Understanding psychological distress among mothers in rural Nepal: a qualitative grounded theory exploration
Open accessAbstract
BACKGROUND: There is a large burden of psychological distress in low and middle-income countries, and culturally relevant interventions must be developed to address it. This requires an understanding of how distress is experienced. We conducted a qualitative grounded theory study to understand how mothers experience and manage distress in Dhanusha, a low-resource setting in rural Nepal. We also explored how distressed mothers interact with their families and the wider community. METHODS: Participants were identified during a cluster-randomised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Questionnaire (GHQ-12). We conducted 22 semi-structured interviews with distressed mothers (GHQ-12 score ≥ 5) and one with a traditional healer (dhami), as well as 12 focus group discussions with community members. Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting. RESULTS: We found that distress was termed tension by participants and mainly described in terms of physical symptoms. Key perceived causes of distress were poor health, lack of sons, and fertility problems. Tension developed in a context of limited autonomy for women and perceived duty towards the family. Distressed mothers discussed several strategies to alleviate tension, including seeking treatment for perceived physical health problems and tension from doctors or dhamis, having repeated pregnancies until a son was delivered, manipulating social circumstances in the household, and deciding to accept their fate. Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husbands for resources. CONCLUSIONS: Vulnerability, as a consequence of gender and social disadvantage, manifests as psychological distress among mothers in Dhanusha. Screening tools incorporating physical symptoms of tension should be envisaged, along with interventions to address gender inequity, support marital relationships, and improve access to perinatal healthcare.
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A few experimental studies from LMICs have shown positive mental health outcomes from peer-delivered interventions.
“A few experimental studies from LMICs have shown positive mental health outcomes from peer-delivered interventions [29–33].”
From Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study (2016) · cites this paper as [31]
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Additional file 1 of Traditional and biomedical care pathways for mental well‐being in rural Nepal
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Additional file 2 of Traditional and biomedical care pathways for mental well‐being in rural Nepal
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- Authors
- Clarke, K., Saville, N., Bhandari, B., Giri, K., Ghising, M., Jha, M., Jha, S., Magar, J., Roy, R., Shrestha, B., Thakur, B., Tiwari, R., Costello, A., Manandhar, D., King, M., Osrin, D., & Prost, A.
- Affiliations
- University College London (GB)
- Mother and Infant Research Activities (NP)
- Venue
- BMC Psychiatry
- Published
- 2014-03-01
- Volume
- 14
- Issue
- 1
- Pages
- 60-60
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3943437
- OpenAlex
- W2158478272
- Cited by
- 42
- References
- 41
- Citations by year
- 2026: 3 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 6 · 2020: 5 · 2019: 4 · 2018: 5 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 1
- FWCI
- 2.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Trust (091561, 100714)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
- Keywords
- maternal distress, rural Nepal, women's mental health, gender inequality, son preference, fertility problems, women's autonomy, coping strategies, traditional healers, family relationships, in-laws, culturally sensitive interventions
- MeSH terms
- Adolescent, Adult, Aged, Family, Family Characteristics, Female, Humans, Income, Middle Aged, Mothers, Nepal, Pregnancy, Residence Characteristics, Rural Population, Stress, Psychological, Young Adult, Grounded Theory
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