The World Health Organization (WHO) estimates that, by 2020, neuropsychiatric disorders will be the second greatest cause of loss of quality of life because of disability or death globally. One in four people attending primary care in developing countries is thought to have a mental illness, yet mental health support is often extremely limited.

Working with women from Goa, India, Dr Vikram Patel from the London School of Hygiene and Tropical Medicine and colleagues found that women with gynaecological symptoms were at an increased risk of depression. Conversely, women who were depressed were more likely to develop gynaecological symptoms.

Both gynaecological symptoms and depression were associated with social issues, including economic problems and 'gender disadvantages' (such as sexual violence, low family support and being widowed).

Current WHO guidelines – which assume that gynaecological symptoms indicate reproductive tract infections – could lead to women with gynaecological problems being incorrectly classified as having a sexually transmitted infection, and could mean that depression and/or social issues affecting them are overlooked. As such, the researchers suggest that treatments for gynaecological problems should target both infection and psychosocial factors.

A separate study showed that mental illness during pregnancy was linked to low-birth-weight babies, who are at an increased risk of neonatal death.

Dr Patel is now leading another Wellcome Trust-funded study to develop an effective, affordable and sustainable healthcare programme that integrates management of depression into routine primary care.

Image: Two health workers teach a class on breast feeding; N Durrell McKenna

External links

• Patel V et al. Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India. Arch Gen Psychiatry 2006;63(4):404–13.
• Patel V et al. The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, India. BJOG 2006;113(4):453–63.
• Patel V, Prince M. Maternal psychological morbidity and low birth weight in India. Br J Psychiatry 2006;188:536.