Mental health is considered as an integrated aspect of overall health and it greatly influences an individual’s thoughts, feelings and behaviors. Also a mentally healthy mother can take better care of herself and her family. The World Health Organization’s (WHO, 2007) proposition of “No health without mental health” has acknowledged mental health as the most significant feature of health. Unfortunately, mental health has generally received scant attention in low income, developing countries.
This research thesis shares a study conducted to promote mental health of women in Pakistan. This chapter will address the background, significance, purpose, and hypothesis of the research study. It also highlights the outcomes of an economic skill building intervention designed to improve women’s mental health.
Study Background
Mental health is recognized as the ability to cope effectively, live productively, and make ‘contributions’ in community endeavors (WHO, 2007). Mental health is determined by various factors including education, employment, economics, and social life styles (WHO, 2005). (Add)
Depression is one of the most common mental disorders affecting people worldwide with an estimated one million people experiencing mental health disorders (WHO, 2002). The global burden of mental disorders is increasing day by day and it is affecting the quality of life of individuals. It has been estimated by WHO (2004) that mental disorders are the third leading cause of disabled life years lost in low to middle income countries. According to another report by WHO (2002) mental and neurological disorders account for 12.3% of disability adjusted life years lost (DALYS) worldwide. Mental health disorders are also recognized as the fourth leading cause of death worldwide (WHO, 2001).

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Mental health disorders rank as the most common and important health disorders that greatly affect women worldwide (WHO, 2001). A recent report of WHO (2008) explains that the disease burden of depression is 50% higher in females than males. Two studies from Pakistan reveal that the reported rate of depression among women living in northern rural areas of Pakistan is 50% (Mumford et al, 1996; Donani & Zuberi, 2000).
Numerous factors contribute to mental health deterioration. In the South Asian region the most common reasons for women’s mental health problems are low socio-economic status, illiteracy, unemployment, and lack of accessibility to health facilities (Thara & Patel, 2006). Another contributor to poor mental health among women is domestic violence. Infact one of the major associations of domestic violence is with mental health problems such as emotional distress and suicidal behaviors (WHO, 2002). A study from Pakistan supports the strong association of domestic violence with anxiety and depression in pregnant women (Karmaliani et al., 2008). If we review these factors critically then it can be seen that all of these aspects are interwoven with each other and any one factor can result in increasing the effect of another factor.
Reports from the United Nations (UN), WHO, and World Bank (WB) indicate that out of 1.3 billion people worldwide who live under poverty, 70% are women. Women only earn 10% of the world’s total income and utilize two thirds of the world working hours (Care, 2005). It is also distressing to see that mostly women living in developing countries, who have less or no education, are financially dependent on their male family members. This financial dependence makes women insecure, helpless, and more vulnerable to poor mental health. Hence, the rationale for choosing to develop and test an economic skill building intervention for this study is the association between economic skill building and women’s status, world wide. Economic skill building refers to the ability or expertness that is acquired through training to generate income and to obtain and retain jobs (Agnes, 1999). Economic empowerment is considered as one of the major contributors for towards women’s mental health. A study on Indian women highlighted that women recognized employment, education and equal opportunities as positive contributors to their empowerment (Kermode, Herrman, Arole, White, Premkumar, et al., 2007).
The other significant component of positive mental health is self efficacy. The phenomenon of self efficacy has been studied many times and has been associated with a positive and confident self image and also as a positive coping source (Luszczynska, Mohamed & Schwarzer, 2005). Bandura, Pastorelli, Barbaranelli, and Caprara, (1999) define self efficacy as “beliefs in one’s capabilities to produce given attainments” (p. 258).
Many psycho-social interventions such as behavioral therapies and counseling programs have been developed and tested to improve women’s mental health. However, very few interventions have been completed in low income countries as compared to high income countries. Women economic empowerment is recommended as an important intervention to improve women’s quality of life and their bio-psycho-social health (WHO, 2007). Empowerment also contributes to women’s health promotion (Attanapola, 2008). Various studies suggest that the economic strength of women is associated with positive family relationships and effective parenting. Increased employment of women has also shown marked reduction in domestic violence (Gibson -Davis et al., 2005). However, we identified no research that developed an economic skill building intervention to promote women’s mental health and economic independency, which would enable them to become self reliant and better able to economically care for themselves and their children.
The present study is a part of a larger randomized control trial (RCT) to test the differential effectiveness of two community based interventions, counseling and economic skill building, to improve maternal mental health and child behavioral functioning. To achieve this goal this study has developed and tested the economic skill building modules for women and measured the outcomes on maternal mental health.
Significance of the Study
There is considerable evidence that economic skill building is associated with positive maternal mental health. Therefore, economic skill building of poor women at risk to poor mental health can potentially prevent adverse mental health and promote overall health. This study aims to fill a gap in research knowledge and to extend the understanding regarding the connection between economic skill building of women and the resulting maternal mental health. Through the economic skill building for job attainment and retention, this study has focused on those obstacles which do not allow women to succeed in employment, such as lack of self esteem, lack of social support, lack of childcare, and lack of training (Brown & Barbosa, 2001). This study may benefit the total community and wider country economic development by proving evidence of the beneficial effects of economic skill building on women’s mental health and their quality of life.
Study Purpose
The purpose of the present research study was to develop and test economic skills building modules for improving maternal mental health. The study intended to help mothers develop skills required for obtaining and retaining jobs, dealing with obstacles or problems that may arise while working, and helping women to maintain balance between work and home tasks.
Study Hypothesis
Following is the study hypothesis.
Mothers in an adult literacy program who complete an 8 hour economic skill building training intervention, delivered weekly by a Community Health Worker (CHW), will report less domestic violence, less depression, and improved self efficacy, compared to mothers who complete an 8 hour counseling intervention, delivered weekly by CHW, and to mothers who receive no intervention.
This chapter discussed the preview of the research study and its background. The following chapter will provide a review of literature and describe the gaps in the literature and, hence, the need to conduct the present study. Subsequently, the later three thesis chapters will share the study methodology and methods, study findings, and discussion on significant findings.