Perceived anxiety and depression and associated factors among women inmates with a long-term sentence in Thailand.

BACKGROUND: In Thailand, the growing prevalence of mental health problems among the increasing number of adult female prisoners has emerged as a significant public health concern. However, studies on the health of women prisoners are primarily conducted in Western societies, and studies in other countries are rare. Thailand, a non-western country, is no exception to this. OBJECTIVES: The objectives of this study were to assess the current levels of anxiety and depression among women drug offenders in Thailand and to identify possible associated factors. METHODS: Data were collected from a sample consisting of 554 women drug offenders serving sentences of eight years or more. Stratified random sampling with proportionate stratification was employed during the data collection. The female inmates were being held in three categories of prisons: correctional institutions, central prisons, and provincial prisons. A single question was used to measure self-perceived levels of anxiety and depression: none, moderate, or substantial. Ordered logit regression was employed in the data analysis. FINDINGS: One out of five (21.1%) of the inmates in the sample reported no perceived current anxiety and depression, 61.7% reported moderate anxiety and depression, and 17.1% reported having substantial perceived levels of anxiety and depression. It was found that chronic health conditions or disease, concerns about economic status, and feelings of shame were associated with the perceived anxiety and depression reported by the inmates. CONCLUSION: The study's findings suggest that integrated mental health services that emphasize a holistic approach that acknowledges the intersectionality of women's mental health and societal gender roles should be provided in prisons. Regular mental health screening and accessible mental health services are essential for all incarcerated women. Empowerment programs during confinement can boost self-esteem and thus lead to better post-release outcomes. The government should also implement programs to alleviate the financial burden on prisoners' households.

Conflict in Skipped Generation Households in Thailand.

A common phenomenon in rural Thailand is that adult children migrate to find work and leave their children behind in the care of their grandparents. The resulting living arrangement is referred to as a skipped generation household. This arrangement can benefit the intergenerational family but can also be associated with conflict. This study explores different types of conflict between grandparents and their adult children in skipped generation households and how they manage these conflicts. In-depth interviews were conducted with 48 grandparents in rural Thailand. Using thematic analysis, conflicts including decision to care for grandchildren, how to raise and discipline grandchildren, where the grandchildren should live, grandchildren's education, and inconsistent remittances from the migrant children to their parents were identified. The findings revealed the strategies grandparents use to cope by either trying to prevent or dealing with conflicts. Buddhist teachings play an important role in the way families react to conflict.

The effect of asset-based wealth inequality on problem drinking among rural Thai elders: a prospective population-based cohort study.

Evidence on the link between income inequality and alcohol-related problems is scarce, inconclusive and dominated by studies from the developed world. The use of income as a proxy measure for wealth is also questionable, particularly in developing countries. The goal of the present study is to explore the contextual influence of asset-based wealth inequality on problem drinking among Thai older adults. A population-based cohort study with a one-year follow-up was nested in a Demographic Surveillance System (DSS) of 100 villages in western Thailand. Data were drawn from a random sample of 1104 older residents, aged 60 or over (one per household) drawn from all 100 villages, of whom 982 (89%) provided problem drinking data at follow-up. The primary outcome measure was a validated Thai version of the Alcohol-Used Disorder Identification Test for problem drinking. Living in areas of high wealth inequality was prospectively associated with a greater risk for problem drinking among older people (adjusted odds ratio 2.30, 95% confidence intervals 1.02-5.22), after adjusting for individual-level and village-level factors. A rise in wealth inequality over the year was also independently associated with an increased risk of problem drinking (adjusted odds ratio 2.89, 95% confidence intervals 1.24-6.65). The associations were not explained by the social capital, status anxiety or psychosocial stress variables. The data suggest that wealth inequality and an increase in inequality across time lead to a greater risk of problem drinking. Efforts should be directed towards reducing gaps and preventing large jumps in inequality in the communities. Further research should investigate the effect of asset-based inequality on various health risk behaviors and its specific mediating pathways.

Migration of children and impact on depression in older parents in rural Thailand, southeast Asia.

CONTEXT Migration is feared to be associated with abandonment and depression in older parents "left behind" in rural areas of low- and middle-income countries. OBJECTIVE To test for prospective associations between (1) out-migration of all children and subsequent depression in parents and (2) having a child move back and an improvement in parents' depression. DESIGN A cohort study with a 1-year follow-up. SETTING A population-based study nested in a demographic surveillance site of 100 villages in rural Thailand. Most out-migration is to the capital city. PARTICIPANTS A stratified random sample of 1111 parents 60 years and older (1 per household) drawn from all 100 villages, of whom 960 (86%) provided depression data at follow-up. MAIN OUTCOME MEASURES Scoring 6 or more on the Thai version of the EURO-D depression scale at follow-up. RESULTS Depression prevalence was 22%. At baseline, 155 (16%) had all their children migrated from the district and 806 (84%) had at least 1 child living in the district. Having all children out-migrated at baseline, compared with having none or some children out-migrated, predicted a smaller odds of depression, after controlling for baseline sociodemographic and health measures (odds ratio [OR], 0.43; 95% CI, 0.20-0.92). Having a child move back in the study year was associated with greater odds of depression at follow-up when adjusted for baseline measures (OR, 1.75; 95% CI, 1.04-2.94), although this was no longer significant after adjusting for changes in disability and marital status since baseline (OR, 1.72; 95% CI, 0.99-2.98). CONCLUSIONS Contrary to our hypothesis, parents whose children are not migrants may be at greater risk of depression than those with migrant children. More understanding is needed about the risks for depression in older rural populations and about the effectiveness of interventions.

Psychological wellbeing, physical impairments and rural aging in a developing country setting.

BACKGROUND: There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. METHODS: A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. RESULTS: Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p < 0.001) but after adjusting for disability the coefficient fell and was non-significant. The parsimonious model for wellbeing included age, wealth, social support, disability and impairment due to paralysis (the effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing. CONCLUSION: In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.

Rural-urban migration and depression in ageing family members left behind.

BACKGROUND: It has been suggested that rural-urban migration will have adverse consequences for older parents left behind. AIMS: To describe correlates of outmigration and to estimate any association between outmigration of children and depression in rural-dwelling older parents. METHOD: Population-based survey of 1147 parents aged 60 and over in rural Thailand. We randomly oversampled parents living without children. We defined an outmigrant child as living outside their parent's district, and measured depression as a continuous outcome with a Thai version of the EURO-D. RESULTS: Outmigration of all children, compared with outmigration of some or no children, was independently associated with less depression in parents. This association remained after taking account of social support, parent characteristics, health and wealth. Parents with all children outmigrated received more economic remittances and they perceived support to be as good as that of those with children close by. CONCLUSIONS: Outmigration of children was not associated with greater depression in older parents and, after taking account of a range of possible covariables, was actually associated with less parental depression. This could be explained by pre-existing advantages in families sending more migrants and by the economic benefits of migration.

Gendered Migrant Social Capital: Evidence from Thailand.

Employing longitudinal data from Thailand to replicate studies of cumulative causation, we extend current knowledge by measuring frequency of trips, duration of time away, level of network aggregation (village or household), and sex composition of migrant networks to estimate a model of prospective migration among men and women in Thailand. We find that trips and duration of time away have distinct influences upon migration; that household level migrant networks are more influential than village level migrant networks; that female migrant networks and male migrant networks have different influences upon migration outcomes; and, that migrant social capital influences men and women's migration differently. Our elaboration provides significant quantitative evidence as to how gender and family variously imbue migration dynamics.