Gender inequality and social exclusion are the primary factors driving mental health problems in Uttarakhand, with people from socially oppressed castes two or three times more likely to be depressed, researchers including those from India claim.
A survey published in the BMJ Open of nearly 1,000 households of Uttarakhand showed that six per cent of adults were identified as depressed.
People were two or three times more likely to be depressed if they were from the most socially oppressed castes, had taken a recent loan, lived in poor quality housing or had not completed primary school.
Researchers from Umea University in Sweden focused over the last four years on how communities in the states of Uttarakhand and Uttar Pradesh can promote, prevent, treat and advocate for mental health.
"I was surprised to find such a strong relationship between social disadvantage and mental illness," said Kaaren Mathias, a mental health programme manager with the Emmanuel Hospital Association in India.
Further qualitative studies, showed that nearly all people with mental distress had experienced social exclusion and many had experienced economic, verbal and physical violence.
However, people also described experiences of belonging, social support, and social participation.