses and efficacy of a community-based psychosocial intervention

Abstract

The prevalence of mental health issues has been witnessing a hike for the last couple of decades. Mental health is an important component of well-being for both an individual as well as the family and the society. Mental health issues affect individual functioning in the personal, social, and occupational domains of life. These issues also hamper the contributions that the affected individuals could have made to society. Among the mental health issues, the most prevalent and disabling is depression, which may also lead to suicidal deaths in severe cases. Global surveys pertaining to mental health have observed that compared to men, vulnerability to depression is higher among women. This vulnerability becomes more concerning when, due to the gender bias in society, women face imposed gender roles, discrimination, injustice, and violence and are left with less participation and autonomy in decision-making. The societal diathesis supplemented with a high treatment gap and scarcity of resources at disposal highlights the need for community-based interventions as the existing approaches have not been able to make a significant impact on the bigger picture. The present study aimed to devise a community-based intervention that could address the issues of relatively higher prevalence of depression and limited access to treatment among Indian women living in the state of Punjab. But prior to the intervention, the identification of relevant psychological vulnerabilities and defences related to depression, as well as the empirical test of their association in this particular context, was important. Therefore, this study was conducted in two phases. The first phase dealt with the identification of relevant factors of transdiagnostic and therapeutic importance in depression, and their association was empirically investigated by assessing 671 women (N=671, Mage=23.71, SDage=6.09) across five districts of Punjab using standardized measures. The results showed that neuroticism, extraversion, rumination, reappraisal, resilience, and self-efficacy were significant predictors of depressive symptomatology among women in Punjab. The results also suggested a pattern, i.e., Psychological Defensive Syndrome (PDS), where women with high scores on extraversion, reappraisal, resilience, and self-efficacy and low scores on neuroticism and rumination experienced less severe symptomatology compared to their counterparts. The second phase targeted the more malleable factors identified and assessed in the first phase by employing a five-session community-based intervention devised to manage depressive symptomatology among the women (Exp. Group: N=114, Mage=23.03, SDage=5.29; Control group: N=37, Mage=24.89, SDage=6.44) screened for depressive symptomatology in non specialized healthcare settings. The five-session intervention effectively improved the PDS as well as the depressive symptomatology. These findings shed light on the significance of identified and tested psychological vulnerabilities, as well as the employability and effectiveness of community-based interventions in non-specialized healthcare settings to prevent and manage depressive symptomatology among women in India. While the PDS can serve as a potential criterion for early identification of depressive symptomatology, the community-based and modular nature of the intervention provides a viable framework for the growth and sustainability of mental health programs in non-specialized healthcare settings.