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Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India

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Abstract

Purpose

Research on employment in people with severe mental illnesses (SMI) in developing countries is sparse and largely limited to employment rates. We conducted a comprehensive study of work, interest in work, and perceived benefits and barriers to work in people with SMI in India.

Methods

Semi-structured interviews were conducted with 550 individuals with SMI receiving private psychiatric outpatient services in two districts in western India, one urban (Pune) and the other rural (Ahmednagar).

Results

More than half of the participants were employed, with significantly more men working (79.4%) than women (35.9%). Higher rates of work were found in rural areas (77.8%), where most work was in family agricultural businesses, than in urban areas (48.9%), where most work was for independent employers. Participants in rural areas worked fewer hours and earned less money, and reported fewer benefits and fewer problems related to work than urban participants. Over 45% of participants working for independent employers found jobs with help from families and extended social networks. Most unemployed participants wanted to work, and desired a variety of supports, including assistance with job finding and illness management.

Conclusions

Gender-specific social role expectations and families play an important role in work in people with SMI in India. Despite higher rates of work in this sample than most studies from developed countries, a significant subgroup was unemployed but wanted to work. Persons with SMI in developing countries may benefit from the adaptation of validated vocational rehabilitation approaches in developed countries to their cultural context.

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Acknowledgements

We are grateful to the following people for their help and contributions to various aspects of conducting the research project:

India: Kedar Deshmukh, Dr. Manjiri Dixit, Dr. Kaustubh Joag, Suchitra Joshi, Dr. Amruta Karande-Patil, Dr. Himani Kulkarni, Dr. Sameer Kulkarni, Chitra Lele, Pranita Pathak, Dr. Shirisha Sathe, staff of Manasdeep Psychiatric and Deaddiction Center, Ahmednagar and Poona Hospital and Research Center, Pune, and all the study participants.

US: Drs. Gary Bond, Robert Drake, Matthew Kurtz, Uma Millner, Peter R. Mueser, E. Sally Rogers, and staff at the Center for Psychiatric Rehabilitation, Boston University.

Funding

This research was supported by the Dudley Allen Sargent Research Fund at Boston University to C. Khare.

Author information

Authors and Affiliations

  1. College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA

    Chitra Khare & Daniel Fulford

  2. Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA, 02215, USA

    Chitra Khare, Kim T. Mueser & Susan R. McGurk

  3. Department of Occupational Therapy, Boston University, Boston, MA, 02215, USA

    Kim T. Mueser & Susan R. McGurk

  4. Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA

    Kim T. Mueser, Daniel Fulford & Susan R. McGurk

  5. Department of Psychiatry, Poona Hospital and Research Centre, Sadashiv Peth, Pune, Maharashtra, 411030, India

    Vidyadhar G. Watve

  6. Manasdeep Psychiatric and De-Addiction Center, Dr. Karandikar Hospital, Laltaki, Siddharthnagar, Ahmednagar, Maharashtra, 414001, India

    Neeraj J. Karandikar & Dipti N. Karandikar

  7. KEM Hospital and Research Centre (KEMHRC), Sardar Moodliar Road, Rasta Peth, Pune, Maharashtra, 411011, India

    Sailee Khare

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  1. Chitra Khare
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Corresponding author

Correspondence to Kim T. Mueser.

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The authors declare that they have no conflict of interest.

Ethical standards

The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The study protocol was approved by the Institutional Review Board of Boston University, USA. All participants gave informed consent prior to their inclusion in the study.

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Khare, C., Mueser, K.T., Fulford, D. et al. Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India. Soc Psychiatry Psychiatr Epidemiol 55, 1593–1606 (2020). https://doi.org/10.1007/s00127-020-01901-0

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