Date of Award

12-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Narjis Rizvi

Second Advisor

Dr. Shafquart Rozi

Third Advisor

Dr. Wafa zahra Jamal

Department

Community Health Sciences

Abstract

Background: Mental wellbeing is defined as the condition in which people can fully utilize their potential, deal with life's stresses, engage in productive and fulfilling activities, and actively contribute to improving their communities. Globally there is a 13% rise in mental health issues in the last decade, making up 1 in 5 years lived with disability. In Pakistan, mental illnesses make up over 4% of the overall health burden, and this burden is more pronounced among women. Research from Pakistan suggests that the following are risk factors for mental illness: low educational status, unfavorable childhood experiences, lack of social support, stressful life events. Research reveal that women experience higher levels of psychological stress as a result of these cultural expectations, and their mental health outcomes are further exacerbated by a lack of social support or a supportive environment. Marriage, central to Pakistani culture, carries heavy societal expectations, especially for women.
Methods: This study used an explanatory sequential mixed methods design. A sample of 241 participants was recruited through snowball sampling for the quantitative phase, Anxiety and depression(outcome) was assessed using the Aga Khan University Anxiety and Depression Scale (AKUADS) and Societal pressure (Exposure) was assessed using Perceived Sociocultural Pressure Scale (PSPS). For the qualitative phase, purposive sampling was employed to select 12 participants for in-depth interviews, ensuring varied experiences of societal pressure. Quantitative data analysis was done using Stata version 15, while thematic analysis was done using Nvivo software 12. 5
Results: Among 241 participants, 62.7% had graduate degrees, and 59.8% were employed, with 74.69% of those feeling pressure reporting these issues, compared to 25.31% who did not. Binary Logistic regression revealed that women facing societal pressure had 2.56 times higher odds of anxiety/depression (OR = 2.56, 95% CI: 1.29 - 5.10, p < 0.05). Those with incomes below 50,000 PKR had 2.31 times the prevalence odds (prevalence OR = 2.31, 95% CI: 1.17-4.54, p >0.05) of anxiety and depression to those earning more than 200,000 PKR. Qualitative interviews validated the quantitative findings and highlighted that societal pressure to get married is based on social norms and religion. Marriage is considered a means for financial security. High income and skilled careers provide women a purpose in life and prevent them from anxiety and depression.
Conclusion: This mixed method study found an association between societal pressure to get married and anxiety / depression among unmarried women aged 25 to 49 in Pakistan. However, high income and health care profession acts as barrier against anxiety/depression.

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Last Page

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