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Low Income and Climate Change Linked to India's Suicide Epidemic
India is in the midst of a suicide epidemic. Recent studies by the World Health Organization (WHO) and Proceedings of the National Academy of Sciences of the United States of America (PNAS) have linked India’s suicides to academic pressures, financial stresses and climate change.

When last reported in 2015, WHO found that 15 of every 100,000 Indians commit suicide, dwarfing many other nations’ rates. More concerning is that teens and young adults account for nearly half of India’s suicides. These high rates can be attributed to a variety of factors.

Academic Pressures
Societally, failure is not an option for many students in India. Many have a hard time coping with poor grades because they believe that scholastic performance is the deciding factor in gaining employment.

Failure in school leads to frustration. Because India’s schools lack emotional support systems for students, many can fall into cycles of anxiousness, helplessness and in extreme cases, suicide. In 2015, one student committed suicide every hour.

Academic pressures were also found to disproportionately negatively affect lower income and impoverished students. These students feel there is more on the line, and when they struggle are more prone to fall into depression.

Financial Stress and Climate Change
Financial stress and climate change are very much linked in India’s agricultural society. With over half of India’s population involved in agriculture in some way, crops and land viability have a huge impact on the mental well-being of Indians.

A 2017 PNAS report linked changing climates to an increase in suicides, attributing nearly 60,000 deaths to climbing temperatures and crop failures. Researchers found that during the growing season, every degree above 20° Celsius could be linked to roughly 70 deaths.

For farmers living from harvest to harvest, every crop is crucial. Failure not only means that you may go hungry, but that the loan servicer may come to collect and repossess the equipment you need to start another crop. India’s suicide epidemic is not only due to climate change, but also to the financial strain it disproportionately puts on poor farmers.

India’s Response
India currently has a number of suicide prevention hotlines. All are NGO-run and none are government funded. This means limited resources and limited accessibility. In the same vein, India currently has a shortage of mental health professionals and mental health infrastructure to address this epidemic.

When asked, many in India believe that suicide is a personal matter that should be handled privately, and until 2014 was considered an illegal act. Mental health professionals believe the stigma of talking about mental health needs to end. Some, like psychiatrist Satyakant Trivedi, believe that it needs to be addressed early.

“Mental health and wellness should be added to school curriculum. Only when children know about these disorders in their formative years will they be able to seek help,” Trivedi wrote in an India Today article.

Addressing mental health in schools, funding appropriate infrastructure and increasing the number of mental health care professionals in India are all good ideas. The road map is there. Leaders just now need to come forward and address India’s suicide epidemic.

Thomas James Anania

Photo: Flickr

Mental HealthIn sub-Saharan Africa, a poverty-dense region, there is a relative lack of mental health services. This is partly because most healthcare resources in sub-Saharan African countries are allocated to infectious diseases such as HIV/AIDS, malaria and tuberculosis.

Ninety percent of malaria deaths, 70 percent of people with HIV/AIDS and 26 percent of tuberculosis cases are concentrated in sub-Saharan Africa. Against this background, mental health problems do not always raise concern. Mental illness accounts for 10 percent of the disease burden in sub-Saharan Africa.

The most common mental disorders in the region are depression and anxiety. The prevalence rates of depression and major depressive disorder in sub-Saharan African countries range from 40 to 55 percent. Among the child and adolescent populations of Sub-Saharan Africa, mental health issues are common. Fourteen percent have mental health problems and nearly 10 percent have diagnosable psychiatric disorders.

Poverty, warfare and disease have all been identified as vulnerabilities and risk factors to child and adolescent mental health in sub-Saharan Africa. In one study conducted in southern Sudan, researchers found that 75 percent of children there suffer from post-traumatic stress disorder. There is a lack of evidence-based research on child and adolescent mental health in sub-Saharan Africa. However, a review of the literature indicates that psychological distress and mood, conduct and anxiety disorders are common among children who have experienced armed conflict.

In 2011 it was estimated that 90 percent of children infected with or directly affected by AIDS reside in sub-Saharan Africa. Rates of anxiety and depression are significantly higher in children who have been orphaned by AIDS than in other children. One study found that 12 percent of children orphaned by AIDS in rural Uganda had suicidal thoughts.

There are several challenges to providing quality mental health services in low- and middle-income countries. Two of these include cost and lack of research and needs-based assessments. Of all medical conditions, mental disorders are some of the most expensive to treat. In most sub-Saharan African countries, treatment facilities are limited in number and often inaccessible to much of the population. But without needs assessments and research demonstrating the value of providing effective treatments and services in the region, improving mental health care and its availability to those who need it remains a relatively low priority.

In recent years, mental health has been getting increased attention in sub-Saharan Africa and new efforts have been developed to improve mental health research and care in the region. In 2011, an association of research institutions and health ministries in Uganda, Ethiopia, India, Nepal and South Africa partnered with Britain and the World Health Organization to research the effect of community-based mental health treatment in low- and middle-income nations and to develop facilities and services in these areas.

Another effort is the Africa Focus on Intervention Research for Mental Health, which is working with several sub-Saharan nations on infrastructure development and has conducted a number of randomized controlled experiments to test affordable, accessible intervention methods for severe mental disorders.

This is only a small sample of the development efforts addressing mental health treatment and services in sub-Saharan Africa. Recognition of mental disorders’ significance in national health and more research on intervention will go a long way toward bettering child and adolescent mental health in sub-Saharan Africa.

Gabrielle Doran

Photo: Google

Mental Health in Poor Communities
While it is proven that poverty leads to cognitive setbacks, similar studies suggest that there are methods to counter poverty and its psychological effects in both the family unit and schools.

Improving mental health in poor communities became a priority in sustainable development over the last decade. Children from low-income families face psychological challenges that are much less common for higher-income children, including developmental delays, mental disabilities, ADHD, anxiety, depression and attention disorders. Parents’ education levels, race and other critical factors are not shown to have as strong a correlation as family income. Scientists trace statistics concerning mental health in poor communities back to inadequate nutrition, obstacles to proper development and chronic stress.

In response to these findings, more promising studies have shown that efforts to improve mental health in disadvantaged populations can be particularly effective during childhood.

For example, nutrition during and for a year after pregnancy is a critical part of cognitive development. Mothers who prioritize nutrition and a high-protein diet during pregnancy and breastfeeding are far more likely to have children free of mental disability.

The parent-child relationship is also crucial. At least one parent or parental figure’s consistent ability to care for a child leads to “secure attachment,” which encourages brain development, feelings of being worthy of love and the development of positive relationships. Professionals today are using attachment theory to understand and assist disadvantaged families.

The takeaway is that prioritizing pregnancy education and support in addition to positive parental relationships can improve mental health in poor communities.

Outside of the family unit, schools are an additional opportunity to promote psychological health in disadvantaged populations. Encouraging students to set goals in the classroom and giving consistent feedback develops student autonomy and intrinsic motivation. Since impoverished individuals are at greater risk of adopting a “victim mindset,” the thought process that external events alone determine their circumstance, drive and independence are crucial to future success.

According to the self-determination theory, surrounding students having material that suggests they can overcome difficult circumstances lead them to believe that they can succeed. Supplementing this school material with similar cultural stories and values at home increases the chances of internalizing positive values.

Organizing students into cooperative learning groups promotes relaxation, high achievement, positive relationships and improved psychological health, according to a 2000 study. Encouraging children to work together may combat the anxiety and stress that results from living in a low-income family and improve socialization.

While the psychological effects of poverty can be discouraging, these studies suggest that simple changes in the home and classroom are highly effective ways of empowering disadvantaged individuals. As research continues in the areas of cognitive development and psychology, further improvement in mental health in poor communities is expected.

Kailey Dubinsky

Photo: Flickr

Depression in India
According to the American Psychiatric Association, depression is defined as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act.” Depression is not just about someone being sad, but rather about an individual lacking the motivation to do anything, from their favorite activities to simply eating. With the disorder affecting 322 million people worldwide, it is a major health concern on a global level. Depression in India is, according to recent reports, at a severe level.

While depression has no limitations as to whom it affects, there are certain areas that have an exceptionally high number of people suffering from the disorder. India is one nation that has been proven to have high rates of depression. In 2016, the World Health Organization (WHO) ranked India as the most depressed country on the planet. The WHO also reported that more than 4.5% of the Indian population suffers from mental illness. While 4.5% may not seem like a significant amount, it is actually equivalent to 56 million individuals.

Depression can be treated with several methods such as medication and therapy. However, Indians who suffer from the disorder lack the resources that they need, due to the fact that only .06% of India’s health budget is used for mental health purposes. This number is shockingly low in light of the fact that well-developed countries usually utilize at least four percent of their health budgets for mental health.

As recent studies have shown, there are only 0.301 psychiatrists per 100,000 individuals in India. With not enough psychologists, nurses and social workers, many who suffer from depression in India are not given the opportunity to receive professional help.

With depression rates in India on the rise, the government is making an effort to decrease depression rates. In March, Parliament passed the Mental Health Care Bill. This bill offers all Indians mental health care, prohibits electroconvulsive therapy on minors and decriminalizes suicide.

Despite advancements, depression still remains a serious issue in the country. However, with new policies constantly being devised, depression in India, as well as throughout the world, will hopefully decrease over time.

Raven Rentas

Photo: Pixabay

Five Reasons for the Link Between Poverty and Mental Health
Poverty and mental health are inextricably tied for a myriad of reasons. A report published by the World Health Organization suggests that poor individuals are twice as affected by mental health conditions compared to rich individuals. The most important reasons for this stark inequality are outlined below.

  1. Destitute living conditions:
    Poverty often results in an inability to afford basic necessities such as food, clothing and shelter. This can result in poor living conditions and in some situations, homelessness, when individuals cannot afford rent or mortgage expenses. The uncertainty associated with living in unstable environments can often elicit a lot of stress, which can predispose individuals to mental health conditions such as depression. Poor standards of living can be addressed through aid provided by developed countries and increased public expenditure on necessary facilities such as schools, hospitals and transport systems.
  2. Stress over prolonged periods of time:
    In 2011, information published by the Fragile Families and Child Wellbeing Study revealed that generalized anxiety disorder, which is characterized by anxiety over non-specific things, was most prevalent in the poorest individuals of a particular sample population. Mothers, especially in developing countries, are constantly plagued by worry about their children’s safety, nutrition and physical and social development. Despite their worries, they are compelled to make ends meet and continue to provide for their families by cooking food, cleaning the house and ensuring utility bills are paid in a timely manner. Access to services that guide women on proper care and upbringing of children can address the effects of excessive stress on children. The government can also play a role in supporting households by providing subsidies and grants for education and discounts for health care. This is a major factor in the link between poverty and mental health.
  3. Unhealthy consumption habits:
    The effects of poverty are compounded by a multitude of problems such as homelessness, debt, risk of violence, increased rates of illness and loss of social standing and self-esteem. These problems can take a severe toll on an individual, resulting in self-harming habits such as excessive alcohol consumption, smoking, drug abuse and consumption of fast food, which is often more affordable than healthier alternatives. An alarming statistic states that approximately 33 percent of individuals suffering from poverty smoke compared to a significantly less 20 percent of individuals who are not poor.Unhealthy habits can be resolved through campaigns educating individuals about the importance of healthy eating and the negative health consequences of smoking and alcohol consumption.
  4. Insufficient access to health care services:
    Individuals suffering from poverty typically have insufficient financial resources, preventing access to affordable health care services. This prevents them from seeking help early, which may result in the progression of their mental health affliction. Poor populations can be encouraged to access health care services through subsidies and increased distribution of local clinics, which make it possible to receive this care without having to travel over long distances. Regular monitoring and sampling for mental health conditions in impoverished societies are also of critical importance.
  5. Diminished attention towards the needs of children:
    Working individuals living in poor households are likely to be preoccupied with several concerns such as debt, stress from work and even relationships with their partner. These stresses may take away attention from the growth and development of their children, leading to adverse effects on the mental health of these children. It is estimated that depression has a prevalence of 0.4 to 2 percent in children ages 6 to 12 years. Parenting training programs and reliable child care services can help children living in poor conditions receive the care they need.

While the relationship between poverty and mental health is complicated, individual measures taken to reduce global poverty are likely to have positive impacts on mental health issues in underprivileged populations.

Tanvi Ambulkar

Photo: Flickr

depression_and_poverty
Most people have encountered something like it: When you spend a long period under high stress, you wind up with a cold because your immune system is down. And vice versa: when you’re sick for a long period, you start to feel down in the dumps.

They’re both examples of the interplay between mental and physical health, something that scientists are learning more and more about. In terms of global poverty, there are many possibilities that could arise from an increased focus on the mental health of those living in the third world. Poverty becomes a third factor in this cyclical relationship.

Those who have mental disorders are more likely to be sick, and also to be impoverished (because they can’t find jobs due to feelings of inadequacy, discrimination or inability to function.) When a person is impoverished, they are less able to afford health care and are also more vulnerable to mental disorders such as depression. And the convoluted cycle continues.

In fact, way back in 1963, in a study by Langner and Michael, it was conceded that generally there is a cause and effect relationship between poverty and mental health.

The link between all three is almost inextricable. The World Health Organization (WHO) offers a few statistics that make this point all too clear.

  • The percentage of HIV/AIDS patients suffering from depression may be higher than 60 percent.
  • Depression occurs approximately twice more often in low-income groups than it does among the rich.
  • “Babies of depressed mothers are 5 times more likely to be underweight and stunted than babies of non-depressed mothers.”

Furthermore, according to WHO, 31 percent of countries don’t have a specific budget dedicated to health. Seventy-six to 85 percent of people with serious mental health conditions do not receive treatment in developing countries.

But this isn’t a depressing indicator that the doom of the world is coming quickly and imminently. On the contrary, understanding the nature of the cycle means that aid can enter into it at any point to keep it from perpetuating itself.

Aid for physical health and economic disparity are most commonly offered to those in the developing world. Perhaps, by taking a look at poverty from a new angle – through the lens of mental health – huge strides could be made towards improving all three areas on a global scale.

WHO’s website states, “Mental health issues cannot be considered in isolation from other areas of development, such as education, employment, emergency responses and human rights capacity building.”

Knowing that that is not what is being done gives humanitarians the perfect opportunity to reconsider what to prioritize in the fight against global poverty and chronic diseases, whether physical or mental.

Emily Dieckman

Sources: Journals of The Royal College of Psychiatrists, Europa, WHO 1, WHO 2
Photo: Google Images

Neural_Bias
Poverty cuts deep – malnutrition, stress, a lack of access to medical care, little social mobility and other factors all affect how a person can interact and engage with their environment and community.

For those in poverty, a neural bias caused by stress can limit one’s ability to consider events neutral; this has implications for education, conflict resolution, gender equality and rates of violence.

This bias is called the hostile attribution bias. The hostile attribution bias primarily affects how people view neutral stimuli, such as a dog barking in the distance, a pencil dropping or a sudden movement by a person nearby.

As a result of this bias, an individual may attribute negative, hostile intent to this action, assuming that the action will end up hurting them in some way. This thinking views the world in binary: good or bad, black or white, safe or unsafe.

For those who grew up in stressed environments and were frequently exposed to or victims of aggression, this is a perfectly natural way to react; it works as a protective mechanism.

But, it also can lead to an inability to focus, difficulty trusting others and higher levels of perceived threats. In addition to its effects on cognition and emotional processing, the hostile attribution bias is also correlated with higher levels of aggression and violence.

While this bias may be protective for those in conflict areas, it also perpetuates conflict whether or not the affected individual is in a conflict zone. Consequently, if an individual is at home or any safe place, they may perceive a threat when there is none.

This can lead to acts of aggression in the home, such as domestic violence, abuse or neglect. If this behavior is being conducted by an adult, this behavior will most likely be passed down to children.

For children with this bias, this affects their development of social skills and also their academic performance.

Because neutral events are immediately perceived as negative, this increases their reactivity and reduces attention while impacting their relationships with teachers and peers. In conjunction with malnutrition and poverty, the hostile attribution bias creates another hurdle to success.

The hostile attribution bias has several implications for aid and development work. First, given the propensity of the hostile attribution bias in conflict areas, mental health initiatives should consider the bias during program development and implementation.

Secondly, since the hostile attribution bias is often occurring in tandem with malnutrition and poverty, it emphasizes the necessity of proper nutrition for mothers and children to ensure healthy brain development.

In ensuring the brain is healthy, the plasticity of the brain is more feasible as individuals move from poverty and conflict zones and the individual will be able to adapt.

While the hostile attribution bias may be a safety skill for those in conflict zones or facing abuse at home, this bias is ultimately maladaptive. As individuals are empowered, gain safety and reduce stress in their lives, addressing this bias will help them be more productive and successful in changing not only their lives but also the lives of those in their communities.

Priscilla McCelvey

Sources: Pacific Standard, Practical Ethics
Photo: Amazon News

power_of_a_smile
When children are photographed, smiles come beaming through; this is generally true regardless of a person’s wealth or lack thereof. Smiles are indicators of happiness and hope that people in poverty can exhibit. While it is very true that many in poverty do not smile as their hope and joy are syphoned away by the cares of harsh everyday living, smiling is still exhibited by many throughout the globe.

Ron Gutman spoke at a TedTalk conference about the power of a smile. He cited studies done by UC Berkeley and Wayne State University who measured the width of alumni yearbook pictures and pre-1950 MLB player baseball cards respectively. They found that the wider the measure of a person’s smile, the longer that person lived and had a more fulfilling life.

This is not just a Western phenomenon. A separate study done by Paul Ekman in Papua New Guinea found that the aboriginal people perceived another person’s smile in the same way the rest of the world does, “to express joy and satisfaction.”

Smiling can be used as an emotional superpower. Gutman says that on average a person will smile around 20 times per day, yet “those with the most amazing superpowers are actually children, who smile as much as 400 times per day.”

Recently, a German study took fMRI images of people smiling and found “that facial feedback modifies the neural processing of emotional content in the brain, in a way that helps us feel better when we smile.”

This research is evidenced, in part, by photographs of people who live in poverty. When photo journalists are on assignment in areas of extreme poverty—in conditions that would strip most people of hope—smiles are spread across the faces of children.

Sebastian Cuvelier witnessed this when he traveled to the slums of Manila for a two month stay. He took pictures of children playing in the filthy streets, children taking baths in a blow-up swimming pool due to the lack of a proper bathroom, a mother smiling as she watched her children play and people living in make-shift houses.

The people of Manila are living in conditions that are heart breaking, but their smile is infectious, lights up their eyes, and draws the viewer in. Their hope shines through, a life that is grounded in family and not letting poverty steal their joy even when they have every reason to lose faith.

Part of the Manila street children’s hope, and the smiles, is through a Nongovernmental Organization (NGO) called The Virlanie Foundation. Their goal says that they are “giving back the smile to street children.” The organization was founded in 1992 and they work to help and protect the street children who are most vulnerable, such as the abused, neglected and orphaned, in order for those children to grow into productive, responsible adults.

Work by organizations like the Virlanie Foundation is important because while a smile is an indicator of hope, poverty tries to steal a person’s smile away. There are just as many pictures of smiling children in slums as there are children who have no smile because they have no future in their current condition. Giving a child hope through practical life-changing resources restores the smile and gives that child a chance to see their hope turn into something tangible. Then that child can use their smile to spread hope to others who need their own superpower smiles restored.

Megan Ivy

Sources: Daily Mail, TedTalk, Virlanie Foundation
Photo: Flickr

HIV_Patients
HIV-positive individuals face enormous challenges, in terms of both size and quantity, and the psychosocial aspect of their plight is often underestimated.

Living with the stigma of being someone who is “infected” can interfere with opportunities, relationships and one’s overall position in society. Many individuals living with the diagnosis face issues ranging from anxiety to suicidal thoughts, from personality disorders to substance abuse.

Feeling the reality of mortality, along with the sudden ostracism from the community that a person once belonged to due to the stigmatized nature of HIV, is enough to bring up these issues for anyone.

While the war against the physical symptoms and spread of the diseases is in full force, the psychological issues faced by sufferers are just as important to address.

While these “side effects” are not always taken into consideration as a priority, the World Health Organization itself “recommends that attention to the psychosocial needs of people with AIDS should be an integral part of HIV care,” according to a National Institutes of Health (NIH) study. Globally, there are many cases where it is being done with great effectiveness.

Microcredit programs provide small loans to people who, due to their life-threatening diseases and discrimination (despite legislation seeking to prevent it), are hard-pressed to receive them from other places. In the case of the Positive Partnership Program in Thailand, loans are provided for partnerships between one HIV-positive and one HIV-negative person.

Infected individuals who received loans through this program reported feeling a greater sense of self-efficacy, increased acceptance in the community and an overall improved outlook on life. HIV-negative individuals who participated in the program reported an increased understanding of HIV and decreased levels of anxiety, fear and discomfort toward HIV-positive individuals.

Programs like this one are exemplary in the move toward integrating HIV-positive individuals into the rest of society. This is on top of the opportunity they offer them to reach and prove their full mental and economic potential, as, in the study’s period of 2004-2006, 91% of the loans given were repaid on time.

Projects similar to this one include a study of a cognitive-behavioral-group program for HIV-positive men in Hong Kong, and another done in rural Uganda using interpersonal psychotherapy. Both of these studies showed that psychosocially-based programs were effective in reducing symptoms of depression and increasing overall mental health.

In truth, the efforts of groups that work to reduce stigma and increase quality of life are incalculably important. As lecturer in ethics and HIV prevention Bridget Haire says, “showing the nation how people living with HIV are a vibrant, vital and productive part of our community cannot be overestimated.”

Perhaps even more poignant are the words spoken by one of the participants in the Thai Positive Partnership Program: “Life is much improved. My social life is back. I may have HIV, but I am still a human being. I have my self-esteem, and my honor.”

Em Dieckman

Sources: UNAIDS, NCBI, The Conversation
Photo: Flickr

mental health
The connection between poverty and mental health is not surprising. The severe emotional strain and stresses associated with making ends meet, poor nutrition and unfavorable living conditions can be extremely high. Depression can be up to two times more prevalent among low-income groups and people with the lowest socioeconomic status are eight times more at risk for schizophrenia.

Yet this problem does not receive adequate attention in many places, partly due to the societal stigmas sometimes associated with mental health issues. Only two percent of national health budgets is dedicated to mental health and up to 31 percent of countries do not have a mental health budget at all.

In India, a string of farmer suicides have been making headlines. Driven to depression by rising debt, small farmers who are unable to make a profit with the scarcity of rainfall and falling prices of crops commit suicide. According to a CNN report, in 2013, 11,722 farmers killed themselves across India. The suicides plunge families further into financial insecurity and hopelessness. Government interventions are crucial to curb these disturbing losses of life. Policies pertaining to land reform, industrialization, agriculture, poverty alleviation, availability of financing and compensation to farmers are all going to be needed to alleviate the burdens on small farmers.

Stigma and isolation complicate matters in treating mental health issues. People who suffer from mental health issues are often discriminated against or are discouraged from seeking treatment.

In some parts of the world, mental problems can be regarded as a sign of an evil spirit. Sufferers are seen by traditional or spiritual healers and are not treated by counselors or psychiatrists. Decades of superstitions and beliefs are hard to overcome, particularly when dealing with a delicate problem.

Many organizations and projects are trying out methods to provide mental healthcare to affected populations, including projects like the Zimbabwe based Friendship Bench Project, which provides counseling sessions, the international Programme for Improving Mental Health Care, which researches on methods to scale up delivery of mental healthcare and India based Sangath, which trains lay people in counseling and works with other nongovernmental and governmental organizations to evaluate and launch models for mental healthcare. Dr. Vikram Patel, co-founder of Sangath, was recently named one of TIME’s 100 most influential people. This might aid in bringing more attention to this urgent issue.

While the Millennium Development Goals can go a long way towards alleviating poverty, which will reduce many of the stressors, mental health issues need to be given importance as a public health issue and duly addressed.

Mithila Rajagopal

Sources: CNN, Prime, Sangath, SciDev, Times of India, World Health Organization
Photo: Flickr