|Year : 2021 | Volume
| Issue : 2 | Page : 87-91
Exploring Perspectives on Mental Well-Being of Urban Youth from a City in South India
Shuba Kumar1, Rani Mohanraj1, Angelin Lidiya2, D Karthikeyan2, Latha Kannan2, Fredric Azariah3, Moitreyee Sinha3, Vijaya Raghavan2, Suresh Kumar4, R Thara2
1 SAMARTH, 100 Warren Road, Mylapore, Chennai, Tamil Nadu, India
2 Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, India
3 CitiesRISE, 33 W 60th Street FL2, New York, NY 10023, USA
4 Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, India; CitiesRISE, 33 W 60th Street FL2, New York, NY 10023
|Date of Submission||23-Apr-2021|
|Date of Acceptance||17-May-2021|
|Date of Web Publication||31-Aug-2021|
Dr. Vijaya Raghavan
Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai - 600 101, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Mental health needs and concerns of young persons in resource-poor settings remain poorly understood and inadequate. How young people understand and perceive mental well-being might differ based on their setting. Hence, the aim of this study was to understand how young people in urban settings perceived mental health and well-being. It also explores their perceived barriers to mental well-being. Materials and Methods: A qualitative study, using focus group discussions and in-depth interviews (IDIs), was conducted with youth aged 18–24 years from three different settings, namely educational institutions, workspace, and urban slums, in Chennai city, South India. The following three themes related to mental health well-being were identified (i) What does it mean? (ii) What affects it? and (iii) How do young people cope? Results: Four focus group discussions (9–10 participants in each) and 15 IDIs were conducted. Findings revealed that mental well-being was affected by relationship issues, academic/career pressures, and social mores; seeking mental health care was stigmatizing and differences in societal norms left young women feeling vulnerable and frustrated. Conclusion: Results highlight the various mental health challenges faced by young people in urban settings in India and underscore the need for more research to better understand the interactions between individual and environmental factors. These, in turn, would inform the development of early interventions to promote mental health and help cope with mental problems among young people.
Keywords: Barriers, India, mental health, urban, well-being, youth
|How to cite this article:|
Kumar S, Mohanraj R, Lidiya A, Karthikeyan D, Kannan L, Azariah F, Sinha M, Raghavan V, Kumar S, Thara R. Exploring Perspectives on Mental Well-Being of Urban Youth from a City in South India. World Soc Psychiatry 2021;3:87-91
|How to cite this URL:|
Kumar S, Mohanraj R, Lidiya A, Karthikeyan D, Kannan L, Azariah F, Sinha M, Raghavan V, Kumar S, Thara R. Exploring Perspectives on Mental Well-Being of Urban Youth from a City in South India. World Soc Psychiatry [serial online] 2021 [cited 2022 Aug 10];3:87-91. Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/2/87/324981
| Introduction|| |
Adolescence and youth can be a period of turmoil for many who must grapple with life experiences and relationship issues., Risk behaviors, including alcohol and substance use, and self-harm, typically emerge during adolescence and can contribute to serious mental health problems., In the context of growing urbanization, other factors such as social, economic, and cultural factors contribute to the emergence of mental health issues among the youth.
A systematic analysis by Gore et al. reported that neuropsychiatric disorders such as major depression and alcohol use, among others, contributed significantly to years lost to disability in young people. Sunitha and Gururaj, in their review, highlighted that common mental disorders, including stress and anxiety, suicidal behaviors, and tobacco, alcohol and other substance use, negatively impact on young people's health. Fears of being treated differently, marginalized or isolated by their peers, coupled with feelings of shame and guilt, act as deterrents to seeking care or to even voicing their problems., Living in urban slums with overcrowding and poor sanitation compounded by poverty, violence, and abuse makes people vulnerable to mental health issues.
The Institute for Health Metrics and Evaluation report states that about 13%–15% of adolescents (10–19 years old) in low- and middle-income countries suffer from or live with a mental disorder. Unfortunately, the mental health needs and concerns of young persons in resource-poor settings such as India remain both poorly understood and inadequate., The need for mental health promotion and early intervention strategies particularly targeting the urban youth are therefore very important.
Hence, to gain insights into how young people in urban settings understood mental health and well-being and their perceived barriers to mental well-being, we undertook an exploratory qualitative study among youth across different urban settings in the city of Chennai, the capital of the state of Tamil Nadu in South India.
| Materials and Methods|| |
This exploratory study was conducted among young people from three different settings, namely educational institutions, workspace, and urban slums in Chennai in the state of Tamil Nadu, India. Chennai is a large city with nearly 7 million population. It is a major educational hub with many large universities, industries, and information technology parks which have resulted in a large influx of young people into the city, both from within the state and from different parts of the country.
Ethics approval was obtained for the study from the Institutional Ethics Committee of the Schizophrenia Research Foundation before the start of the study.
Youth aged between 18–24 years residing in Chennai city were purposively selected to participate in focus group discussions (FGDs) or in-depth interviews (IDIs). They were recruited from two city colleges: from urban slums and from an organization that employed many young people. All interviews were conducted at the locations where the respondents were recruited from.
Although we had separate IDI and FGD guides, the components of both were similar. They began with broad questions such as “what make you happy,” “what do you understand by the term mental well-being,” “what stresses you out” to probing about “what interfered with positive mental well-being” and “the role of family, culture, college/workplace, relationships in promoting or acting as barriers to mental well-being.” All the IDIs and FGDs were done in English or Tamil (the local language) depending on the convenience of the participant and took about an hour or more to complete.
Each audio-recorded IDI/FGD was transcribed verbatim. Those done in Tamil were translated into English and checked for quality assurance by the investigators. Data analysis was done using NVIVO, and followed the framework analytical approach described by Ritchie et al. and Spencer which began with data familiarization. To develop the codebook, five transcripts were initially coded inductively by two independent coders (SK and RM). The coding scheme developed by each of the coders was reviewed and differences in coding were discussed and resolved. The process of coding guided the identification of categories and themes that best explained the data. The indexing and charting stage comprised sifting through the data and identifying suitable quotes illustrating the themes. The final stage of analysis, namely mapping and interpreting, involved synthesizing the quotes, categories, and themes, and identifying linkages between them to provide a holistic understanding of the phenomena.
| Results|| |
The 15 participants to the IDIs comprised 8 young men and 7 young women. A total of four FGDs were conducted, one each in a college and workplace setting which was a mixed group of young men and women and two FGDs one with young men and another with young women were done in a slum community. There were a total of 9–10 participants in each FGD. The average age of participants inclusive of both the IDIs and the FGDs was 21.2 (±4.8) and average years of education was 13.4 (±2.9).
Themes of analyses
Following the framework analytical approach, the three themes of analysis were identified that best explained the data. These were as follows:
Mental well-being and mental illness
- What does it mean?
- What affects it?
- How do young people cope?
Mental well-being and mental illness: What does it mean?
Interpretations of the term mental well-being were varied. It was associated with terms such as “serenity and peace,” an emotional state that would enable individuals to better understand their capabilities, helping others, good physical and mental health, being happy, being free from stress and tension, not being bossed over, being part of a supportive social network be it family or friends, being engaged in work that was enjoyable even to such simple needs as being able to eat good food and being able to have a good time with friends. Being financially stable was also seen as an important contributor to mental well-being by all the different youth groups.
Mental well-being means serenity and peace. I think you should be very strong and then you will be able to perform the day-to-day activities and give your 100%… Having a serene mind helps you explore more dimensions of life it helps you to understand yourself your capability your potential, so I think it is really essential (IDI – Student, Young Woman No. 1).
Good companion good friends…It's not about how many friends you have. It's about how the friends are. So, no need to have thousand contacts on WhatsApp or posts. we should have time for ourselves (FGD Workspace – Mixed Group of Young Men and Women).
Similarly, the term mental illness also elicited varied interpretations. One term used by the youth from the slums and employed to describe mental illness was “overthinking.” The implication was that those who tended to brood a lot or dwelt too much on an issue could be manifesting a mental illness. Not being in control of one's emotions and having excessive anger was mentioned as a sign of mental illness by young women from the slums. A few students spoke of people going through mood swings, who felt deeply depressed despite all material wealth and were, “not feeling well from inside, were not feeling happy” as indicative of a mental illness.
Mental illness means magnifying little things. Sometimes, it so happens that they showed a lot of love on someone finally when the person betrays them, they go through the phase of depression (FGD Students – Mixed Group of Young Men and Women)
Mental well-being and mental illness: What affects it?
Achieving and maintaining a state of mental well-being was not easy for the youth who described many barriers. For youth from the slums, being in a state of mental well-being seemed more like a distant dream. The slum in which they lived had gained notoriety for the high rates of violent crimes and rampant alcohol and substance abuse, as a result, they felt that people from outside the community and the police tended to view them with suspicion contributing to a deep sense of frustration and anger. As one young man, a respondent from the FGD said, “We should get out from this area. We should study well and go for good work” which to him appeared to be the best way of escaping the poverty, crime, and violence that surrounded him.
In the evenings, we are not able to stand in a group and talk because everyone is drinking and shouting. The police at times grab us along with them and take us to the police station to interrogate us (FGD Slum – Young Men).
In contrast, the FGDs with the employed youth and college students who largely belonged to the middle and upper socioeconomic strata, centered on safety and security. The employed youth spoke more about being in jobs which were either of no interest to them or for which they were not qualified. However, necessity had propelled them into those vocations contributing to some dissatisfaction. A young college student felt his life was like that of a “pressure cooker” which began during school when students had to make decisions on the particular academic stream they intended to follow; then, to securing good marks, to get into a good college; and eventually to getting into a good job, all of which contributed to a great deal of stress and tension. The role played by parents and the influence they had in shaping their children's lives was particularly expressed by students who felt that parents needed to draw a fine balance between giving children the freedom to live the life they wanted and ensuring that they did not, “go on the wrong path.”
I feel parents are supposed to be the ones responsible for building the foundation in their teenagers' life. They need to know where to control your children and where not to. They need to understand about the modern world they are living in today. They need to let their child live. But when the child goes on the wrong path, definitely as parents they need to guide them (IDI – Student, Young Woman No. 3).
Love failure (failed romantic relationship) was a recurring theme. One-sided attachment led to self-harm, suicidal ideation, and attempts. Young men took to drinking alcohol and using drugs to cope with their loss. Young women feared that if their parents found out about their relationship, they would be prevented from attending college or going to work, would be confined to their homes and in some instances even forced into marriage.
Love until it is not a failure is jolly, but if it is a failure then it is a problem and can even lead to suicide (FGD Slum – Young Men).
Young women across all stakeholder groups spoke of barriers they faced both from their own families and from society. They were mandated to return home early be it from college or from work – even at the cost of their careers. Those from the slums were often not allowed to visit their friends. There were even curbs on the kinds of clothes they wore. Getting married and having a family was considered most important for young women, as a result, families did not prioritize their careers. They were frustrated at the different sets of rules imposed on them by their families' viz-a-viz young men.
After 9 O'clock, we cannot go outside the house. In the morning too, before 5 am we can't go out alone. That is very frustrating (FGD Slum – Young Women).
Mental well-being and mental illness: How do they cope?
A range of strategies from the philosophical to the practical were used to cope with stress and to promote mental well-being. The importance of maintaining a degree of equanimity, of learning to love and accept oneself, of focusing on one's own ambitions and not letting life get you down was expressed by all participants. Other more practical measures involved doing something to distract oneself such as reading, listening to music, or playing a sport. Having good friends with whom one could discuss and share feelings was considered critical to well-being. Their first point of contact when they were feeling low or needed help were their close friends who they believed were nonjudgmental and offered meaningful advice. Counselors were seen as strangers who may not be able to solve their problems. Further, if they were seen seeking help from a counselor or a psychiatrist, it would only serve to stigmatize them further.
I share everything with my friends openly. Only my friends will know what is in my mind. I will tell all my sadness, happiness everything to them… (IDI – Employed, Young Man No. 7).
Whatever the situation is you need accept yourself the way you are you need to start loving yourself the way you are so that every time you go out meet people, no matter how they talk to you or however judgmental they may be you need to prepare yourself …if you can prepare yourself then no matter where you go whatever people say you can always stay calm (IDI – College Student, Young Woman No. 4).
| Discussion|| |
This qualitative study sought to explore the perceptions of young people from different urban settings in a city in South India regarding mental health and well-being.
Young people's narratives revealed the dynamic influences that factors such as academic and career pressures, societal mores, and relationship issues exerted on their state of mental well-being. Familial and societal expectations requiring young people to conform in terms of being successful in academics, in their careers, in financially supporting their families, and in getting married (more so for young women) were often overwhelming to them. While participants spoke of the value of parental support and guidance in shaping their lives, they also emphasized the need for parents to give them the freedom and space they needed to enable them to live life to the fullest. Other studies from India have dwelt on these very factors as contributing to poor mental health, even driving some young people to contemplate suicide., Parikh et al. described the intense distress experienced by their teenage study participants in trying to fulfill parent's and teacher's expectations. Resnick et al. described how perceived connectedness to family and school contributed to better mental health outcomes and to reduced risk-taking behaviors such as smoking and alcohol use among adolescents.
Failed romantic relationships or “love failure” as it was commonly alluded to, was another major source of distress. Rejection of love led to depression, and increased use of alcohol and drugs as a means of coping by young men. Fears of the relationship causing shame and embarrassment, possibility of termination of their education or work, and even being forced into marriage were particularly stressful for the young women. Much has been described about the challenging nature of romantic relationships and its positive and negative effects on young minds. According to Shulman et al., developing and maintaining healthy relationships with the opposite gender requires “specific abilities which differ from those learned and used in other types of interpersonal relationships.” The fact that adolescents may lack the coping skills to deal with the demands of these new contexts suggests the need for educating young people on the skills required to maintain satisfactory relationships., Furthermore, given the taboos surrounding such interactions in our societies and the restrictions imposed on young people, particularly young women, to engage in healthy interactions with the opposite gender, it is important that parents and families be guided on the value of maintaining open and honest communication with their children as the key to building trust and understanding between them.
Youth from slums and impoverished backgrounds were exposed to violence, crime, and substance abuse – a fact that was reported by many of our study participants making them more vulnerable to mental health issues. This combination of poverty, stigma, poor understanding of mental health problems, and its management is a potent brew that seriously compromises their mental well-being resulting in their diminished productivity, poor quality of life, and risk of suffering severe psychiatric problems during their later adult life, another well-documented fact. The results highlight the need for mental health literacy in schools, colleges, workspaces, and communities as a means toward reducing stigma and providing support to the phrase “no health without mental health.”
Stereotypical gender norms were particularly restrictive for young women. Many middle- and low-income families prioritized marriage and childbirth for the daughters. Those from higher socioeconomic backgrounds who were better educated, did describe enjoying more freedom in terms of social interactions and travel. Young men also described being entrusted with the responsibility of supporting their families which they found to be burdensome. The life of young women living in the slums presented a particularly grim picture, with restrictions imposed on the type of clothes they wore, on their freedom of movement, social interactions, and how they behaved in public. Patel and Kleinman described that women in poverty were subject to several negative outcomes ranging from physical abuse, forced marriage, not being allowed to study and to limitations in their activities outside the home. Families and communities need to move away from stereotypical gender roles, be reciprocative and understanding of the desires and ambitions of the youth, and facilitate their growth into healthy adulthood.
The major limitations of the study were as follows: 1. It was conducted only with urban youth, therefore, the findings from the study cannot be generalized to youth from rural settings. Moreover, cautious translations of the findings to other urban cities in India are needed, as various social, cultural, and ethnic factors could play a role in formalizing perceptions toward mental health and well-being; and 2. Although vulnerable youth from the slum community were included in the study, other vulnerable groups such as transgender youth, homeless youth, youth in conflict of law, and homeless were not included in the study; 3. The study could have benefited from interviews with family members, school/college teachers, and even employers of concerns where young people work.
Notwithstanding, the use of qualitative methods with youth from different urban-based backgrounds has highlighted several mental health challenges that they face in our society. Given their large numbers in our population, it is a public health concern and necessitates that they be addressed not only to enhance mental well-being and productivity but also in the hope that this will avoid later adult mental health problems.
We acknowledge the collaborative partnership of citiesRISE in this study. citiesRISE is a multistakeholder initiative committed to transforming mental health globally through local innovation, coalition building, and youth-led action.
Financial support and sponsorship
This study was supported by cities RISE through the funding from Co-Impact and Rural India Supporting Trust.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dasen PR. Rapid social change and the turmoil of adolescence: A cross-cultural perspective. Int J Group Tensions 2000;29:17-49.
Jacobson L, Churchill R, Donovan C, Garralda E, Fay J, Adolescent Working Party, RCGP. Tackling teenage turmoil: Primary care recognition and management of mental ill health during adolescence. Fam Pract 2002;19:401-9.
Patton GC, Coffey C, Cappa C, Currie D, Riley L, Gore F, et al
. Health of the world's adolescents: A synthesis of internationally comparable data. Lancet 2012;379:1665-75.
Arbour-Nicitopoulos KP, Faulkner GE, Irving HM. Multiple health-risk behaviour and psychological distress in adolescence. J Can Acad Child Adolesc Psychiatry 2012;21:171-8.
Tayfun T, Asli B. Impacts of urbanization process on men. Anatol J Psychiatry 2008;9:238-43.
Srivastava K. Urbanization and mental health. Ind Psychiatry J 2009;18:75-6.
] [Full text]
Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, et al.
Global burden of disease in young people aged 10-24 years: A systematic analysis. Lancet 2011;377:2093-102.
Sunitha S, Gururaj G. Health behaviours and problems among young people in India: Cause for concern and call for action. Indian J Med Res 2014;140:185-208.
] [Full text]
Eisenberg ME, Neumark-Sztainer D, Feldman S. Does TV viewing during family meals make a difference in adolescent substance use? Prev Med 2009;48:585-7.
Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: A qualitative study. BMC Psychiatry 2012;12:157.
Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull World Health Organ 2003;81:609-15.
Institute for Health Metrics and Evaluation (IHME). Findings from the Global Burden of Disease Study 2017. Seattle, WA: IHME, 2018.
Belfer ML. Child and adolescent mental disorders: The magnitude of the problem across the globe. J Child Psychol Psychiatry 2008;49:226-36.
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: A global public-health challenge. Lancet 2007;369:1302-13.
Ritchie J, Lewis J, Nicholls M, Ormston R. A guide for social science students and researchers. Qualitative research practice. London: sage. 2003.
Gonsalves PP, Hodgson ES, Michelson D, Pal S, Naslund J, Sharma R, et al.
What are young Indians saying about mental health? A content analysis of blogs on the It's Ok To Talk website. BMJ Open 2019;9:e028244.
Prasad KM, Angothu H, Mathews MM, Chaturvedi SK. How are social changes in the twenty first century relevant to mental health? Indian J Soc Psychiatry 2016;32:227. [Full text]
Parikh R, Sapru M, Krishna M, Cuijpers P, Patel V, Michelson D. “It is like a mind attack”: stress and coping among urban school-going adolescents in India. BMC Psychology. 2019 Dec;7(1):1-9.
Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, et al.
Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278:823-32.
Gómez-López M, Viejo C, Ortega-Ruiz R. Well-being and romantic relationships: A systematic review in adolescence and emerging adulthood. International journal of environmental research and public health. 2019 Jan;16(13):2415.
Shulman S, Davila J, Shachar-Shapira L. Assessing romantic competence among older adolescents. J Adolesc 2011;34:397-406.
Larson RW, Clore GL, Wood GA. The emotions of romantic relationships: Do they wreak havoc on adolescents. The development of romantic relationships in adolescence. Cambridge: Cambridge University Press. 1999:19-49.
Davila J, Kashy DA. Secure base processes in couples: Daily associations between support experiences and attachment security. J Fam Psychol 2009;23:76-88.
Jaya J, Hindin MJ. Premarital romantic partnerships: Attitudes and sexual experiences of youth in Delhi, India. Int Perspect Sex Reprod Health 2009;35:97-104.
Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al.
No health without mental health. Lancet 2007;370:859-77.
Chakraborty K. 'The good Muslim girl': Conducting qualitative participatory research to understand the lives of young Muslim women in the bustees of Kolkata. Child Geogr 2009;7:421-34.