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Mental health concerns and disorders on Azad Kashmiris on the rise; is

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Azad Kashmiris on the rise; is economic diversity the cause?

By

Rafat Yasmeen (MA)

Research Title: ................................................................................................................................ 3

Introduction ..................................................................................................................................... 3

Aims and Objectives ................................................................................................................... 3

Research Question ....................................................................................................................... 4

Review of Literature ....................................................................................................................... 4

Research Methodology ................................................................................................................... 7

Results and Discussion ................................................................................................................... 8

Thematic analysis ...................................................................................................................... 11

References ..................................................................................................................................... 16
Research Title:

“Mental health concerns on Azad Kashmiris on the rise; is economic diversity the cause?”

Introduction

Mental health disorders are listed among the highest-burden in disease affecting a larger

proportion of the population globally. According to Gopalkrishnan (2018), mental health

disorders usually result in decreased productivity and have a severely negative impact on the

efficiency and productivity of the workforce, eventually impacting on the overall performance of

the state or nation. As far as the impact of economic recession in terms of a country’s setting is

concerned, the condition of vulnerable countries has been found to be substantially worse, and

where the rate of unemployment is precariously high on global platforms, is much less with a

deteriorating labour market. On the other hand, Diana et al. (2015) identified via literary analysis

that economic diversity is the force increasing unemployment and economic recession across the

country or state. As the relationship between unemployment and economic diversity have some

deeper roots, Watson & Deller (2017) believe the economic diversity of the neighboring country

is found to impact on the rate of unemployment. Similarly, in the case of Azad Kashmir, the

economic recession of Pakistan and India due to Brexit has affected the economic sustainability

in Azad Kashmir.

Aims and Objectives

This study investigates the major force behind the increase in mental health concerns and

disorders in Azad Kashmir. However, as per the literary evidence, it is perceived that the

economic recession is the factor influencing economic diversity, eventually affecting the mental

health and wellbeing of the population living in Azad Kashmir. In addition, Brexit is supposed to
be an agent behind the economic recession; however, this research will explore and ensure the

role of Brexit in economic recession and the influence of economic diversity over the mental

health of the residents of Azad Kashmir.

Research Question

As the literary evidence has revealed that the mental health concerns and disorders are relatively

higher in the population of Azad Kashmir, it is time to identify the potential behind it. However,

some reliable resources claim that the economic recession is the cause behind the increased

prevalence of mental disorders. This research will explore multiple resources to ensure whether

the economic recession is the cause of rise in mental health concerns or not. The study question

of this research is as follows:

“Is economic recession the cause for a rise in mental health concerns and disorders on Azad

Kashmiris?”

Review of Literature

According to the statistical investigation conducted by Dar (2020), it is significantly evident that

the residents of Azad Kashmir perceive a greater level of psychological disorders. As per the

article published by Chawla & Sodhi (2011), in “The New York Times”, several causative

forces, including the prolonged period of war and violence, lockdowns and economic recessions,

were highlighted. The factor that Housen et al. (2017) discussed are found to be the major cause

of the ongoing surge in mental health crisis across the population of Azad Kashmir.

While discussing the ongoing surge in mental health concerns in Azad Kashmir, the survey

conducted by Diana et al. (2015) revealed that even before the outbreak of the global crisis
“Covid-19 Pandemic,” fifty per cent of the women, and thirty-seven per cent of men reported

having clear symptoms of anxiety disorder. On the other hand, whilst exploring typical factors

impacting on the mental health of individuals, Kohnert (2021) stated that the economic recession

is the major cause identified as the force influencing mental health instability. However, Watson

& Deller (2017) emphasised that the economic recession is more impacting on the vulnerable

population. Diana et al. (2015) considered populations in countries who have been “hardest hit”

by Covid Pandemic for a longer period or recently are the most vulnerable segment.

In terms of economic recession, the vulnerable countries are found to be under the most adverse

impact. As Deller & Watson (2018) stated, the rate of unemployment is reported to be severely

higher during the recession period of countries, eventually affecting their performance on a

global scale. As the economic recession is supposed to be intertwined with the deteriorating

labour market and disrupted employment and economic plans, Prescott et al. (2016), via literary

analysis, surfaced that the economic diversity and increased unemployment are heavily

interlinked and have a direct impact on the economy of the state. In other words, the most

vulnerable population suffers the most. In the case of Azad Kashmir, the economic recession is

always linked with the increased rate of suicide, while the cases of psychological traumas and

mental health deterioration remain unnoticed.

Following the literary pieces of evidence, it is suggested that there is a diverse need for the

effective implementation of “mental health awareness programmes” where the provision of

adequate and timely intervention is also necessary to reduce the risk of suicides and increased

prevalence of mental distress and mental disorders (Repper & Stickley, 2021). As evident, the

residents of Azad Kashmir are severely vulnerable in terms of economy, health and mental care
services; the region is required to introduce some of the potential interventional plans for the

welfare of mankind.

In addition, MacLeod & Brownlie (2014) recommended that implementing cost-effective

preventive measures might minimise the reoccurrence of mental concerns and disorders among

the vulnerable and disadvantaged populations during the recession period. As James &

Prilleltensky (2012) believe, incorporating effective measures for unemployed people via social

assistance, media, and human welfare organisation support can effectively reduce the rate of

mortality and mental disorders. Hussain et al. (2021) stresses the need to introduce quality

primary and mental health care services so disadvantage population needs can be dealt with

appropriately, typically during the recession period.

The literary evidence so far has revealed that the smart use of social and fiscal policies is an

effective approach to deal with the recession. As evident, Repper & Stickley (2021) state that

proactive use of effective policies may be very helpful for the facilitation of the labour market,

domestic support, community, health and mental care needs, and debt relief programs. As Deller

& Watson (2018) believe, cutting the budget for mental health services during the recession is

not an effective measure; instead, the governmental bodies must ensure the effective

implementation of a care plan and interventional financial policies to ease the burden for

disadvantage population.

As the mental health consequence, after the recession phase is severely dependent on the

context-dependence, James & Prilleltensky (2012) suggests that the regulating bodies must

monitor the justifiable implementation of facilitation as well as the provision of appropriate

support so that the rate of mental health concerns and mortality can be reduced.
Research Methodology

In accordance with the settled aims and objectives of this research, i.e., exploring the relationship

between economic recession and increased mental health concerns among the population of

Azad Kashmir, the most effective research paradigm is interpretive research philosophy.

According to Baker (2000), the interpretive philosophy is based on the firm belief and perception

of the researcher. It is more about the interest and belief of the investigator. Simultaneously,

Ketchen & Bergh (2006) stated that the research approach is an elaborated systematic plan that

allows the researcher to conduct the entire investigation while focusing on the study's

fundamental aims. As far as the research approach of this investigation is concerned, it is

perceived that the qualitative research approach would be the most appropriate. According to

Goddard & Melville (2004), the qualitative research approach typically involves collecting non-

numeric data sets, typically the ones based on opinions, concepts, ideologies, experiences,

concepts, and existing theoretical evidence. According to the concept proposed by Ketchen &

Bergh (2006), the research strategies can simply be elaborated as a comprehensive, structured

plan to conduct particular research. However, the selection of an appropriate research strategy is

crucial for the acquisition of appropriate research outcomes. As per the nature of this research

and the requirement of the settled research objectives, it is expected that the secondary research

strategy would be the most appropriate choice for the acquisition of suitable research objectives.

For the acquisition of appropriate research objectives, the selection of an appropriate data

collection approach is essentially necessary. The researcher of this research project, in

accordance with the research approach and research strategy and settled research philosophy,

decided to explore a number of authentic databases, including “EbscoHost, Web of Sciences,

Scopus, IEEE Xplore, Directory of Open Access Journals (DOAJ), ERIC, JSTOR and Google
Scholar”. Where the search strategy will include the use of effective keywords including

“Mental health”, “Mental distress”, “Mental disorders “Azad Kashmir”, “economic recession”,

and “economic diversity”. However, screening literary evidence will be done based on precisely

developed inclusion and exclusion criteria, as illustrated in table 1.

Table 1

Inclusion criteria Exclusion criteria

Studies conducted or published within the past Studies conducted or published before 2011.

ten years, i.e. 2011-2021.

Studies documented in Standard English Studies documented in a language other than

Language. Standard English Language.

Studies focusing on mental health and Studies focusing on areas other than mental

economic recession. health and economic recession.

Results and Discussion

As stated earlier, this research is based on the principles of qualitative secondary research, i.e.,

desk-based research. According to Goddard & Melville (2004), desk-based research typically

includes a wide range of literary resources to explore the answers to a settled research question

and meet the research objectives appropriately. For that purpose, the researcher of this study has

settled some inclusion and exclusion criteria as illustrated in table 1. In accordance with the

settled criteria, four of the essential resources are selected. According to the evidence and

conclusions presented in the literary resources, the investigator will conduct thematic analysis to

propose an effective conclusion in later sections of the study.

S Author and year Research Title Research objective Research Findings

no.

1. Diana “Mental health The aim of this It is revealed that the

Frasquilho, outcomes in times research is to explore period of recession is

Margarida of economic the impact of economic highly associated with

Gaspar Matos, recession: a recession on mental the increased

Ferdinand systematic health. prevalence of mental

Salonna, Diogo literature review” health.

Guerreiro,

Cláudia C.

Storti, Tânia

Gaspar & José

M. Caldas-de-

Almeida (2015)

2. Tambri Housen, “Prevalence of This article aims to This quantitative study

Annick Lenglet, anxiety, depression investigate the identified that the

Cono Ariti, and post-traumatic prevalence of mental prevalence of mental

Showkat Shah, stress disorder in health concerns across distress/disorder among

Helal Shah, the Kashmir.” the residents of the adult population of

Shabnum Ara, Kashmir and identify Kashmir is recorded as

Kerri Viney, their possible causes. around 45 per cent,

Simon Janes, where 41 per cent

Pintaldi. (2017) of depression while 26

per cent reported

anxiety, and 19 per cent

have reported having

probable PTSD.

3. Brian Cooper “Economic crisis This research aims to The results surfaced

(2011) and mental health” identify whether that the economic

economic recession recession is highly

affects mental health or associated with the

not while exploring the increased rate of

possible reasons. unemployment and

mental health concerns.

In addition, mental

health instability can

also be identified by the

increased rate of

suicide and suicide

attempts.

4. Camilla “Economic This study explores the This research endorsed

Haw, Keith recession and interaction between the the impact of economic

Hawton, David suicidal behaviour: economic recession and recession on the

Gunnell, Stephen Possible the increased rate of increased prevalence of

ameliorating health concerns. In distress/disorder.

factors.” addition to that, the

study will also explore

the ways to reduce this

adverse impact of the

recession on mental

health and suicidal

behaviour.

Thematic analysis

According to Baker (2000), a thematic analysis is an essential analytical approach suitable for

qualitative data analysis. This data analysis allows the researcher to find the embedded repetitive

themes within the literary resources to find the settled research questions. Following the

principles of thematic analysis, the researcher identified two essential themes identified by the

researcher i.e. “Theme 01: Economic recession is highly linked with mental distress and

disorder” and “Theme 02: The prevalence of mental health concerns is increasing exponentially

amongst Azad Kashmiri residents”.

Thematic extraction table

Sn Author and year Research title Key Findings Major themes

o.

1. Diana “Mental health It is revealed that the • Economic recession

Margarida of economic highly associated with with mental

Gaspar Matos, recession: a the increased distress.

Ferdinand systematic prevalence of mental • The prevalence of

Salonna, Diogo literature review” health. mental health

Guerreiro, concerns is

Cláudia C. increasing

Storti, Tânia exponentially

Gaspar & José among the residents

M. Caldas-de- of Azad Kashmir.

Almeida (2015)

2. Tambri Housen, “Prevalence of This quantitative study

Annick Lenglet, anxiety, depression identified that the

Cono Ariti, and ptsdpost- prevalence of mental

Showkat Shah, traumatic stress distress among the

Helal Shah, disorder in the adult population of

Shabnum Ara, Azad Kashmiri Kashmir is recorded as

Kerri Viney, population.” around 45 per cent,

Simon Janes, where 41 per cent

Giovanni showed the symptoms

Pintaldi. (2017) of depression while 26

per cent reported

anxiety, and 19 per cent

probable post-traumatic

stress disorder (PTSD).

3. Brian Cooper “Economic crisis The results surfaced

(2011) and mental health” that the economic

recession is highly

associated with the

increased rate of

unemployment and

mental health concerns.

In addition, mental

health instability can

also be identified by

the increased rate of

suicide and suicide

attempts.

4. Camilla “Economic This research endorsed

Haw, Keith recession and the impact of economic

Hawton, David suicidal behaviour: recession on the

Gunnell, Stephen Possible increased prevalence of

Platt (2015) mechanisms and suicides and mental

ameliorating distress.

factors.”
Theme 01: Economic recession is highly linked with mental distress.

As per the precise analysis of literary evidence, it is concluded that the phase of an economic

recession is highly associated with the increased prevalence of mental distress and mental health

problems. According to Dean et al. (2011), the study revealed that the recession period involves

mental distress. The increased rate of suicide is also observed, along with the increased use of

illicit substances and suicidal behaviour. On the other hand, MacLeod & Brownlie (2014)

endorsed the relationship between recession and mental distress and stated that the recessions

period is found to be heavily tangled with the higher suicidal rates and increased suicide

attempts. However, the studies so far revealed that the actual cause of increased suicides, self-

harm and mental distress is prolonged recession of the economy. As Watson & Deller (2017)

believe, the economic recession significantly caused unemployment, job insecurity, reduced

production in production units, and reduced consumer demands and export. Where the other

essential factors include financial losses, house repossession and bankruptcy. Deller & Watson

(2018) believe the concerns associated with the financial issues, directly and indirectly, lead

towards the mental health problems, including anxiety, depression, substance abuse, and suicidal

behaviour. Countries that do not have appropriate plans for their residents' welfare are more

likely to witness increased suicide rates than countries with better welfare plans.

According to Gopalkrishnan (2018), the impact of the global economic down turn on the

population is reported to be expressed by the increased mental health concerns. Considering the

historical basis of financial crises globally, it is identified that the stress of increased

unemployment, social insecurity, and poverty have always forced the vulnerable population
towards suicides, increased psychiatric illness, substance and alcohol misuse and related

disorders. Simultaneously, Cooper (2011) stated that the countries during their recession period

usually cut back their budget for mental health services as part of “government austerity

programs”. Cutting the budget short, affects the performance and proficiency of psychiatric

service severely while the population is in increased need of mental and psychiatric care and

assistance.

Theme 02: The prevalence of mental health concerns is increasing exponentially among the

residents of Azad Kashmir.

In accordance with the literary pieces of evidence, it is revealed that the estimated prevalence of

mental health concerns and mental distress among the adults from Azad Kashmir is found to be

45%, in which 41% were found to be adults with clear symptoms of depression, whilst 26%

showed symptoms of severe anxiety and 19% had a probability of PTSD (Diana et al., 2015).

Factors found to be persistent across responders included, an unsatisfactory source of income,

traumatic events or experience in terms of financial crises, and their belonging from rural areas

with limited access to quality facilities.

According to Kohnert (2021), the Asian economic crises severely involved an increased

unemployment rate, leading to a prominent surge in the suicide mortality rate. This direct

influence of economic recession over the weakening of financial management is an extreme

factor causing the vulnerable population mental distress and an increased rate of suicidal

mortalities.
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