Mental health articles

As described above, patterns of settlement are changing rapidly, as migration from rural to urbanareas, induced in part by the search for employment and education, augments the rapid natural growth that most urban areas of the developing world have experienced over the past few decades. Between 1965 and 1990 populations have become increasingly urbanin all parts of the world. The highest rates of urbanization have occurred in Latin America and the Caribbean, where in 1990, 72% of the population lived in urban areas, compared to 57% in 1970. In recent years, the most rapid increase in urbanization has beenin low- and middle-income countries.

There are few studies that investigate a causal relationship between urban residence and mental health symptomology among the aged. Studies conducted in the general population differ in their findings. For example, some authors  support the traditional idea thaturban residence is associated with poor mental health.Dohrenwend and Dohrenwend summarize in thefollowing manner:

Despite important studies.., that have led us to question thepopular stereotypes of urban living, we have shown that thebest evidence suggests that overall rates of psychiatricdisorder are indeed higher in urban than in rural areas; notall types (there is no evidence that total rates of psychosis arehigher in urban than in rural areas) but important subtypessuch as neurosis and personality disorder are responsible forthis result. Moreover, within urban areas, not only the totaloverall rates but total psychoses, schizophrenia, andpersonality disorder are disproportionately concentrated inthe lowest social class.

More recent individual studies seem to contradictthis perspective. For instance, Cheng observedno significant differences in rates of minor psychiatricmorbidity in rural, suburban and urban communitysamples in Taiwan.

What seems certain is that specific risk factors suchas poor environmental conditions, poverty, malnutritionand low education levels relate individuallyand/or collectively to poor mental and physical healthamong the elderly. In conjunction with thesethreats, the very process of urbanization andmigration from rural areas can compound negativehealth effects. Harpham proposed a model in whichincreased stressors, including long-term difficulties(e.g. 'poor, overcrowded physical environment,' 'needfor acculturation if migrant') and life events (e.g.'migration'), and reduced social support (e.g.'reduction of extended families,' 'increase in singleparent households') are associated with 'mentalill-health'. In a study of psychologicaldistress and depression among the elderly in two SouthAfrican townships, Gillis et al. propose migrationand acculturation, in the context of extreme poverty,as important risk factors associated with poor mentalhealth. Living conditions in both townships weredifficult, but the subjects in the newly settled oneexhibited higher rates of depression which wereassociated with respondents' worse perceived healthstatus and inadequate housing (the longer settledresidents had better living conditions and greater perceived health status). Ramos, Blay and Mari produced similar findings from a study in So Paulo,Brazil. Elderly residents originating from a rural area(i.e. definite migrants) were almost twice as likely asthose born in an urban area to suffer from a psychiatricdisorder. Prevalence rates of disorders were alsosignificantly higher for residents who had been livingin their homes for less than five years and for those inthe lowest per capita income group (< $50.00 permonth), in comparison to those who lived in theirhomes more than five years and to those in the highestincome group (> $250.00 per month), respectively.Although most aggregate data suggest that urbandwellers have higher income levels than their ruralcounterparts, the level of aggregation often masksacute income inequalities. Some studies indicate thatthe poor in urban areas are less well off than the poorin rural areas. Average daily per capita caloric intakewas lower among the urban poor than the rural poorin Pakistan, Brazil, India, Thailand, Trinidad, Chad,Korea and Indonesia. In the shanty towns of Northeast Brazil, poor residents interpret commonsymptoms such as weakness, disorientation, tiredness,confusion and depression through the folk diagnosticcategory of "nerves". Scheper-Hughes argues that the complex of mental symptoms relatingto 'nerves' results largely from chronic hunger andconcern about having enough food.

Tags: Health, mental, Mental health, symptomology