Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
Karnataka Health Promotion Trust, Bangalore, Karnataka, India.
BMC Public Health. 2019 Jan 10;19(1):48. doi: 10.1186/s12889-018-6355-z.
Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India. There is a paucity of research on the determinants of psychological distress, particularly among the poorest girls in the poorest communities. The purpose of this study was to assess the prevalence and correlates of different indicators of psychological distress among 13-14 year old low caste girls in rural, south India.
Cross-sectional survey of 1191 low caste girls in two districts in north Karnataka, conducted as part of a cluster randomised-control trial. Bivariate and multivariate logistic regression analysis assessed correlates of different indicators of psychological distress.
More than one third of girls (35.1%) reported having no hope for the future. 6.9% reported feeling down, depressed or hopeless in the past 2 weeks. 2.1% reported thinking they would be better off dead or of hurting themselves in some way in the past 2 weeks. 1.6% reported sexual abuse, 8.0% rrecent eve teasing and 6.3% having no parental emotional support. Suicidal ideation was independently associated with sexual abuse (AOR 11.9 (3.0-47.0)) and a lack of parental emotional support (AOR 0.2 (0.1-0.5)). Feeling down, depressed or hopeless was independently associated with recent eve-teasing (AOR 2.9 (1.6-5.4)), a harassing or abusive school environment (AOR 3.9 (1.8-8.2)), being frequently absent (AOR 2.8 (1.5-5.5)) or having dropped out of school (AOR 2.1 (1.0-4.3)), and living in Vijayapura district (AOR 2.5 (1.6-4.1)). Having no hope for the future was independently associated with a range of factors, including recent "eve-teasing" (AOR 1.5 (1.0-2.4)), being engaged (AOR 2.9 (0.9-9.7)), not participating in groups (AOR 0.5 (0.4-0.6)) and a lack of emotional support (AOR 0.6 (0.4-0.7)).
Rather than being a time of optimism, a third of low caste girls in rural north, Karnataka have limited hope for the future, with some contemplating suicide. As well as having important development benefits, interventions that address the upstream structural and gender-norms based determinants of poor mental health, and provide adolescent services for girls who require treatment and support, should have important benefits for girls' psychological wellbeing.
Prospectively registered at ClinicalTrials.GovNCT01996241 . November 27, 2013.
青少年心理健康障碍已成为许多低收入和中等收入国家（包括印度）的一个主要公共卫生问题。目前，关于心理困扰决定因素的研究很少，尤其是在最贫困社区中最贫困的女孩中。本研究的目的是评估印度北部两个农村地区 13-14 岁低种姓女孩不同心理困扰指标的患病率和相关性。
这是一项横断面调查，在北卡纳塔克邦的两个区对 1191 名低种姓女孩进行了调查，该研究作为一项集群随机对照试验的一部分。使用二变量和多变量逻辑回归分析评估不同心理困扰指标的相关性。
超过三分之一的女孩（35.1%）表示对未来没有希望。在过去 2 周内，有 6.9%的女孩表示情绪低落、沮丧或绝望。在过去 2 周内，有 2.1%的女孩表示她们想死，或者想用某种方式伤害自己。1.6%的女孩报告遭受过性虐待，8.0%的女孩报告最近遭受过调戏，6.3%的女孩没有父母的情感支持。自杀意念与性虐待（比值比 11.9（3.0-47.0））和缺乏父母情感支持（比值比 0.2（0.1-0.5））独立相关。情绪低落、沮丧或绝望与最近的调戏（比值比 2.9（1.6-5.4））、骚扰或虐待性的学校环境（比值比 3.9（1.8-8.2））、经常缺勤（比值比 2.8（1.5-5.5））或辍学（比值比 2.1（1.0-4.3））以及居住在维杰亚瓦达区（比值比 2.5（1.6-4.1））独立相关。对未来没有希望与一系列因素独立相关，包括最近的“调戏”（比值比 1.5（1.0-2.4））、订婚（比值比 2.9（0.9-9.7））、不参加小组活动（比值比 0.5（0.4-0.6））和缺乏情感支持（比值比 0.6（0.4-0.7））。
在北卡纳塔克邦农村地区，三分之一的低种姓女孩对未来没有希望，有些女孩甚至考虑自杀，而不是充满乐观。除了具有重要的发展效益外，解决导致心理健康不良的上游结构性和性别规范决定因素，并为需要治疗和支持的女孩提供青少年服务的干预措施，将对女孩的心理健康产生重要的积极影响。
前瞻性注册于 ClinicalTrials.GovNCT01996241 。2013 年 11 月 27 日。
