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Advanced Neurology Depression and its risk factors in India

manual of mental disorders, 8,10,11 the Montgomery–Åsberg Culture encompasses a group’s collective beliefs,
depression rating scale, and the center for epidemiologic customs, and behaviors. It shapes traditions, language, arts,
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studies depression scale, with each scale having different and social norms that define identities and interactions
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sensitivity and specificity (Tables 1 and 2). Moreover, the within communities, evolving and varying widely across
review revealed that no specific scale has been developed societies. As a significant factor linked with depression,
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for use in India. However, several widely used scales have understanding the role of culture in depression in the
been linguistically translated, standardized, and validated Indian context is crucial. Research indicates that “cultural
for the Indian context, and show promising reliability influences” significantly impact gender roles, behaviors,
(Tables 1 and 2). and societal expectations, contributing to disparities in
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To understand the increasing prevalence of depression mental health and achievement between genders. For
in India, researchers have used various methods to identify example, women, influenced by cultural norms, are 2 times
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the contributing risk factors. more likely to experience depression than men. Moreover,
gender disparities contribute to a pronounced increase in
3.3. Risk factors depression rates among girls during adolescence. 20,21

A disease’s risk factors refer to any attribute, characteristic, Depression is influenced by longstanding societal
or exposure that increases the likelihood of developing expectations regarding gender roles and limited emotional
the disease. These factors can stem from various sources and financial support in familial and marital contexts. In
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and are broadly categorized as external and internal. particular, in the context of marriage, child marriages reveal
External factors encompass a range of indicators such as a complex issue that is deeply rooted in cultural and societal
lifestyle factors, behavioral patterns, and physiological norms. Despite legal protections, India harbors the highest
states. Meanwhile, internal factors also play a significant number of child brides in the world, with 223 million girls
role and include genetic predispositions and epigenetic married before adulthood, comprising approximately a
modifications. Risk factors contribute to the overall third of the world’s total (Ending-Child-Marriage.pdf
probability of disease occurrence and vary in impact (unicef.org). Annually, approximately 1.5 million girls
depending on individual circumstances and interactions marry under the legal age of 18 (Ending-Child-Marriage.
with other factors. In preventive medicine and public pdf (unicef.org), reflecting the deep-seated cultural
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health, recognizing and identifying a disease’s risk factors practices perpetuating this phenomenon. Recent studies
is crucial as it enables targeted interventions to mitigate have emphasized the profound and negative consequences
risk, promote health, and enhance outcomes. of early marriage, including heightened risks of depression,
abuse, and adverse health outcomes. 23,24 This practice also
3.3.1. External or environmental factors correlates with the increased odds of tobacco use among

Stress is recognized as a pivotal external risk factor for women who were married as children, underscoring broad
MDD, and it is defined by the WHO as “a state of worry disparities in health outcomes. Addressing child marriage
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or mental tension caused by difficult situations” (Stress- requires challenging cultural norms and societal structures
WHO.int). From a physiological standpoint, stress through legal, social, and educational interventions to
encompasses “any change that triggers physical, emotional, protect and empower young girls. Stressful experiences
or psychological strain or pressure.” As an intrinsic aspect such as seeking healthcare, education, employment, and
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of the human condition, stress arises from various sources domestic violence disproportionately affect women,
such as traumatic events, disappointments, or feelings of impacting their mental well-being. Gender-specific norms
unease; therefore, it impacts everyone to some degree. shape factors such as upbringing, education, relationships,
Critically, people’s response to stress can profoundly affect and broader social influences, contributing to differing life
their overall well-being. experiences for young women compared with men. 19,26,27
There are two distinct types of stress: Eustress and In the cultural context of students, depression manifests
distress. Eustress, which is often viewed as a positive with symptoms such as restlessness, anxiety, and cognitive
motivator, can promote improved performance. In difficulties, which are often linked with personal factors
contrast, distress acts as a negative force that can such as perceived failure. Specifically, depression reflects
overwhelm individuals and lead to exhaustion, despair, and a significant economic disparity among Indian university
impaired functionality. Among the Indian population, students: those from rural and socioeconomically
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this review reveals different sources of distress that deeply disadvantaged backgrounds often endure heightened
affect people’s lives, focusing on gender, academic stress, feelings of despair due to limited financial resources,
occupational stress, and unemployment. exacerbating feelings of low self-worth and insecurity. These
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Volume 4 Issue 3 (2025) 32 doi: 10.36922/an.5940