Lesley Jo Weaver

Moving Beyond Hunger and Nutrition: A Systematic Review of the Evidence Linking Food Insecurity and Mental Health in Developing Countries

Food insecurity is a significant problem in the developing world, and one that is likely to increase given the current global food crisis spurred by rising oil prices, conversion of food to biofuels, and reduced harvests in the wake of natural disasters. The impacts of food insecurity on nutrition status, growth, and development are well substantiated; less is known about the non-nutritional impacts of food insecurity, such as its effects on mental health. This systematic review assesses current findings regarding the impacts of food insecurity on mental health in developing countries. Both qualitative and quantitative studies are considered. The results of the search reveal that little work has examined these issues directly, and serious methodological flaws are present in many of the existing studies. Gaps in the literature, implications, and research priorities are discussed.

Applying syndemics and chronicity: interpretations from studies of poverty, depression, and diabetes.

Medical anthropologists working with global health agendas must develop transdisciplinary frameworks to communicate their work. This article explores two similar but underutilized theoretical frameworks in medical anthropology, and discusses how they facilitate new insights about the relationships between epidemiological patterns and individual-level illness experiences. Two cases from our fieldwork in New Delhi and Chicago are presented to illustrate how syndemics and chronicity theories explain the epidemic problems of co-occurring depression and type 2 diabetes. We use these case studies to illustrate how the holistic agendas of syndemics and chronicity theories allow critical scholars to attend to the macrosocial factors contributing to the rise of noncommunicable diseases while still honoring the diversity of experiences that make individual illness experiences, and actual outcomes, unique. Such an approach not only promotes a more integrative medical anthropology, but also contributes to global health dialogues around diabetes, depression, and their overlap.

Developing and Testing Locally Derived Mental Health Scales: Examples from North India and Haiti

Cross-cultural studies of mental health and illness generally adhere to one of two agendas: the comparison of mental health between sites using standard measurement tools, or the identification of locally specific ways of discussing mental illness. Here, we illustrate a methodological approach to measuring mental health that unites these two agendas. Using examples from our work in India and Haiti, we show how researchers can use mixed methods to identify idioms of distress, develop locally derived tools to measure them, evaluate the psychometric properties of these tools, and contextualize the results with relevant ethnographic information. Such an approach is beneficial because it generates results that attend to important cross-cultural differences in expressions of distress while still maintaining comparability of mental health and illness across research sites.

Reorienting women's health in low- and middle-income countries: the case of depression and Type 2 diabetes.

Womens health in low- and middle-income countries (LMICs) has historically focused on sexual and reproductive health. However, understanding how women acquire, experience, and treat non-reproductive health conditions, such as non-communicable diseases, has become a fundamental public health concern. Special attention to the social determinants of LMIC womens health can provide socially and culturally relevant knowledge for implementation of policies and programs for women increasingly confronting these ‘New Challenge Diseases’. This article uses the example of depression and Type 2 diabetes comorbidity to illustrate how attending to the social determinants of mental and physical health beyond the reproductive years contributes to a more holistic agenda for womens health. For instance, we must address the plurality of experiences that shape womens health from social determinants of depression, such as gendered subjugation within the home and public sphere, to the structural determinants of obesity and diabetes, such as poor access to healthy foods and health care. Attending to the complexities of health and social well-being beyond the reproductive years helps the womens global health agenda capture the full spectrum of health concerns, particularly the chronic and non-communicable conditions that emerge as life expectancy increases.

Type 2 Diabetes and Anxiety Symptoms Among Women in New Delhi, India

OBJECTIVES We explored the relationship between mental health and type 2 diabetes among women in New Delhi, India, in 2011. METHODS We recruited a convenience sample of 184 diabetic women from 10 public and private clinics. They completed a finger-stick blood test and a questionnaire assessing demographic characteristics, depression and anxiety symptoms, and diabetes-related disabilities restricting their performance of daily tasks. A subsample of 30 women participated in follow-up qualitative interviews at their homes. RESULTS More than one quarter of our sample of diabetic women reported high levels of anxiety symptoms, whereas 18% reported high levels of depression symptoms. Anxiety symptoms were patterned according to recency of diabetes diagnosis, with 40% of women diagnosed less than 2 years before their interview reporting high anxiety symptom levels, as opposed to 23% of women diagnosed more than 2 years in the past. Depression and anxiety scores differed with respect to their relationship to recency of diagnosis, number of children, blood glucose level, and functional disabilities restricting performance of daily tasks. CONCLUSIONS Screening for anxiety among people with diabetes has been overlooked in the past. Anxiety appears more prevalent than depression, especially during the first 2 years of the disease.

Tension Among Women in North India: An Idiom of Distress and a Cultural Syndrome

Abstract The existing literature on Indian ethnopsychology has long asserted that somatization is a key aspect of experiences of distress. The study of idioms of distress arose out of work done in India (Nichter in Cult Med Psychiatry 5(4):379–408, 1981), but ironically, little subsequent work has systematically explored idioms of distress in this part of the world. This ethnographic study focused on the term tension (tenśan) and its relation to a cultural syndrome among women in urban North India. This syndrome appears to involve rapid-onset anger, irritation, rumination, and sleeplessness as key symptoms. It is often linked to specific circumstances such as domestic conflict and is associated with the stresses of modern urban life. People who report more symptoms of tension had consistently higher scores on the Hopkins Symptoms Checklist-25 for depression and anxiety. In this cultural context where psychiatric care is highly stigmatized, the language of tension can aid providers of mental healthcare (many of whom, in India, are not psychiatrists or psychologists) to identify and communicate effectively with potential patients whose mental healthcare needs might otherwise go unaddressed.

Zika virus in American Samoa: challenges to prevention in the context of health disparities and non-communicable disease

Abstract Background: Zika virus (ZIKV) is linked to deleterious foetal and neonate outcomes. Maternal exposure to ZIKV through mosquitoes and sexual fluids creates a public health challenge for communities and policymakers, which is exacerbated by high levels of chronic non-communicable diseases in American Samoa. Aim: This study aimed to identify structural barriers to ZIKV prevention in American Samoa and situate them within locally relevant cultural and epidemiological contexts. Subjects and methods: This study assessed knowledge, attitudes and access to ZIKV prevention among 180 adults in American Samoan public health clinics. It queried knowledge about pre-natal care, protection against mosquitoes and condom use. Results: Women were most likely to identify pre-natal care as important. The majority of participants were able to identify how to prevent mosquito bites, but may have been unable to follow through due to socioeconomic and infrastructure limitations. Few participants identified condom use as a preventative measure against ZIKV. Prevention misconceptions were most pronounced in women of low socioeconomic status. Conclusions: These findings reinforce the need for a multi-pronged approach to ZIKV. This study highlights the need for information on culturally specific barriers and recognition of additional challenges associated with dual burden in marginal populations where social inequalities exacerbate health issues.

Transactions in Suffering: Mothers, Daughters, and Chronic Disease Comorbidities in New Delhi, India.

The biomedical definition of comorbidity belies the complexity of its lived experience. This article draws on case studies of women with diabetes and various comorbidities in New Delhi, India, to explore intergenerational transactions surrounding suffering in contexts of comorbidity. The analysis synthesizes sociological theories of chronic disease work, psychological theories of caregiver burnout, and anthropological approaches to suffering and legitimacy to explore how, when, and by whom womens comorbid sources of suffering become routinized in everyday life. The analysis demonstrates, first, that comorbid suffering is not simply a matter of the addition of a second source of suffering to an existing one; rather, it comprises complex interactions between suffering, disability, family dynamics, and quality of life. Second, it illustrates several social routes through which comorbid suffering can fade into the background of everyday life, even when it is severe. Close attention to how suffering works in cases of comorbidity will be important as comorbid conditions become increasingly commonplace around the world.

Special Section on Comorbidity: Introduction

In the mid-20th century, Rene Dubos criticized the biomedical community for what he called “The Doctrine of Singular Etiology”: a powerful and pervasive axiom that reduced the disease process to a single cause for a single magic bullet (1959). As an alternative, Dubos called for a more ecological approach to human disease that recognized multiple, interacting factors that could either increase or reduce the risk and severity of noncontagious as well as contagious diseases. Although Duboss writings were (and continue to be) well received, his critique had little impact on the epistemology of biomedicine or public health at the time. This was partly because of rapid technological developments that diverted lay and professional attention away from socio–environmental determinants and partly because health professionals were only beginning to recognize the complexities of emerging chronic diseases. This article is protected by copyright. All rights reserved

Special Issue on Comorbidity: Introduction

In the mid-20th century, Rene Dubos criticized the biomedical community for what he called “The Doctrine of Singular Etiology”: a powerful and pervasive axiom that reduced the disease process to a single cause for a single magic bullet (1959). As an alternative, Dubos called for a more ecological approach to human disease that recognized multiple, interacting factors that could either increase or reduce the risk and severity of noncontagious as well as contagious diseases. Although Duboss writings were (and continue to be) well received, his critique had little impact on the epistemology of biomedicine or public health at the time. This was partly because of rapid technological developments that diverted lay and professional attention away from socio–environmental determinants and partly because health professionals were only beginning to recognize the complexities of emerging chronic diseases. This article is protected by copyright. All rights reserved