Kashmir: Prevalence of mental disorders

Depression is a well prevalent, possibly life-threatening condition that affects hundreds of millions of people all over the world. It can occur at any stage of life from childhood to later life, and puts a huge cost upon society. There is a triad of core symptoms: low or depressed mood, anhedonia (loss of pleasure activities), and low energy or fatigue. Other symptoms are also often present, such as irritability, difficulty in concentrating, sleep and psy­chomotor disturbances, feelings of guilt, low self-esteem, and suicidal tendencies etc. Depression is not a homogeneous disorder but rather is a complex problem with many subtypes like psychotic, neurotic, postpartum, involutional melancholia, season affective disorder, retarted, dysthymic, agitated depression etc.

It is a disorder of major public health importance, in terms of its prevalence and the suffering, dysfunction, morbidity, and economic burden. The report on Global Burden of Disease estimates the prevalence of unipolar depressive episodes to be 1.9% for men and 3.2% for women, and the one-year prevalence has been expected to be 5.8% for men and 9.5% for women. It is likely that by the year 2020 if current trends for demographic and epidemiological change continue, the burden of depression will enhance to 5.7% of the total burden of disease and it would be the second leading cause of disability-adjusted life years (DALYs), second only to cardiovascular diseases. Study has shown that there is a gender wise difference in prevalence of depression globally with higher in men than women. The number of women suffering from depression is more (60%) as compared to men (40 %). Women have a higher prevalence of depression in all the age groups than males and it is highest in the age group 20 to 40 years.

Mental, physical and social health, are important strands of life that are closely interwoven and extremely interdependent. It is more likely subsequent particular classes of experience – those involving conflict, disruption, losses and experiences of humiliation. The extent, suffering and burden in terms of disability and costs for individuals, families and societies are surprising. Mental disorders are worldwide, but prevalence varies from place to place that depend and affecting people of all countries and societies, individuals at all age groups, women and men, the rich and the poor, from urban to rural areas. Mental working is basically interconnected with physical and social functioning and health outcomes. The mental health is affected by displacement through conflict and war, by stresses on families, and by economic hardships. For the many persons who face uncertain futures including those by conflict or disasters, the burden of serious emotional and behavioral disorders trouble their lives. Many people living in the conflict zones suffer from post-traumatic stress disorder. Communities and societies enormously face situations of armed conflict. While this trend is visible in different parts of the world, it is of serious concern to the South Asian region. International Kashmir dispute between India and Pakistan is a root cause for (post traumatic stress disorder (PTSD) and major depressive disorders (MDD) especially in youth and women are the victims in the state. Large-scale violence may also take the form of mass uprisings against the oppression of dominant classes. Civilians are more and more being targeted in these episodes of violence. To lessen military casualties, civilians are used as protective shields; torture, rape are carried out to demoralize and to destroy the cultural links and self-esteem of the inhabitants. Traumatic events such as shooting, killing, rape and loss of family members, loved ones, disappearance of their kins and kiths. The amount of psychosocial problems that results from this mass exposure to traumatic events can finally threaten the scenario for long-term stability in society.

Kashmir which is known as paradise on earth. It’s marvelous beauty and sociable people is well known. Over the past 24 years Kashmir became associated with violence. Rightly, the latest studies have shown that the percentage of depression prevalence in valley is 55.72 per cent .The study has further stated that more than half of the population is suffering from the mental illness-most of them from the Post -Traumatic Stress Disorder (PTSD) which has highest comorbidity with the depression. Many have suffered tragic incidents of a war-like situation, which by their nature are beyond the patience of common man. Many are observed to bloodshed that is distinguishing feature of such situation. Thousands of people have lost their lives or limbs, and thousands have been remained orphans and widows. Many have disappeared and disappearance rate is at alarming situation. Many educational and healthcare institutions have suffered damages. Likewise, with disruption of development works consequent upon warlike situation, added concerns are unemployment, poverty, relationships etc.

The situation in Kashmir can best be explained as a conflict. What predominates in such conflicts is the use of terror to exert social control, if compulsory by disrupting the fabric of grassroots; economic, social and cultural relations; the major target of the soldier is often the population rather than the territory and psychological warfare is a central part. As can be expected, the reasons for mental health can be considerable. Kashmir is not just a law and order problem but there are social, emotional, political and psychological phases involved.

Health care is supported by the private sector hospitals, nursing homes, clinics, faith healers, etc. The already inadequate health care infrastructure further added to the depression making the people susceptible to health problems and other forms of deprivation. This mass departure together with poor governance led to malfunctioning of health sector in general but rural health services in particular. Mental health has been ignored for far too long. In spite of increase in psychiatric diseases due to ongoing conflict, terrific stressful conditions, overwhelming fear and uncertainty during the last 24 years, not much attention is being paid to develop and modernize the present infrastructure.

Women are an integral, part and partial of society. Several roles that they played in society render them at greater risk of experiencing mental problems than others in the community. Women tolerate the burden of social responsibility associated with being wives, mothers and care taker of others. More and more, women are becoming an essential part of the labour force and in one-quarter to one-third of households they are the prime source of income (WHO, 1995). Women are more likely than men to be adversely affected by specific mental disorders, the most common being anxiety related disorders and depression. Women are not given special rights and they are being deprived from fundamental rights. They are treated somewhat badly and dowry factor, relationship with spouse and other family members are also the causes for depression and suicide. Women in Kashmir have been closely linked with political mobilizations and continue to be victims in the ongoing cycle of violence and abuse.

The ongoing shutdowns and curfews, hartals in the Kashmir valley have affected the locals psychologically economically and morally. The killings of youth, mostly protestors, in the last couple of years have triggered the biggest anti-India demonstrations in last couple of years across Muslim-majority Kashmir valley. During the last two decades, due to the intensed situation in the valley, the stress levels among the youth have becomes very high and put them in a dilemma. The youth have become captive of mental depression. There is a lot of frustration and hopelessness in them. Already there was so much of unemployment here, but now, due to these troublesome situations, there is more stress and fear in people. The curfew has compelled the locals to be imprisoned in their own houses. The current situations have led to so much of stress among the people that people do not know what to do. People are not even certain that if they go out of the house, they will be able to come back home safely. According to a survey conducted in 2009 by the Kashmir chapter of the agency called Action Aid International, 29 percent of the unemployed males in Kashmir smoke in order to relax themselves. A 12 per cent, which includes women, take sleeping pills to overcome stress and depression. Four percent of the respondents of the survey take drugs to ease mental tension. Drug-addiction is of major public concern.

Educational institutions like universities and other professional colleges are very insufficient in the state this compels the students to move outside the state and this not only degrades the economy of state but makes the educated youth frustrated because of expensive means outside. So, govt should pay heed for the establishment higher education institutes to overcome the hurdles faced by the students which make a student prone to this illness.

The situation in India in terms of patients getting possible treatment for depression is worse. Psychiatric services are very insufficient in India with less than one psychiatrist for half a million population. Most psychiatrists are concentrated in metropolitan cities and in vast areas of the country, the nearest may be hundreds of kilometers away. There is lack of awareness about the psychiatric education and rehabilitation centers.The Cases of depression presenting in general health care are either not recognized or treated with improper drugs or inadequate doses of antidepressants. The patients frequently visit doctors leading to bigger utilization of insufficient health services. If proper doses of antidepressants are used, depression can be successfully treated in 65%-85% cases with decline in suicides by 70%-90%.Recurrent episodes can also be prevented by using pharmacotherapy. If these figures are used to the total economic costs of depression, it can be understand that treatment even within one country can save billions of dollars besides decreasing the burden on health care services.

It is time depression should be considered as a major public health problem, at least at same level with cardiovascular disease and malignancy. A widespread programme to deal with depressive disorders needs to be creating without delay. Health professionals can be easily trained to observe depressive disorders. The societal stigma linked with mental illness should be tackled so that the symptoms are understood as signs of illness rather than being voluntary in nature. Programmes for enlightening of depressive disorders in schools/colleges and workplaces should be commenced. Recruitment of psychiatrists, psychologists are very important. This would help in competently decreasing the enormous burden of this illness in country with limited resources like India.The only drawback in various mental disorders especially MDD (depression) makes a person mentally handicapped and more prone to suicide attacks.

In nut shell I will conclude this, to lessen the burden of mental disorders in Kashmir valley it should have separate and autonomous psychiatric institutes or brain research centre with adequate facilities so that more and more time is to be devoted on these neuropsychiatric diseases by hosting international, national conferences, seminars camps, symposiums and research. In valley, here is single psychiatric hospital which faces the enormous burden of patient overloading and that too only getting clinical treatment. In rest parts of Country there are many research institutions like NBRC Manesar Gurgaon, NIMHANS Bangalore, Centre for brain development and repair NCBS Bangalore, Centre for neuroscience IISC Bangalore are highly competent.

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The author is a Research Scholar in the Department of Zoology, Neuropsychiatric Genetics, Aligarh Muslim University, India. You can contact him at sajadamu@gmail.com

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