Mental health tester for construction workers

Testing Primary Levels of Anxiety and Depression in Lower Income Population

 Abstract

This study is comprehensive of detecting primary levels of anxiety and depression amongst the population which is frequently undiagnosed in mental health criteria. In community settings, mental health conditions like anxiety and depression are frequently underdiagnosed. This study evaluated the viability of a mental health screening corner and determined how common they were among attendees at a health camp. The Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used in a cross-sectional screening. A significant percentage of people tested positive for a range of symptoms, most of which were mild to moderate and some of which needed additional testing. The screening was well received, demonstrating a decrease in stigma and a willingness to participate in mental health evaluation. In order to encourage early detection and prompt intervention, these findings support the incorporation of quick screening tools into community health programs and draw attention to the hidden burden of mental health problems.

Keywords- Mental health, Lower income population, Anxiety, Depression, GAD7, PHQ9.

 A STUDY BY

Priyanka C Naidu in collaboration with LEVELLERS FOUNDATION.

 Introduction –

“Mental health disorders affect around 500 million people worldwide. In India, around 10–12% of people are affected by a mental disorder either due to stress, depression, anxiety, or any other cause. Mental health of workers affects the productivity of the workplace, with estimates putting these losses to be over 100 million dollars annually.” (Sheldon Rao, 2015). Even during lockdown majorly this idea of mental health on daily wage workers was seen predominantly, Building construction, home maintenance, dry cleaning, rag picking, playing traditional instruments, cooking, hairdressing (barbers), cleaning containers at tea stalls and mini tiffin centers, waste collection, street vending, mechanical workshops, supermarkets, retail stores, and weightlifting in the market offers employment opportunities to wage workers.[7] However, the periods of confinement disrupted the functions of all those places and thus totally closed the lives of day workers without food, money, routine medicines, and to meet the needs of children (Banjari & Sahu, August 2022). Recently, the minimum wage has been gaining attention among researchers as a policy tool to improve various health outcomes (Leigh et al., 2019)  Three recent papers that examine the link between minimum wages and suicide, which is closely associated with mental health, all find that higher minimum wages are associated with lower suicide among less-educated individuals. “This study in the US again was in consideration of reviewing the mental health of daily wage workers, especially considering the factor of financial stability, whether its increase or decrease affects their mental health. This study contributes to the literature by examining whether higher state minimum wages are associated with mental health among low-income, less-educated prime-age workers in the United States.

Although it is plausible that increases in the minimum wage could improve minimum-wage workers’ mental health by alleviating financial stress, there has been surprisingly little research on the effect of minimum wages on mental health. The findings outside the United States seem mixed.” (Kuroki, December 2021). If we take women into consideration, the gender also plays a very important role if we try to analyse the role of mental health in lower income population, “Low-income urban working mothers face many challenges in their domestic, environmental, and working conditions that may affect their mental health. In India, a high prevalence of mental health disorders has been recorded in young women, but there has been little research to examine the factors that affect their mental health at home and work.” In this research, we can see “Through a primarily qualitative approach, we studied the relationship between work, caring for family, spousal support, stress relief strategies and mental health amongst forty eight low-income working mothers residing in urban slums across Bangalore, India. Participants were construction workers, domestic workers, factory workers and fruit and vegetable street vendors. Qualitative data analysis themes included state of mental health, factors that affected mental health positively or negatively, manifestations and consequences of stress and depression, and stress mitigators. Even in our small sample of women, we found evidence of extreme depression, including suicidal ideation and attempted suicide. Women who have an alcoholic and/or abusive husband, experience intimate partner violence, are raising children with special needs, and lack adequate support for child care appear to be more susceptible to severe and prolonged periods of depression and suicide attempts. Factors that pointed towards reduced anxiety and depression were social support from family, friends and colleagues and fulfilment from work. This qualitative study raises concerns that low-income working mothers in urban areas in India are at high risk for depression, and identifies common factors that create and mitigate stress in this population group. We discuss implications of the findings for supporting the mental health of urban working women in the Indian context. The development of the national mental health policy in India and its subsequent implementation should draw on existing research documenting factors associated with negative mental health amongst specific population groups in order to ensure greater impact.” (Travasso, 2014).

 HYPOTHESIS

1.    Null Hypothesis- daily wage workers/ lower income population do not have chances of having anxiety or depression.

2.    Alternate Hypothesis- daily wage workers/ lower income population do have chances of having anxiety or depression.

METHODOLOGY

This study examined a group of 10 individuals, which all happen to be male respondents. This research was parametric in relation to the income, social class, and educational criteria. There were no parameters regarding a specific, age, gender or educational criteria. Their responses are kept confidential and used only for the purpose of the research and findings. This research is descriptive cross-sectional analysis on the basis of convenience sampling in a slum settlement. The GAD 7 and PHQ 9 tests were administered via one-in-one person interviews to ensure understanding.

TOOLS -

1. The GAD-7 (Generalized Anxiety Disorder-7) is a 7-item, self-report questionnaire used to screen for and measure the severity of generalized anxiety disorder in adults and adolescents. It assesses symptoms experienced over the past two weeks, such as nervousness, uncontrollable worry, and irritability, with scores ranging from 0 to 21. It is a quick tool designed for primary care to screen for GAD, though it also helps identify other anxiety disorders like panic disorder or social anxiety. Respondents rate how often they have been bothered by 7 core symptoms over the past two weeks. The GAD-7 is a validated, widely used clinical tool, but it is not a replacement for a full diagnostic interview by a mental health professional. (Spitzer, 2006)

RELIABLITY & VALIDITY - boasting high internal consistency (Cronbach’s 0.89–0.91) and good construct validity. It shows strong, clinical, cutoff, performance, (sensitivity, 89%; specificity, 82%), with, results, that, are, consistent, across, various, populations.

2. The PHQ-9 is a 9-item, self-report diagnostic tool that scores DSM-IV-based depression symptoms on a 0-3 frequency scale over two weeks, enabling severity monitoring. It includes question 9 regarding suicide ideation and a final, non-scored functional impairment item to assess treatment efficacy. (Kroenke, 2001)

RELIABLITY & VALIDITY -  The Patient Health Questionnaire-9 (PHQ-9) is a highly reliable and valid self-report tool for screening and measuring depression severity, with high internal consistency (Cronbach’s 0.86–0.89). A score of $\ge$10 demonstrates 88% sensitivity and 88% specificity for major depression. It is widely used in primary care and research.

PROCEDURE –

For this project the primary levels of anxiety and depression were tested amongst the lower income population in a slum settlement specifically. It was done as a facility for this population to actually consider mental health’s importance, and also for the foundation to know about the mental health status of working class in conditions which differ from the normal urban population. The GAD7 and PHQ9 tests of anxiety and depression were administered to this population in one-in-one interview format. For effective understanding and smooth administration, the questions of these questionnaires were read out and responses were collected from one individual at a given time. Since this research was a part of a facility camp, the data was collected using convenience sampling method.  A total of 10 responses were successfully collected by the members, out of which all responses were of male participants. GAD7 and PHQ9 have a four-point Likert scale scoring pattern. The scores of both tests were calculated and interpretation was done according to the manual.

RESULT 

1. The result for GAD7 indicates that there is 50% of the population having minimal anxiety. 40% having mild anxiety. As well as 10% population having severe anxiety.

2. The result for PHQ9 indicates that there is 70% of the population having minimal/no depression. 20% of the population is having mild depression. Lastly 10% having moderately severe depression.

 DISCUSSION

The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) were used in this study to assess anxiety and depression symptoms in participants attending a health camp. A special chance to evaluate psychological well-being in a community-based, easily accessible setting was made possible by the inclusion of a special mental health area within a general health camp.

The results show that a significant percentage of participants tested positive for various degrees of anxiety and depression symptoms. This is consistent with previous research indicating that mental health issues are frequently common but underappreciated in community populations, especially in non-clinical or low-resource settings. This study's opportunistic screening strategy draws attention to the hidden burden of mental health issues that might go unnoticed otherwise.

Because of their validated psychometric qualities, shortness, and ease of administration, the PHQ-9 and GAD-7 proved to be useful and effective in a camp setting. Their use made it possible to quickly identify people who needed additional psychological testing or treatment. This confirms earlier findings that these instruments are appropriate for widespread screening and can be successfully incorporated into outreach and primary healthcare initiatives.

The viability and acceptability of including a mental health area in a general health camp is a significant finding from this study. When mental health screening was provided in addition to standard medical care, participants seemed open to participating, indicating less stigma and greater transparency in a non-specialized setting.

By normalizing mental health conversations within general health contexts, this integrated model may aid in closing the treatment gap in mental healthcare.

Additionally, early detection through these screening programs can help with prompt referral and intervention, which may stop the development of more serious mental health conditions. In the context of community health, where access to specialized mental health services may be restricted, this is especially pertinent.

But there are some restrictions that need to be taken into account. Response bias and situational factors may have an impact on the use of self-report screening tools, which is not equivalent to clinical diagnosis. Furthermore, generalizability may be limited because the camp-based sample might not be entirely representative of the overall population. Additionally, any inference of causality or longitudinal trends is precluded by the cross-sectional nature of the screening.

The study emphasizes the significance of incorporating mental health screening into community health initiatives despite these limitations. Future studies could examine the impact of such interventions on mental health outcomes, the efficacy of referral pathways, and longitudinal follow-up.

In conclusion, it is both possible and beneficial to use the PHQ-9 and GAD-7 in a health camp setting for the early detection of anxiety and depression. Creating mental health spaces within community health initiatives can be a useful tactic to raise awareness, lessen stigma, and increase access to mental health services.

CONCLUSION-

According to the results, the null hypothesis was rejected and the alternate hypothesis that the daily wage workers/ lower income population do have chances of having anxiety and depression

References

Banjari, S., & Sahu, T. (August 2022). Effect of Lockdown on Mental Health of Daily wage Workers: A Review Article . p S94-S97.

Kroenke, K. S. (2001). The PHQ-9: validity of a brief depression severity measure. 16(9) 606–613.

Kuroki, M. (December 2021). State minimum wage and mental health in the United States: 2011–2019. 1.

Leigh et al. (2019).

Sheldon Rao, N. R. (2015). Depression, anxiety and stress levels in industrial workers: A pilot study in Bangalore, India.

Spitzer, R. L. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.

Travasso, S. R. (2014). A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India. .