Mental health on two continua: mental wellbeing and common mental disorders in a community-based cross-sectional study with women in urban informal settlements in India.

backgroundWe considered the suggestion that mental health is the product of two intersecting continua: psychological distress and mental wellbeing.

objectivesTo understand prevalences of low mental wellbeing, depression and anxiety, and examine associations between them and with sociodemographic variables.

methodsIn a cross-sectional survey in informal settlements, 4906 women aged 18-49 years answered questions on mental wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale: SWEMWBS) and symptoms of depression (Patient Health Questionnaire: PHQ-9) and anxiety (Generalised Anxiety Disorder: GAD-7). We used regression models to examine associations of lower mental wellbeing with symptoms suggesting moderate-to-severe depression and anxiety, and with sociodemographic characteristics.

resultsAbout 15% of women reported symptoms of low wellbeing, 9% symptoms of moderate-to-severe depression, and 6% symptoms of moderate-to-severe anxiety. Women with low wellbeing did not necessarily report symptoms suggesting anxiety or depression, and women with anxiety or depression did not necessarily report low wellbeing. In adjusted models, poorer and less educated women were more likely to report low wellbeing. Symptoms of anxiety or depression were more likely to be reported by widowed, separated, or divorced women, women who were in paid employment, and women who used drugs or alcohol themselves or whose partners did. Women with low wellbeing had at least double the odds of reporting symptoms of moderate-to-severe depression or anxiety than women who reported greater wellbeing.

conclusionThe findings support the idea of two continua of mental health. How individual women cope with mental illness and nevertheless enjoy a state of wellbeing deserves more study.