A Study On Mental Health In Urban Versus Rural Community:

Mohamed M.hosny Shehata

SUIiiMARYReaching peaceful f~ontiers, after an exhaustivooxcursion, digging f~r f.acts and scientific logicaldeductions about the sit1.’_.J.~oifonmental - ill -health in both rural and urban cOlilDlunities in Egypt,it is noV! ripe to condense ~l1efacts upon which theforth comming recoillmendatioliswill be founded.A systematic sample of 200 patients extractedfrom University Hospital out-patient clinics was exploitedin that study, which Dlcluded 103 urban and 97 ruralpatients from both Alexandria and Dakahlia Governorates.Rural and urban stratification was the maintheBe for investigation and discussion. However, anexll2.UE:tivreeview of literature was presented includinGa classification of mental disorders and the popularconcepts about these diseases.A historical review was important to be incLuded,as well as a survey of the ecological factorsof mental illness (1. e, biological, psychological andsociological). Psychiatric ther2·PY - being one of the- 234 -prinary J.ines of prophyla..xis - was outliLled ’Nith thepurpose of being comprehensive. The statistical situationo:c mental health se:L’vices in Egypt Vias givendue cOI13ideration.Analysis of the field study l’.elS yielded vi’caldemo~raphic data: males constituted 54.5 % of the totalgrou:’ l.n_vestigateu, 54.3 IC- of urban patients and 54.6 ;)0of rural patients. Hemales constituted the remainder.The average age of the total group was 31.7 +1L1-.78 years. ’I’he average age for urban patients was33.98 ~ 7.47 years, where-as that of rural patientswas 28.86 :t 6.14 anel the difference Vias found to bestatistically si&~ificant.Patients less than 15 years of aoe cO;Jstituted10 ~0of the total sample, 60 ~0-J±’ whomwere males,as ielJ. as 60 (0 were rural patients. ’I’he age g:coup15 _ 2:) years had the highest frequency i.e 28 % ofthe total sample, 57.1 % of whomwere males and 51.8 >,were rLlral patients. The age group 25 - 35 years constituted24.5 % where-as the age group 35 - 45 years-_.. --------- --------------------------- 235 -constituted 14.5 ;0 The ase group 45 - 55 y.constituted 16 ~’c’ and the a=,8 group 55 -t- constituted7 10. lt was found that the majority of the investi-Sated sample were below 45 years of abe (77 ~,,).The group of patients below legdl age of marriaGeaDlOunted to 25 patients, 20 of whom suffered f’r-oraorGanie brain lesions and mental deficiency. Hifteen ofthese were rural patients. The married group constituted35.4 ;j of the total sample, 53. 2 ;~,of whom were urban patien’cS.’:l:wenty-eie;mhatrried patients (45.1 70) were psyehoneurotie,the majority of whom came from urban areas(71.4 fo). Psychoses affected 22.6 ;0 of the married patients,the majority of whom were rural victDlls (71.4 %).The ”Single” group attained the highest frequencyin the srunple (37.1 %), most of whom came from ur-Ocill lucalities (55.4 ~:~,). nSL”’1.g1ei psychoneurotics consti”cuteu(36.9 %) of that group. In this and in more thanone item of analysis, the hypothesis that urbanizationpaves the way for psychoneurosis is further documented.The ”Single” psychotics as well as the mental deficients--_.--- --- -------- ------ 236 -exceed those 1,resent in other marital stiJ,tes.’:l:h8”Divorc.ed-” [jI’oup in the sample amountedto 21.7 ~b of the total. ,’lOst of the divo.rced were psychoneurotics(34.5 510) and the ],lo.J01- ity of psychoneuroticscame from urbal1 localities (69.7 50). Ps~’choticsconstituted (26.3 10) and the majority came from rurallocaHties (60 ~,,).The ”Vlidowed-”group constitute(l, 6.99 jo, mostof ’.1homcame from rural localities (66.6 rn. Fifty percentof this group were rural patients affected with psychoneurosisand orgal1ic brain lesions.The masculule modal age for ill8.rriaGe in ruralareas was 19.5 years where-as it is 25.4- years L”1 ur-bariareas. The feminine modal age for marriage in ruralare::lB was 14- years, where-as it is 18.75 years in urbanareaB.Investigation of the educational level revea.lcd that illiteracy is wide - spread in both ruralarid urban patients. It amoun.ts to 4-9.4- ~:-in rural -------- 237 -victims and 36.9 ~”in urban ones. These rates differedsignificantly from genera.l rates of illiteracy. Psychoticsconstituted 27 50of illiterate rural patients, whereasPsyc::loneurosis stand at the top of the list in urbanlocalities (36.8 %).A aizec.ble seGmentof r-ura.Lj1atiEmts ”who canread and w’rite” were affected with organic brain lesions(40.7 i’i). Rural psychotics ”who can read and write”constituted 37 ~” of the total for that group. Psychoneurotj_cs constituted 18.5 1:’ of that educiitional level.Rural }latients who attained primary education amountedto 13.6 ~o of the total. Urban patients of the same educationallevel constituted 25.2 roo It was evident thatpsychoneurosis stands high in this educational level inboth urban and rural residences. This arouses the attentionthat education c~~ be similar to urbanisation,as educated rural patients have similar proneness tothat disease. A finding which fortifies this assumptioni.s the distribution of rural patients amongotherfw:ther levels of education, where it is found that thosewhopassed to secondry schools and higher education ”fallunder’ the category of ”psychoneurosis”.- 238 -The reflections of Occupation on mental health1;Jerevaried. In the sample investi[;atod 12 industrialworkers who lived in rural localities constituted 6 %of the total sample. It is observed that 41.7 ~o ofthese workers were affected with psychoneurosis as amanifestation of the city jobs practised by many ofthem. The urban industrial psychoneurotics constitutecl~;I.9 ’/0 of urban L’1.dustrial workers. AgricUlturalwo:cLe1’samounted to 31.9 ’}’o in rural patients, 61.3 70of ”hoillhad psychosis and organic brain lesions. Only4 (12,.7 %) had psychoneurosis. ’rwo-thirds of the agriculturalworlcers in the sample living in urban areaswere a.Lfected with psychoneurosis.A sizeable segment (45.4 %) of rural patientswho)ractised aQ~llListrative jobs were psychoneurotics.Psychbnour.oticSo·constituted two-thirds of all urbanadrrill1istrators. This denotes that the job of administrati.on predisposes to pSYChOl18urosisnt both :I.’esidences:urban and rural.It was fOllild that 71.9 % of urban sales workerswere psychotics, where-as 23 % of rural sales workers--- ------------- 239 -suffered from trhe aane syndrome. Hifty percent of urban”housewives and others” succumb to psycheneurosis.Mental deficiency st2illds high (44.4 %) in the group ofsnude.o.t s referred frOB schools, which appeared in thesample.Study of SOl~ces of referral of psychiatricpatients, showed that general practitioners referred7.2 ;’” rural patients, and IO.7 )b urban ones amountingto 9 ~’) of all psychiatric individuals in the sample.The Group referred by relatives amounted to 35 yo ofthe total, 42.3 ;tu of whomwere rural victims. The mostproIlinent diagnosis for rural patients referred by relativeswere psychosis and organic brain lesions. Urbanpatients referred by relatives constituted 28.I ~oof all urban patients ~~d the most promDlent diagnosesfox’ those patients were psychosis and pschoneurosis.Forty-two percent of urban pationts soek psychiatricadvice by themselves probably being aware ofnodLca.l. problems and. facilities, the majorioY of whomwere psychoneurotics. Police - referred cases amountedto 7.:5 Yo, two-thirds of whomwere rural patients. The..•. 21;0 -most yrominent diagnosis for police - referred caseswas ps;ychoses. School - referred cases were mostlydiae;noE:edas mentally deficient who amount to 72.4 70of all students referred by school. Rural, mentallydeficiEmt, school-referred patients constitute 57 % ofthe total for that source of referral.Stratific,.::-tion of psychiatric syndromes withrespect to residence has revealed that psychoneurosisconstitutes the most prGvalent diagnosis in the totalsample investigatGd having a rate of 35.5 ;!Q. MorethDll two-thirds of these (69.1 %) were urbDll patients.Rural psychoneurotics constituted less than one-thirdof the total (30.9 1’0), Psychoneuro tics constituted’+7.6 ;’ of total urban patients and 22.7 10 of rural patients.Psychoses affected 20.5 5o:Jf the sample. RuralI,sychotics dominated urban psychotics having thefollowing rates respectively: 58.5 % and 41.5 %. Thisshowed that psychoneurosis is mostly an urban diseasewhere-as psychosis puts itself as a rural one. Ruralpsychotics and. urban psychotics constituted 24.7 5/0 and- 241 -16.5 ~u respectively.Rur&l p~tients affected with orGanic brain lesionsconstituted 24.7 % from total rural patients, whereasur-bun victims constituted 11.7 %of all urban pa ti.ent s,lVientallydeficient patients constituted 13.5 >,0 of theslliuple,51.8 of whom wero rural patients and 48.2 %were urban.Stratification of psychiatric syndromes withrespects to age, has sho’vu that patients below I5 yearsof age wore exclusively affected with mental deficiencyand orGanic brain lesions.Study of rural patients of the age group I5-25years, has shown that 34.5 % of that ago group were psychoneurotics.Organic brain lesions had the same rating.Rural ;)sychotics of that age group constituted I7.2 ~/o,whore-as hent8.1 deficiency affected I3.8 50 of thatgroup. Two-thirds of the urban patients of that agegro~J were psychoneurotics. llientaldeficienay affected25.9~. Psychoneurosis affected a total of 50 ~ of bothresidences of that age group and therefore stands high- 242 -as Cl prominent disease of that age.The most frequent diagnosis of the age 25-45years was psychoneurosis in urban patients (53.2 50and psychosis in rural patients 00.3 70)’ ’I’he age gro’:,,:45 .;. still shows that psychosiS (34 ;70) remains the dominantdiagnosis in rural areas, where-as psychoneurosis(30.4 ~) and psychosis (26 %) are the most frequent di~Snosisin urban victims. Organic brain lesions were evidenti.n those over 55 yeers of age (42.8 %).Strcttification of psychi2.tric syndro’;l8s Ylithrespect to sex has shoYmthat females are highly proneto psychoneurosis at all levels, rural, urban and total.psychoneurotic rural females constituted 59 ;1” of all ruraljhtien’Gs affected with psychoneurosis and 14.4 % ofall rural patients in the sample. -,”’romall rural femalesthey constituted 31.8 %.Psychoneurotic urban females constituted 55.1 :/,.of all urban pCltients affected with psychoneurosis and25.2 50 of all urban patients in the sample and 57.4 )”from all urban females. Forty-five percent of all fomaloBin the investigated sample were psychoneurotics.-------- 243 -Psychotic rural females exceeded rural malesnav ing the same disease (45.I %). Psychotic urban femalesexceeded (52.9 %) urban males having the salliedisease.The percentabe frequency of psychotic femaleswas found to be 24.1 ;c from total fe,nales in the aamp Lcand tt.isgives the second position as a ’isychiatric hazardfor females, psychoneurosis being, the first.Organic brain lesions were the most prominentdiagnosis for rural males and amounted to 24.5 to for allrural maleS. Psychosis ~~d mental deficiency have ar-at o of 20.7 ;0 for each fron rural males. Psychoneurosisi8 not a significant hazard for rural males, asit oLfected only 15 ’/e of rural males. However urbanmales differ from rural males in the fact that psychoneurosisis their most prominent diagnosis, followedby organic brain lesio~s. Urban psychoneurotics constituted39.3 ’/0 of all urban males. Urban patientshaving organic brain lesions amounted to 17.8 jb fromall c~ban males. Psychotic urban males and those affectedwith mental deficiency have the same rate(14.~;%) from all urban l!Jales.- 244 -Stratification of psychL,tric syndromes withreS)8ct to symptauatalagy hc’csshoi.n tt:.;tt r;omost fI’erluont symptoms were those of affectivity di,’;c:’iers, forthe total sillnpleffildfor rural patients. Th( secondcategory of symptoms in frequency were sler;p disorderswith respect to the total group and for urbffilpatients.The third complaint as regards frequency ofoccurrence, is memory disorder at all levels: total, ruralffildurban. O,rientation disorders have got the leastfrequency for all levels. The most frequent symptomsin the age group ( - 15 years ) was found to be memorydisorders accou.~ted for by mental deficiency and orgffilicbrain lesions as dominffiltsyndromes of that age group.The most frequent symptoms in the age group15 - 25 years were affectivity ffildsleep disorders. Inthe ,:30ijroup 25 - 45 years a.lee: , affectivity andthouD1t disorders predominated. Sex disorders progressin a linear fashion to attain a peak during 45 -55 yea~s of age. Durinb the (55 + years) age gr’oup,the mo st prominent disorders were those of memory andaffectivity.- 24-5 -In a broad consideration of the leading symptOlilSinpsychiatric syndromes it was fOillluthat porceptio:l disorders were more prevalent in psychoses andorganic brain lesions and is of negligible importancein psychoneurosis. It was fOillldthat 63.4- % of psychoticshave perception disorders a..’ltdhet 50 ’/0 ofthose affected with organic brain lesions have theSa;}8 symptoms.Thought disorders predominate in mental deficielcy,psychosis and organic brain lesions and isof ~egligible significffilce in psychcneurosis~ It wasfound that 88.8 % of all those affected with mentaldeficiency, 78 ’/0 of psychotics and 58.3 ’/0 of those affoctedwith organic brclin lesions have thought disorders.Affectivity disorders prevail in psychoneurosis,psychosis and organic brain lesions, as it affects87.3 ~ of psychoneurotics, 80.5 % of psychotics and 77.7 %of those having organic brain lesions. Sex disordersprevail in psychotics to a rate of 56.1 ’/”.Sleep disorders are widespread but predominate