In 2010 and 2011, PASEO’s director, Brieanne Kohrt, investigated the prevalence and correlates of maternal depression amongst urban migrant women in Peru. Findings revealed that nearly 2 in 3 women met criteria for clinical depression. The largest risk factor for depression- beyond poverty-beyond low social capital- beyond educational disparities- was present domestic violence. 66% of women reported experiencing some kind of domestic violence (DV) at the time the study took place- albeit physical, emotional, or sexual. This rate is higher than any other study to date in Latin America.
In addition, domestic violence impaired women’s parenting abilities. Women in situations of DV had less energy for parenting, were less warm, and engaged in fewer parenting activities crucial to children’s socioemotional and cognitive development. Children living in situations of domestic violence had greater levels of internalizing behaviors (e.g. depression or anxiety symptoms, social withdrawal, and low self-esteem). Impaired parenting partially explained the relationship between DV and children’s internalizing behaviors.
Based on findings from this study, we have worked with our partner NGO, SKIP, to try to continue and further programs that slowly but systematically reduce the likelihood of domestic violence in urban migrant communities such as the community of El Porvenir, where SKIP works. This includes individual and couples therapy with women experiencing DV and their partners and social work charlas on what constitutes DV and where to get help in the community. However, this also includes indirect and holistic strategies, including classes for secondary students on characteristics of healthy and unhealthy relationships, psychoeducational groups for children on alternative methods for resolving conflicts to reduce aggression, working with new parents to encourage attachment behaviors with their infants, and providing economic development support, such as microloans and budgeting workshops, as financial stress and lack of job opportunities for men are thought to exacerbate DV.
While a start, this is not enough. Further research is needed on the men in this community- not only those who perpetrate abuse, but also those who ceased violent behaviors or never engaged in them in the first place, so that their resilience can be learned from and passed on to others. A better understanding of men’s identity- as fathers- as husbands- as Peruvians- as migrants- is needed to be able to promote healthy family functioning.
Finally, there is a greater need for mental health services in these communities. Two in three women met criteria for clinical depression in this urban migrant community- and while all will not require psychiatric or psychological support, having the option to seek such services is necessary. Less than 2% of the government health budget across Latin American countries goes to mental health, and little of this is channeled to domestic violence services or care for common mental illnesses such as depression or anxiety.
Treatment for depression in women in urban migrant communities needs to be creative. Women need to be empowered and educated- respected and heard. Holistic and systemic interventions- and a focus on training and task-shifting, are a crucial step. Programs that train trusted lay people in the community to deliver social support and skills-based treatments is feasible and has been successful in such places as Uganda, Pakistan, and India. However, there needs to be investment- financial and emotional- from governments, NGO’s, communities, and individuals, to make these types of programs effective and sustainable. Mental health for all needs to involve all.