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Abstract
Objectives This study used a population-based cross-sectional survey to describe the prevalence of psychosocial disability and unmet need for access to services in North India.
Setting This study was conducted in Dehradun district, Uttarakhand, in 2014.
Participants A population-based sample of 2441 people over the age of 18 years.
Primary outcome measures The Rapid Assessment of Disability survey tool identified people with disability and used an adapted version of the Kessler scale to identify those with psychosocial disability. It additionally collected information on socioeconomic variables, access to community services and barriers to participation. Prevalence of psychosocial disability and unmet needs and descriptions of barriers to services were calculated, and multivariable logistic regression was used to assess associations between risk factors and psychosocial disability.
Results Prevalence of psychosocial disability was 4.8% and 75% of participants with psychological distress also reported comorbid functional impairments. Adjusted ORs for depression of more than two were found for people who were unschooled, unemployed and of moderate or poor socioeconomic status. The unmet need for access to services was significantly higher in every domain for people with psychosocial disability and was more than 25% in the areas of employment, health service access and community consultation. People with psychosocial disability encountered greater barriers in each domain compared with controls.
Conclusions People who are poor, uneducated and unemployed are two to four times more likely to have psychosocial disability in Dehradun district. They face unmet needs in accessing community services and perceive negative social attitudes, lack of physical accessibility and lack of information as barriers limiting their participation. Social policy must increase access to education and reduce poverty but additionally ensure action is taken in all community services to increase information, physical accessibility and social inclusion of people with psychosocial and other forms of disability.
- depression
- anxiety
- mental health
- epidemiology
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors NG, GVSM and MM conceived of the study and the overall design, HP and KM performed data analysis, and KM wrote the first and subsequent drafts. LS supported data collection and NG and MM supported study design, analysis and overview of the whole paper. All authors provided input into drafts of the paper.
Funding CBM (an international development organisation with a focus on disability) funded this research. As they are not a research council they do not use grant numbers.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The ethics committee at the Indian Institute of Public Health - Hyderabad and the ethics committee of the CHGN Uttarakhand Cluster granted ethics approval.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There is no additional unpublished data from this study available.