DR. KAMAL HAIDER (Research Supervisor) Assistant Professor Federal Urdu University of Arts, Science & Technology - Karachi AYESHA NIGHAT Research Scholar (M

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EVALUATION OF THE JOINT FAMILY SYSTEM AS A MAJOR CAUSE OF DEPRESSION AMONG MARRIED WOMEN OF SINDH

DR. KAMAL HAIDER (Research Supervisor) Assistant Professor Federal Urdu University of Arts, Science & Technology - Karachi AYESHA NIGHAT Research Scholar (M. Phil) Hamdard Institute of Education and Social Sciences, Hamdard University Karachi Abstract: Depression is found to be a common cause of depression among married women all over the world. This problem has not spared any country or culture including Pakistan. Married women in Pakistan, generally, and in the region of Sindh, particularly, face depression mainly when they are part of joint family system. The depression influences behavior of these women affecting their day to day life and, in turn, the life of their whole families. Later on it is affecting the society. Depression is the fourth largest illness in the world. The ratio of depression between the male and female patients in the world is 2:1 represent (Sadock, 2007).In present times, when people all over the developing world are suffering from economic and social problems, the system of joint families is becoming less popular due to various reasons including cultural, social and economic ones. Pakistan with a population exceeding 160 million, majority lives in the rural areas and it is marked with illiteracy or very low standard of education. In Pakistan, particularly in Sindh, most women undergo serious depression problems. Due to severity of the problem the researcher has taken the initiative to evaluate the major causes of depression and its effect among the married women of the Sindh‟ Keywords: Depression in Joint Family System, depression in married women, cause of depression, depression, joint family system.

1. Introduction: Depression is one of the widespread psychiatric disorders observed by Mental Health professionals as well as by general practitioners. Depression includes a variety of medical things from easygoing commotions that is usually situate in normal as well as anxious individuals to a relentless sickness that can be described as vegetative signal as restlessness or impatience, motor retardation, untimely awakening, weight failure and anorexia. It can also be categorized by some subjective symptoms such as self criticism, apathy despondence, sensitivity of unimportance and desperate obsession (Silber 1989). In recent years, different scholars have worked on depressive illness to an extent; they are Sartorius, Winokur, Leonhard, Angst, Perris, Meyer Hamilton, Brown and others. Depression is universal key civic dilemma (Sartorius 1947). Depression has been identifying as a diverse pathological thing from early Egyptian era. More or less everybody has practiced depression, in any case in its milder and more transitory type. Feeling of hurt is unavoidable precedent of life, and when it crop up, nearly all of us suffer blue, depressing, disheartened, uninterested and reactive. The upcoming split and a few of the cost set off living. Such retain are usual at every position in two times, 25-30 % of college student face mild depression (Seligman 1991).

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According to Greek and Roman contents, medical doctor in the Persian and then followed by the Muslim world expanded their thoughts on the subject of melancholia throughout the Islamic Golden Age. Ishaq ibn Imran (d. 908) merged the ideas of melancholia and phlebitis (Jacquart, 1996). The notorious Persian physician Avicenna in the 11th century explained melancholia as a depressive form of atmospheric confusion wherein the individual could turn into doubtful and build up convinced kinds of phobias. In the 17th century, an English scholar Robert Burton wrote a book that was his influential intellectual effort of that time. The Structure of Melancholy depicted on several hypotheses as well as his personal practices. Burton recommended that depression may perhaps be contested through well diet, ample sleep, melody and momentous exertion, beside discussion regarding the setback with a companion. In the period of the 18th century, the humoral theory of melancholia was progressively more disputed by unconscious and conscious elucidations; orientations to shadowy and ominous circumstances confer approach to thoughts of deliberate motion and tired energy (Jackson, 1983). German physician Johann Christian Heinroth still argued melancholia was a commotion of the essence owed to ethical clash inside the patient. In 1856, French psychiatrist Louis Delasiauve introduced an early treatment referring to a psychiatric indication, and later on in the year 1860, it was emerging in medical phrase books to submit as a physiological and metaphorical inferring of expressive function (Berrios, 1988). From the time of Aristotle, melancholia had been connected with men of wisdom and scholarly brilliancy, an exposure of meditation and ingenuity. The newer perception derelict these links and, in the course of the 19th century, it happened to more linked with women. In 1917, Freud presented a paper title “Mourning and Melancholia” and in this paper he compared the state of melancholia to mourning. He conceived to facilitate the intention failure, for example the loss of a respected affiliation from beginning to end of death or a quixotic division, with the outcome of biased loss also; the miserable personage has recognized by means of the object of liking through an insensible, egotistical process called the libidinal cathexis of the character. In 1952, the DSM-I restricted to depressive response and in 1968 the DSM-II classified depressive neurosis, defined as a disproportionate reply to internal divergence or a certain occurrence, and as well he incorporated a depressive type of manic-depressive neurosis contained by foremost sentimental disorders (Apa, 1968). In the mid of 20th century, further psychodynamic theories were projected. Existential as well as humanistic theories stand for a dynamic assertion of distinctiveness (Freeman, Epstein and Simon, 1987). Viktor Frankl who was Austrian existential psychiatrist linked melancholy to thoughts of ineffectiveness and worthlessness (Frankl, 2000). Frankl's logotherapy concentrated on the stodgy of an "existential vacuum" connected amid such stances, and possibly functional for dejected youngsters (Seidner, Stanley, 2009, Blair, 2004). In 2006, Rollo May who is known as an American existential psychologist assumed that "Depression is the inability to construct a future" (Geppert, 2006). Generally, May engraved, "Depression occurs more in the dimension of time than in space” (May, 1994, P.133), and the unhappy personality not succeed to appear in front eventually well. Thus, spotlighting on some peak in due course outer the depression offers the enduring a perception, an observation on lofty so to converse; and this may possibly crack the manacles of the depression. (May, 1994, P.135) Humanistic psychologists squabbled that gloominess outcome as of a strangeness stuck between society and the individual's inborn coerce to character actualization or to comprehend individual‟s occupied impending (Boeree, 1998, Maslow, 1971). In, 1971, Abraham Maslow theorized that depression is particularly expected to occur when the world prevent a sagacity of "richness" or "totality" for the self-actualizer (Maslow, 1971). During the 20th century, investigators conceived that melancholy was sourced through a chemical disparity in neurotransmitters in the brain. In the 1950, a theory supported with annotations ended of the belongings of reserpine and isoniazid in varying monoamine neurotransmitter stages and distressing depressive signs (Parker, 2000). In the period of 1960s to 70s, manic-depression arrived to submit only one form of mood anarchy usually known as bipolar disorder, which was eminent from (unipolar) depression. A German psychiatrist Karl Kleist then allied the terms unipolar and bipolar. In 2000, according to report of World Health Organization (WHO), depression is the most important source of disability as calculated by years mislaid as a result of disability (YLDs) and the 4th primary provider to the overall

ijcrb.webs.com FEBRUARY 2013 INTERDISCIPLINARY JOURNAL OF CONTEMPORARY RESEARCH IN BUSINESS VOL 4, NO 10 lumber of disease as premeditated by disability Adjusted Life Years (DLYs). Through the year 2020, depression is predictable to attain second position of the status of DALYs considered for everyone, and among both sexes. At the moment, depression is before now the 2nd source of DALYs in the age class of 15-44 years for both sexes jointly (WHO, 2007). Pakistan is standing at the 9th place of crowded country among the other countries of the world, it stands 34 among the 37 poor-income countries in area wise. It has over 160 million populations. There are only 250 psychiatrists for such a bulky residents (World Health Report, 2001). Accessible substantiation recommended social tribulations as a key root for disquiet and depressive disorders in Pakistan, and it has on the whole pervasiveness of 34% (Mirza, Jenkin, 2004). There are no such good health indicators in Pakistan. As a developing nation, at present it is standing at the 6th place with thickly populated country in the work with the projected population of 166 million (Population reference Bureau, 2006). The average expected life once birth is 62 years. The aged life is 65 or more than 65 years as of 4% i.e. 6.6 million of the total population (Population reference Bureau, 2006). The elderly in Pakistan countenance a huge amount of psychological, social and physical healthiness troubles and the greater part is displeased in the midst of the accessible health care services (Zafar, Ganatra, Tehseen, Qidwai, 2006). In Pakistan, the large numbers of the aged people depend on their family especially on their children and/ or grandchildren for corporeal, communal and monetary support (Itrat, Taqui, Qazi, Qidwai, 2007). The stipulation of this care, particularly physical care is extra handy in a joint family system. Mason has recommended that urbanization is expected to grind down the family‟s to think about for elderly members and in addition to reduce residence of mature children with parents (Mason, 1992). Consequently, we theorized that the old who lives in a nuclear family system is likely at a superior jeopardy of anguish from depression than those residing in a joint family system. The occurrence of depression in women comes into view very significantly with the rates of at least 60% in two village‟s assessment (Mumford, Nazir, Jilani, 1996). It has easily shown that the ingredient of the cause for this lofty incidence of depression deceit in the noticeable social difficulty, countenance more than others by women (Hussain, Creed, Tomenson, 1997). In metropolitan cities of Pakistan, where the pervasiveness of depression is not consequently high, stumpy educational condition was more strongly connected with depression than poverty (Mumford, Minhas, Mubashar, 2000). A high incidence of depression in Pakistan, which is almost occurred due to chronic instances (lasting more than one year) (Hussain, Creed, Tomenson, 2000). While we established a soaring stage of social difficulty, the disheartened cluster had number of children, in the current study of the similar data put, we tested the hypothesis that in Pakistan depression in women is very much allied with bad didactic condition and this is more imperative than the other susceptibility issues of depression occured in the west. The most important depression is a persistent mess of multifaceted etiology (Kessler, 1997). In Islamic civilizations, the relations within family and community grasp a vital pose in the life of the entity, and they can put up an incredible input to the beneficial procedures (Gater, DeAlmeida, Barrientos, Caraveo, Chandrashakar, Dhadphalc, Goldberg, Alkathiri, Mubashar, Silhan, Thong, Torres-Gonzales, Sartorious, 1991). Before the establishment of Pakistan, the joint family system was very much common, but at presents the world social advancements also pretentious Pakistani culture, and specifically the propensity of nuclear family system is proceeding with joint family system. The progression in joint family system covers vigorous consequences at one end while on the other it paves detrimental signs and all these turn into the source causes for devastation of a society (Khatoon, 2007). 1.1 Women’s Mental Health in Sindh, Pakistan: Pakistan is a country where social manners and standards beside cultural practices hold a very imperative part in women‟s mental health. The pious and cultural divergences, beside with dehumanizing behaviors towards women, the unmitigated family system, participation of in-laws in everyday lives of women, signify key questions and stressors. These types of observations in Pakistan have shaped the extreme marginalization of women in plentiful areas of life, which has had an unpleasant psychosomatic collisions.

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At the family level, birth of a baby is rejoiced and celebrated, while a baby girl is mourned and is a source of gilt and despair in many families. Boys are given priority over girls for better food, care and education. Subservient behaviour is promoted in females. Divorcees and widows are isolated and considered „bad omens‟, being victims of both male and female rejection especially in village. Marriage quite often leads to wife-battering, conflict with spouse, conflict with in-laws, dowry deaths, stove burns, suicide/ homicide and acid burns to disfigure a woman in revenge (Niaz, 2000). Violence against women is very common in Pakistan. The violation of women‟s rights, the discrimination and injustice are obvious in many cases. A United Nations research study1 found that 50% of the women in Pakistan are physically battered and 90% are mentally and verbally abused by their men. A study by women‟s Division on “Battered Housewives in Pakistan” (National Commision on the Status of Women, 1997) reveals that domestic violence takes place in approximately 80% of the households. More recently the Human Rights Commission report (Rehman, 1998) States that 400 cases of domestic violence are reported each year and half of the victims die. Hundreds of women are disfigured or die of stove-burns every year. The victims are usually young married women and the aggressors include husbands and in-laws. A large study at Jinnah Post Graduate Medical Centre, Karachi back in early 1990s (Siddique, 1990) showed that twice as many women as men sought psychiatric care and that most of these women were between 20s and mid 40s. Another 5-years survey (1992-1996) at the University Psychiatry Department in Karachi (Agha Khan University/ Hospital) (Zaman, 1992-1996) showed that out of 212 patients receiving psychotherapy, 65% were women, 72% being married. The consultation stimuli were conflict with spouse and in-laws. Interestingly, 50% of these women had no psychiatric diagnosis and were labeled as „distressed women‟. 28% of women suffered from depression or anxiety, 5-7% had personality or adjustment disorders and 17% had other disorders. The „distressed women‟ were aged between 20 to 45. Most of them had a bachelor‟s degree and had arranged marriage relationships for 4-25 years with 2-3 kids, and the majority worked outside home (running small business, teaching or unpaid charitable community work or involved in voluntary work). Their symptoms were palpitations, headaches, choking feelings, sinking heart, hearing weakness and numb feet. 1.2 Definitions of Depression

The term depression is extremely broad, variably defining an effect, mood states, disorders, or syndromes-as well as disease states. A depressed „affect‟ usually occurs in response to a specific situation and is defined as a transient and non-substantive state of feeling „depressed‟, „sad‟, or „blue‟. WHO (World Health Organization) An emotional state of mind characterized by feelings of gloom and inadequacy, leading to withdrawal. Depression is a mental state of excessive sadness characterized by persistently low mood, loss of pleasure and interest.

1.3 Symptomatology

Depression is a term which has a number of different meanings. The first meaning is that of a mood, which may be normal. In this sense it is synonym for plainer English terms such as sad, unhappy, miserable, low in spirits, blue or down hearted. The second meaning of depression is a mood W/c is a symptom, part of the syndrome of an affective disorder. Thus patient may be near to tears or weeping. They may go beyond weeping into a state of anhedonia, which may hold to be the core symptom of a depressive illness and one which predicts a good response to anti depressants. Finally depression is also, used as the name of a syndrome or syndromes of mental illness (Thompson 1989). Cognitive symptoms are also a central part of depression. Depressed people have difficulty concentrating and making decisions. The usually have low self-esteem, believing that they are inferior, inadequate, and incompetent. When setbacks occurs in their lives, depressed people tend to blame themselves; when failure has not yet occurred, they expect that it will and that it will be caused by their own inadequacies. Depressed people almost always view

ijcrb.webs.com FEBRUARY 2013 INTERDISCIPLINARY JOURNAL OF CONTEMPORARY RESEARCH IN BUSINESS VOL 4, NO 10 the future with great pessimism and hopelessness (Clark et al. 1999). Motivational symptoms in depression involve an inability to get started and to perform behaviors that might produce pleasure or accomplishment. A depressed student may be unable to get out of bed in the morning, let along go to class or study. Everything seems too much of an effort. In extreme depressive reactions, the person may have to be prodded out of bed, clothed, and fed. In some cases of severe depression, the person‟s movements slow down and she or he walks or talks slowly and with excoriating effort.

1.4 Theories of Depression:

Kraeplin (1921) suggested that people with cyclothymic personality were more prone to develop manic depressive disorder. Krestchmer (1936) proposed that patients of Pyknic body build were particularly prone to affected illness. Subsequently Leonhard 1962 reported this association to be stronger among patients with bipolar disorder than among those with unipolar disorder. No signal type of personality seems to predispose to unipolar depressive disorder; in particular depressive personality disorder has no such association (Gelder, 1991).

1.4.1 Psychoanalysis:

The psychoanalytic theory of depression began with a paper by Abraham in 1911, and was developed by Freud 1917 in a paper called “Mourning and Melancholia”, Freud suggested that, just as mourning results from loss by death, so Melancholia results from loss of others kinds. Since it was apparent that not every depressed patient had suffered an actual loss, it was necessary to postulate a loss of „Some abstraction‟ or internal representation, or in Freud‟s terms the loss of an object. He proposed that the depressed patient regresses to an earlier stage of development, the oral stage, at which sadistic feelings are powerful (Freud 1937).

1.4.2 Charles Ferster (1973):

Behavioral analysis one of the early behavioral analyses of depression was offered by Ferster 1973. He suggested that depression is primarily a verbal phenomenon where in verbal behavior is under central of inner states rather than external stimulus relationships. The theory suggests that depression is indeed a reduction in motivated behavior. In addition, depression may be a motive to seek new source of positive reinforcement.

1.4.3 Lewinsohn’s Behavioral theory (1974, 1976)

Lewinsohn‟s Behavioral theory posited that depression could be seen as a type of extinction phenomenon, a response to a loss or lack of response contingent reinforcement.

1.4.4 Learned helplessness theory:

In its original form the theory posited that depression results from experience with uncontrollable aversive experience (Seligman, 1974, 1975). What is learned is an over generalized sense of helplessness to control aversive stimuli in new situations where control is possible? The attribution reformulation (Abraham et al, 1978) stated that helplessness results from the interaction of an aversive event with a negative attribution style.

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1.4.5 George Klerman (1984) Depression arises within a social context. a. Loss of grief b. Role disputes c. Role transitions d. Interpersonal deficits

1.4.6 Reham (1977)

Depressed individuals have deficits in the ability to monitor their own behavior. They also have difficulty generating rules and solutions for problems situations.

1.4.7 Cognitive Theory,

Back (1972) Stresses negativity of cognition rather than perceptions of control. The essential feature of depression from Beck‟s perspective is the negative triad of a negative view of the self, the world of the future. The depressed person is seen as having distorting perceptions of the worked, self of future in a negative direction.

1.5 Classification of Depression

The ICD-10 subdivides depressive episode as follows:  Mild (with or without somatic symptoms)  Moderate (With or without somatic symptoms)  Severe (with or without psychotic symptoms)

Mild depression is more common and the symptoms are more like an exaggeration of ordinary unhappy ness with marked tearfulness. Mood varies, depending on external circumstances and fluctuates from day to day. There is also marked anxiety and patients tend to be irritable. They brood over their problems and have difficulty in getting to sleep. There are no delusions or hallucination and somatic symptoms are not prominent. Mild depression response bet to psychological treatment rather than physical methods or treatment. Depressed mood, loss of interest and enjoinment and increased fatigability are usually present along with symptoms of reduced self esteem, ideas of guilt and unworthiness and a disturbance of sleep and appetite. The low mood varies little from day to day and is often unresponsive to circumstances, yet may show a characteristic diurnal variation as the day goes on. An individual with moderately severe depression will usually have considerable difficulty in continuing with domestic, social or work activities. Severe depression is characterized by pervasive sadness of mood, which has a different quality from ordinary sadness. It cannot be expressed by tears even if the patient wants to try and is unrelated to external circumstances. Biological symptoms, e.g. early morning awakening, diurnal variations of mood, anorexia and weight loss are often prominent, and psychotic symptoms such as delusion and hallucinations may be present. Severe depression usually responds best to physical methods of treatment rather than psychological treatment alone.

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1.6 The Joint family

The joint family is also known as „individual family‟ and sometimes as „extended family‟. It normally consists of members who at least belong to three generations: husband and wife, their married and unmarried children; and their married as well as unmarried grandchildren. The joint family system constituted the basic institution in many traditional societies, particularly in the eastern, societies.

1.6.1 Advantage of joint family

- Stable and Durable: The joint family is more stable and durable than the single unit family or the nuclear family. Individual may come and go but the family as a unit stands. It contributes much to the continuation of the cultural tradition. - Ensures Economic Progress: The joint family meets the basic needs of its members-food, clothing and shelter-a first condition of economic progress. - Ensures Economy of Expenditure: Savings are possible here since the household purchased are done jointly. No single member has an absolute right in family property. Everyone is bound to become spendthrift. The head of the family does not permit the members to become e extravagant. - Secures the advantage of division of labour: Here the work is distributed among the members on the basis of age and sex. Members co-operate with one another since they hold the property in common. Especially for agricultural tasks, the joint family is better fitted. As K.M. Kapadia has pointed out: “The Indian farmer used to be producer, seller, labourer and investor combined. Each of these functions can be performed efficiently to the advantage of the family if it is a joint one.” - Serves as a Social Insurance Company: For the people such as orphans, widows, the deserted, divorced, separated and the neglected, the joint family serves as a social insurance company. It gives them food, shelter and protection. - Provides Social Security: The joint family gives social to the weak, aged, sick, infirm, the unable, the disabled and such other needy persons. An individual‟s life from cradle to cremation is looked after by the joint family. In times of accidents, crises and emergencies, one can rely on one‟s joint family for the needed help. - Provides Leisure: Since the work is shared by all the members on the basis of age, sex and experience, they get more leisure time. More hands at home can finish off the work with minimum time and provide enough leisure to the members to relax. Here women are the main beneficiaries of leisure. - Provides Recreation Also: The joint family is an ideal place of recreation for all the members. Childish play between the two aged and the little babies, the funny talks of the, old, the broken language of the younger ones, the expression of sisterly, brotherly and motherly love and the like make the joint family life a pleasurable one. Social and religious ceremonies that take place the family bring even the relatives together and tighten the ties. - Helps Social Control: The joint family by exercising control over the behavior of its member‟s acts as an agency of social control. The individuals are taught to subordinate their individual interests to the group interests. - Provides Psychological Security: The joint family provides psychological security to its members. By creating a harmonious atmosphere in the family, it contributes to the development of social solidarity. It prevents the growth of excessive individuation inside the family. - Promotes Co-operative Virtues: Joint family is said to be the breeding ground of love, self-help, co-operation, tolerance, discipline, loyalty, generosity, sacrifice, service-mindedness and obedience and such other virtues of life. It instills the socialistic spirit among the members. “Work according to one‟s ability and obtain according to one‟s needs”, and “all for one and one for all”,-are said to be the mottos of a joint family.

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1.6.2 Disadvantage of Joint family

- Retard the development of personality: The joint family does not provide enough scope for the members to develop qualities of adventure, self-determination, industriousness, etc. The elder ones take up too many responsibilities and the younger ones are overprotected. - Damages individual initiative and enterprise: The joint family does not provide proper opportunities for the members to develop their talents. Any new enterprise or adventure on the part of the young people is discouraged by the head of the family. This adversely affects the individuality, originality and creativity of the young members. - Narrows down Loyalties: Joint family makes the members to develop narrow-mindedness. It is said a member is more likely to develop a sense of loyalty to the family rather than to the larger society. These family units develop strong opposite principles which result in disintegration and division within the society at large. - Promotes idleness: The joint family is said to be the home of idlers and drones. Since all the members are assured of their basic necessities of life, no one takes interest in the productive activities. Further all the relatives may flock to the joint family with their idle habits and may become life-long parasites. - Not favorable for saving and investment: The need for saving does not arise here because all are assured of their basic needs. There is no inspiration for the accumulation of capital and investment. Saving is not possible also for one has to share one‟s income with the large family. - The centre of quarrels: The joint family is said to be the hotbed of quarrels and bickering especially among the womenfolk. Since women come to the family (after the marriage) from diverse socio-economic and religious background, they may find it difficult to adjust themselves properly. Quarrels very often take place between the elder and they younger members of the family. - Denies Privacy: Since the joint family is always overcrowded, privacy is denied to the newly wedded couple. They cannot express openly their love and affection for the invariable presence of other members causes embarrassment for them. They rarely get opportunity to talk about their personal matters. Hence they fail to develop intimacy. - Affects socialization of children: Due to the lack of intimacy and privacy between the husband and wife, the socialization of children is affected very badly. The parents cannot always give personal attention to the upbringing of their children. The children become more attached to their grandparents and often they pick up the idle habits and age-old ideas. - Undermines the status of women: In patriarchal joint families, women have only secondary role. They are not given sufficient freedom to express and to develop their personality. Their inner feelings are never recognized. They are made to work like servants. Women are treated as non-entities here. They can hardly resist their elder even for just causes because obedience is enforced upon them. In such families sons are preferred to daughters. - Encourage litigation: The joint family encourages litigation. Normally disputes over the common property crop up at the time of partition. Such dispute are taken to the courts which are dragged on for years leading to the waste of time, energy, money and more than that, loss of mental peace. - Favors uncontrolled reproduction: The joint family is found to be associated with higher birth rate. Members do not feel the need to adopt birth-control measures. Since the joint family takes up directly the responsibility of feeding, rearing and educating the children, the married members do not experience the urgency and necessity of restricting the number of issues. - Limits social mobility: The joint family is said to be more conservative in nature. Since it is dominated by tradition, it is slow to respond to the modern trends. It does not encourage its members to go after change. Members are more concerned with safeguarding their status rather than with changing them. Hence social mobility is very much limited here.

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- Encourages nepotism: Some are of the opinion that the joint family system is the root cause of nepotism and discrimination. It is said that the public servants and officials belonging to one or the other family are more likely to favour their own kith and kin on public issues or in matters of providing job even at the cost of merit (C.N.Shankar Rao, 1990).

1.7 Family System

The traditional family in South Asia is the joint family system (Mason, 1992). The greater proportion of the population in Pakistan (66%) lives in rural areas where the main occupation is agriculture (Population reference Bureau, 2006). The joint family system is predominant in the rural areas. One of the main advantages of a joint family system is the availability of a large workforce for occupation which demands one, like agriculture. Also housing costs are shared. There is usually a joint economic production from the male members of the household. In a joint family system, there exists a strong differentiation of authority across generations, and a relatively passive role of females. The elderly male holds an authoritative place in the family because he controls the family‟s property and exerts control over the younger generation. Their position demands obedience and loyalty. On the contrary, elderly females possess limited authority over the household and its matters. Despite the disparity in roles, both elderly males and females are shown respect by the younger generation in the family. Female gender was also a significant risk factor for depression on multivariate analysis. Two recent reviews showed that female gender is consistently a significant risk factor for depression in the elderly. A high prevalence of depression in women, ranging from 25% to 66%.

1.7.1 Family system in Pakistan:

Family system in every country will vary depending upon their culture and style of living. Urban family system has been developed as nuclear family system, due to the socioeconomic confinements inflicted by the customary joint family system. In Pakistan, the joint family system is quite usually found. Joint family usually comprises father, mother, children, grand father and mother, and they live together with their people in the same family unit. Moreover, the governing male of the house will play a significant role with respect to the well-being of his family unit. Also, they give a good care and take the responsibility to guard their grandparents. Above all, they respect their folks and grandparents! People in Pakistan dearly follow the joint family system and live their life along with their folks. Conversely in the recent years, urbanization has directed to the alterations and amendments in the existing family system, in larger cities. Moreover, the realism of urbanization will make the social units living together to get less exerted and large nuclear group. This method of practice will commonly be practiced and determined in developing countries. When considering the elder people in Pakistan, they usually stick with their offspring or grandchildren to get a complete support and care. They rely and depend on their people to get their assistance and support in all aspects such as physical, social and financial wellbeing. Giving physical and emotional support is quite usual in joint family system. Joint family is absolutely good as living separate without your people will bring quite several difficulties. Urbanization and its growth tend to promote the growth of the nuclear family and moreover it abates the care and support to the elder people in the family. People in Pakistan are greatly trilingual and most of the people living here are Muslims. They give much respect to their customs and traditions and they closely follow the worth-taking family values (htt://asian-women-magazine.com/families-in-pakistan.php).

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1.7.2 Islam and joint family system in Pakistan:

In Pakistan by and large there is a joint family system in which there are grandparents, uncles, aunties and lot of cousins. Although this family system is undergoing a drastic change with a greater influence of media and education but people do not feel this change a good one. In a joint family systems now lot of crisis emerge on the issues like distribution of household tasks, allocation of financial responsibilities among different members, division of resources in the form of food and money. There are various reasons of each emerging issue in joint family system. Firstly; members of joint families have no income security. As if a person has surety that whatever he earned it is his own then he could become ready to invest and entrepreneurs for the economy of the country through proper savings. Joint family system also creates problems in children rearing. As among various loving relations mostly it becomes impossible for parents to prohibit their children from various bad habits, rude attitude and wrong behaviors. Loving relations like uncles, aunties and grandparents do not like to stop children harshly. They do not like to blame or scold their young grand children and hence they bring up in a wrong support of their loving relations which impacts their whole life badly and therefore they do the same wrong deeds in their mature life and hinder their own career and give loss to the country‟s economy also. When little boys and girls groomed up in such an environment where there are people who support them for wrong deeds then become irresponsible individuals of the country who contribute to prevent developmental process. Being an Islamic country, Pakistan‟s people prefer to adopt Islamic systems in their lifestyles, it is important to inform people of Pakistan are a joint family system is strictly forbidden in Islam. He does not like the live mix of girls and boys in a kind of family. There are limits of Islam to control illicit intimate relations. Some families in Pakistan are required to remain in the joint family system, but try to follow this religious tradition in a bad way. This creates many problems in the lives of women. Even in families strict Islamic policy (as opposed to Islam), mainly men attached to their wives to their room alone. They do not allow them to move freely in the home, including mortgage loans. In this way, women do too many problems while living in freedom.

1.7.3 Influence of Joint family system on socio economic development of Pakistan

The development of a country depends on the role of people living in society. If individuals play their role actively and positively, so that its growth will be and whether there will be an increase in their equal and proper distribution of resources between individuals in society. Pakistan has an independent media and judiciary, both of which play a crucial role in improving the social and political setting than Pakistan. But there is also a need to understand the problems on the bottom line social groups, primarily middle and lower class families income. The behaviors and attitudes of these two classes and is based also create many obstacles in the development process of Pakistan. There is a lack of tolerance, non-compromising attitude, lack of character, responsibility, lack of impartiality in the behavior of individuals in these classes. This type of behavior and attitudes of individuals to produce and developed in the early stages of preparing their families. Joint family system is a lot of emotional attachment, improved and feel that separating the family to leave their relationships damaged and weakened family ties. Joint family system is basically a form of organization. This organization is defined by the standards and values closely monitored by all members. All members have their tasks and responsibilities clearly defined to perform. There is an equal distribution of each family member in the resources available in terms of money, food and other requirements. Joint family system also creates problems in the education of children. Like most of the various relationships in love, it is impossible for parents to prohibit their children from various bad habits, bad attitudes and bad behavior. Loving relationships such as aunts, uncles and grandparents do not prevent children in the strict sense. Because these boys and girls are also supported financially, even if they have completed their education and career, often, sometimes you get married so they do not bother to work hard to win all their needs themselves may also decide their future life, make no independent step spiritual are closely dependent and unable to decide the time.

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Joint family system is suitable for the rich class of Pakistan, but boys and girls maintained the family of such a system is not economically viable for the country because they are spoiled by their parents. Whereas middle-class families, this system cannot be refused and a great change is happening now. And in the case of lower-class families, this system increases more and more poverty because of its many drawbacks and deficiencies.

2. Research Methodology:

The population of this research will be the married women lives in a jointly family system and already diagnosed as a depression patient reported in OPDs of department of Psychiatry in Liaquat University of Medical and Health Sciences and Sir Cowas Jee Jahangir Institute of Psychiatry Hyderabad, Sindh. These women live in both rural and urban areas of sindh – Pakistan. The population will be large and diverse. More over it is scattered over a large geographical area. Therefore, stratified random sampling design will be adopted. 100 Sample will be collected from the OPDs of department of Psychiatry in Liaquat University of Medical and Health Sciences and Sir Cowas Jee Jahangir Institute of Psychiatry Hyderabad, Sindh. These OPDs consist of patient coming from Karachi, Hyderabad, Nawab shah, Badin, Thatta, Dadu, Sanghar, Mirpur khas, Umer Kot, Tharparkar, Khairpur and Tando Mohammad Khan. These samples are the married women who live in a jointly family system and already diagnosed as a depression patient reported in OPDs. Stratified random sampling design will be used to select the sample. When subpopulations within an overall population vary, it is advantageous to sample each subpopulation (stratum) independently. Stratification is the process of dividing members of the population into homogeneous subgroups before sampling. Self administered questionnaire was designed for taking data from the respondents. The questionnaire has total 2 Sections. Section 1 was completely comprises of 28 demographics items/questions, where was section 2 contains 36 questions. These 36 questions of Section II find out the causes/factors of depression as a major cause in joint family system. These questions are used as a tool of research and comprised of structured form. They are designed in a very proper manner, and it is very easy to response and answer. Data was collected through self administered questionnaire. The researcher personally visited OPDs of department of Psychiatry in Liaquat University of Medical and Health Sciences and Sir Cowas Jee Jahangir Institute of Psychiatry Hyderabad, Sindh, and collected data through this questionnaire. Although this procedure was time consuming, but it relents high rate of responses to the researcher. Two types of statistics were used to analyze the data. First inferential statistics then descriptive statistics. Inferential statistics is a conclusion made on the basis of data which is subject to random variations of some kind while descriptive statistics are used to describe the main features of a collection of data in quantitative terms. In testing the main hypotheses, the t test was used. In item-wise analysis which involved categorical data, the chi-square was used.

3. Hypotheses:

H1: There will be no significant effect on rate of depression among younger and older women living in a joint family system. H2: There will be no significant effect on rate of depression among literate and illiterate women living in a joint family system. H3: There will be no significant effect on rate of depression among women bearing fewer children and more children living in a joint family system. H4: There will be no significant effect on rate of depression among rural and urban married women living in a joint family system. H5: There will be no significant effect on rate of depression among working married women and house wives living in a joint family system.

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4. Discussion:

This is the study on psychosocial perspective of married women at Hyderabad, Sindh suffering from depression as diagnosed by using DSM-IV TR Diagnostic criteria for depression (APA, 2000). The married females in this non clinical study have been found in the age range of 16-55, further distinguished into two groups of by demarcating into 25 years and down where 43 patients. While 57 patients have been above 25 years age. Table No-1 this shows that married female are more in the age group of 25 and above where patients over numbered by 57%. Depression is commonly a female illness and dominantly presents in the gender differences in the ratio of 2:1 (Weissman and Klarman, 1977). Nawabshah study (1997) on depression have shown the married women are more in both the rural and urban areas reporting for psychiatric help (P<0.05) the percentage of married woman was 34.5% (69 cases) (Hussain et al 1997). While 31 cases in the study were single and comparison was no significant. However table No-1 shows that 25 years and above age of the patients are more and outnumbered (57%) as compared to less than 25, which is 43%. Statistically below 25 years of age the frequency of answer of the questioners mentioning symptoms the mean value is 110.01, ±18.85 and above 25 years age group it is 98.89, ±17.36. T test shows 3.05 values while P value is 0.0029. In this way the older patients have shown a significant difference with their counterpart and hypothesis nullified in this study on married and joint family patients suffered from depression. A literacy rate in any community is important while in the developing countries of the world which also includes Pakistan the rate is 58.32 as shown in the book of statistic Pakistan (2009). In this piece of research literate married women patients are 39%. The educated class shows depressive symptoms by affective and cognitive symptoms. Like lack of attention and concentration with the element of sadness, while illiterate class shows depressive symptoms through summarization and this somatization work under the cultural umbrella and religious faiths (Sartorius N, 1974 & 1986). The data shows clinical differences at the variable of educational status or literacy. The literate married patients are less in number (39%) while illiterate cases have outnumbered by 61%. Therefore on basis of statistics the mean at the variable of literate patients is 97.69 ±18.76 and illiterate patients have shown 107.50 ±17.94. The t-value is -2.60 and the P value difference is significant by 0.0108. The hypothesis is nullified and depression in married women is more in illiterate class. Brown and Harris (1975) have shown a much clinical differences in the working class of the married women and also focused on number of children and their age as vulnerability factors causing depression (Brown et al 1975). The number of children more then 3 and less than 14 years of age have been shown a difference in working women suffering from depression. In this study 79% married women in joint family system are having 3 and above children and have developed mental disorder i.e. Depression while number of children acted as vulnerability factors dominantly in this study. One or two children cases in married women in joint family system the cases are 21 with mean 103.00 ±19.46 and on other variable it is 103.79 ±18.77. The t test value is -0.16 and P-Value is 0.8732.

Therefore Table No-3 shows the difference in the number of children in the married women and the hypothesis is nullified by showing that more depression cases are having more children. The number of children in the rural population means more helping hands therefore rural married female produces more children then the urban women.

Although it is significant to right that in Pakistan the family system in working under the shadow of culture and religion. The area of Pakistan well distinguished into urban and rural, (Pakistan Book of Statistic 2009). Table No-4 shows that 68% of population in living in the agro-based rural areas and 32% in urban areas. If we compare the joint family system in married women which is 43% as compared to urban this is 57%. The married women have outnumbered in the urban areas from the joint family system. Although urban section of the community in Pakistan do not enjoy the joint family system and wanted to enjoy the independence life style without pressure of in-laws. However the cases reported more because of probable cause of joint family system which prevailed in this study. There are 43 patients in the rural community with mean 108.20 ±18.52 and urban community

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57 cases with 100.24 ±18.44. The t-test value is 2.139 and P-Value is 0.0349. That means the rural joint family system is more supporting rural females where joint family system is more prevalent and supporting the females as compare to the urban joint family system which seems to be a causative factor for depression. Although in rural population joint family system where kitchens are separate in a compound that means joint family system is non supportive to females of urban areas while well supporting in the rural population. The study conducted at Nawabshah (1997) study on depression keeping in view the urban and rural sections thrown light on the family system and pointed out the females suffering from depression do have the impact of family system (Hussain et al 1997).

Therefore the hypothesis is nullified when the joint family system is tested upon the urban and rural communities married women in joint family system.

Table No-5 reflects the working and non working status of married women in joint family system suffering from depression and reporting to psychiatric out patients clinics of Psychiatry, Liaquat University Hospital and Sir Cowajee Jehangir, Institute of Psychiatry, Hyderabad. The working married women cases are 24 with mean 97.66 ±19.88 and house wives (non working) subjects are 76 with mean 105.51 ±18.20. The t test value is -1.72 and P- values 0.0886. The non working women concept is more prevalent in Pakistan and females are very happy with status of house wives. The concept of house wife, in western and European countries, is all together different as compared to this part of the world. The house wives in the urban society enjoys by staying at home even not going outside and kept in the boundaries of house and observing parda/ Hijjab. However the element of jealousy and poor understand ability put them in emotional problems when they compare themselves with the working women in the urban community. The urban working women actually walk on two edges sword while dwelling with routine of their levies and jobs. These females suffered from depression while supporting the family and also at times their parents. Therefore the urban married woman is actually in emotion trouble with ambiguity. The rural women assist the field work in the agro-base community and understand it as part of their life. Therefore the hypothesis regarding the joint family system and the variable of working women and non working women is tested and nullified. The less number of working women (24%) probably showing the joint family system supporting the working women. However single/ nucleus family system will increase the duty of working woman in the urban society.

5. Conclusion:

Depression is a common psychiatric illness in which sadness and helplessness is dominantly present in the symptoms. There are over 20 psychological theories and areas of biological discoveries in the genesis of depression. However in the last quarter century researchers have focused the social areas as causative factors which are focus of address in this piece of research. This study has focused joint family system as causative factors in depression which is not the only factor responsible for development of depressive illness. This study has focused 36 areas and 28 demographic areas for testing and specifically five areas have been addressed extensively. a) Age co-relation b). Literacy rate c). Number of children d). Urban and rural community and e) working status of the subjects. At the variable of age the 25 years and above patients have been tested and cases are more (57%) and with difference at p- value is 0.0029(Table No-1). The literacy rate is also tested (Table No-2) where illiterate cases are 61% showing the dominant subjects have no basic school or college education in comparison with literate subjects, the difference is the P-value 0.0108. Although in Pakistani society children play an important role for successful marriages and children usually accepted in a great number as compared to western society. Reproduction rate in Pakistani society is very high and there are number of departments working at government level to have a control over the population. The degree of awareness about the number of children required for the family is increasing in Pakistani community. In this study married women in depression from joint family system have shown more than three children (79%) and the difference with less than three children is shown in p-value 0.8732(Table No-3).

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Pakistan is well distinguished in urban and rural community. The urban areas have been defined as a city life (Cosmopolitan/ Corporation) which is 32% of the total population of Pakistan. The larger area of Pakistan agro- based and communities are living in far flung areas, where life is simple and economics is subsistence. 43% cases were from the rural areas, which is comparatively less number as for as 68% of rural areas of Pakistan. Because of far flung livings the depressive illnesses could not be treated due to absence of psychiatrists or mental health professionals even at district head quarter levels. Therefore it is understood the depression in joint family system is more in the rural areas (Table No-4). The urban cases are 57% and t value is 2.139 and p value is 0.0349. Therefore depression does not spare any community and exists at all levels of communities. Although female of Pakistan and especially married women enjoys the house wives status quite extensively, therefore males are responsible to make the bread and butter for the family. The working women are just 24 cases which is very low as compared to the 76 subjects of this study who were house wives (Table No-5) that mean the females are joint family system do enjoys the joint family system but do not feel like working/ helping the family economics. The t value is -1.72 and p value is 0.0886.

6. Recommendation:

Depression is a common psychiatric illness and present in females more dominantly. In this study joint family system has been focused as causative factors in married females suffering from depression. This study contain 100 cases only, however more cases may be taken and assess for the future research in married females. The married females as a result of family conflicts and disturbances meet with separation and at times with divorce may also be taken as subject of research as a causative factors. Similarly the males may also be focused for research that how a male in a joint family dealing with spouse. Therefore it is recommended that depression may be assessed on psychosocial basis by taken other social variables like marriage, broken marriage, separation and divorce.

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Annexure Table No-1

Age Correlation V/S Cases N = 100

S. No Variable Cases Percentage Mean SD t-Test P-Value

Below 25 1 43 43% 110.01 18.85 years 3.05 0.0029 25 years and 2 57 57% 98.89 17.36 above

Table No-2 Education Status V/S Cases N = 100

S. No Variable Cases Percentage Mean SD t-Value P-Value

1 Literate 39 39% 97.69 18.76 -2.60 0.0108 2 Illiterate 61 61% 107.50 17.94

Illiterate married women are more in this study

Table No-3 Number of Children V/S Case N = 100

S. No Variables Cases Percentage Mean SD t-Value P-Value

1 1-2 Children 21 21% 103.00 19.46 -0.16 0.8732 3 or Above 2 79 79% 103.79 18.77 Children

More than 3 children cases married patients have outnumbered (79%)

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Table No-4 Community V/S Cases N = 100

S. No Variable Cases Percentage Mean SD t-Value P-Value

1 Rural Areas 43 43% 108.20 18.52 2.139 0.0349 2 Urban Areas 57 57% 100.24 18.44

Table No-5 Working Status V/S Cases N = 100

S. No Variable Cases Percentage Mean SD t-Value P-Value Working 1 24 24% 97.66 19.88 Women -1.72 0.0886 2 House Wives 76 76% 105.51 18.20