Population-based Survey in India Partner Alcohol Use, Violence and Women's Mental Health: Material Supplementary from Downloaded Partner Alcohol Use, Violence and Women's Mental Health: Population-based Survey in India

Drunkenness and alcohol misuse by the male partner are associated with poor mental health and spousal violence among married women in India. 1–3 Research outside India documents that men's alcohol problems increase the risk of depression in their female partners; 4–6 exceeding the risks associated with women's own alcohol use disorders or spousal violence. 5 Gender inequities play a key role in women's health, 7,8 including in the impact of spousal violence 3 but have not been included in studies on partner alcohol use and women's mental health. Similarly, most studies do not include women's own alcohol use and may overestimate associations between partner alcohol use and depression in women. 5 Thus, an overall limitation of existing research is the lack of simultaneous examination of different psychosocial risk factors and, thereby, a limited understanding of the interrelationships between such factors in women's poor mental health. Alcohol misuse represents a public health crisis in India that has yet to receive adequate attention. 9,10 About 30% of male drinkers in Goa, India's smallest state, 11 use alcohol hazardously. 12,13 Common mental disorders, a term used to describe non-psychotic affective disorders (depressive and anxiety disorders), 14,15 are documented in 6.6% of women aged 18–45. 16 Economic deprivation, poor marital relationships and gender disadvantage increase and employment decreases risk for postnatal depression in Goan women. 15,17 However, the role of partner alcohol use in women's depression has not been systematically assessed. The present study examined associations between various psychosocial risk factors, including demo-graphics, partner alcohol use, partner violence and gender violence-related attitudes and common mental disorders in a community sample of women in Goa (Fig. 1). We hypothesised that a lack of resources (e.g. poor education and unemployment) and gender violence-related attitudes confound the association between partner alcohol use and common mental disorders in women; and that partner violence and partner alcohol-related problems each mediate the association between partner alcohol use and women's poor mental health. As a result of the low prevalence of women's drinking (55%) in India, 18 although we assessed women's own alcohol use, we did not include women's drinking in our model. Method Participants We report data from a population study on alcohol use patterns and sexual risk behaviours conducted in rural and urban areas in Northern Goa, selected purposively to represent the local Goan situation. Given the study's focus on sexual risk, participation was limited to women aged 18–49 …