Psychiatry
International Journal of Social
http://isp.sagepub.com/content/55/4/306
The online version of this article can be found at:
DOI: 10.1177/0020764008095117
2009 55: 306
Int J Soc Psychiatry
Ietza Bojorquez, Nelly Salgado de Snyder and Irene Casique
Women From a Mexican Rural Area
International Migration of Partner, Autonomy and Depressive Symptoms Among
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INTERNATIONAL MIGRATION OF PARTNER, AUTONOMY
AND DEPRESSIVE SYMPTOMS AMONG WOMEN FROM
A MEXICAN RURAL AREA
IETZA BOJORQUEZ, NELLY SALGADO DE SNYDER & IRENE CASIQUE
ABSTRACT
Background: The emigration of Mexicans to the USA has increased in the last
decades, and little is known about the effect of this on the mental health of those
who stay behind.
Aims: To evaluate the association of emigration of husband and depressive
symptoms (DS) among women who stay in Mexico. We also tested the hypothesis
that the husband’s migration would increase the woman’s autonomy, which in
turn would decrease DS.
Methods: A survey was conducted in a rural area in Mexico. Participants (n = 418)
were selected through probabilistic sampling in three stages: localities, house-
holds and individuals. DS were evaluated using the Centre for Epidemiological
Studies-Depression (CES-D) scale.
Results: Having a partner in the USA was associated with higher odds of scoring
above the cut-off point in CES-D (OR 3.77, 95% CI 1.92–7.43). Economic auto-
nomy was also associated with DS (OR 1.45, 95% CI 1.04–2.02).
Conclusion: Migration of husband was associated with DS among women. The
construct of autonomy and its operational definition should be further explored.
Key words: depression, migration, personal autonomy, women, Mexico, rural
INTRODUCTION
International migration in search of labour has increased in recent years, prompted by economic
differences between countries. People from less-developed economies migrate – either temporarily
or permanently – to those countries where labour force is needed, thus bringing a diversity of
public health consequences. Emigration from Mexico to the USA has been increasing in the last
decades. In 2004, according to Mexico’s National Population Council (CONAPO, web page), 10.2
million Mexicans were permanently established in the USA.
The effect of migration on mental health has been studied in a number of countries and for
diverse contexts. Schizophrenia and common mental disorders are reported to be highly prevalent
among migrants (Bhugra, 2004). But a less explored area has been that of the consequences of
emigration on the mental health of those who stay in the communities of origin (Salgado de Snyder
et al
., 2007). The migration of the father has been reported to result in psychological difficulties
International Journal of Social Psychiatry. Copyright © 2009 SAGE Publications (Los Angeles, London, New Delhi,
Singapore and Washington DC) www.sagepublications.com Vol 55(4): 306–321 DOI: 10.1177/0020764008095117
BOJORQUEZ ET AL.: DEPRESSIVE SYMPTOMS AMONG WOMEN FROM A MEXICAN RURAL AREA
307
for children and teenagers (Aguilera-Guzman et al., 2004; Pottinger, 2005). On the other hand,
the effect of migration to the USA on drug use in rural communities in Mexico was found to be
mediated by social cohesion and cultural identity, thus showing that the impact of this phenomenon
depends on a number of social circumstances (Wagner et al., 2002). Qualitative interviews in Ireland
with people who had experienced the emigration of a close friend or relative showed responses
of sadness and grief (Sheehan, 1996). Women who stay behind experience feelings of sorrow and
uncertainty about the chances of eventual family reunification (McGuire & Martin, 2007).
Massive Mexican migration to the USA began during the 1940s, and was predominantly male for
some decades. This pattern has been changing and every day more women cross the border either
to rejoin their families or in search of work (CONAPO, web page). Nevertheless, in the case of
established couples it is still common for women to stay in Mexico, taking charge of house and
children; and, for extended periods of time, these women keep in touch with the absent men
only by telephone. Women in this situation experience their partner’s migration as stressing life
events (Salgado de Snyder, 1996). And as life events have consistently been associated with the
onset of depressive symptoms (de Graaf et al., 2002; Kendler et al., 2002; Olstad et al., 2001),
an association could be expected between partner’s migration and depressive symptoms (DS)
among these women.
It has also been suggested that male migration allows an increase in women’s autonomy.
Women who stay in local communities while their husband migrates are reported to experience an
increase in decision-making power and in their participation in collective action in the family as
well as in the community (Chant, 1992; González de la Rocha, 1989; Hondagneu-Sotelo, 1994;
Zárate, 2000). As lack of autonomy could be a gender-related risk factor for DS (Patel et al.,
2006; Silverstein & Perlick, 1995; WHO, 2000), an increase in female autonomy following
the partner’s migration might lessen its negative effects on mental health among those women
who stay behind.
Another social factor related to DS is social support, which has been suggested as a buffer for the
impact of stressing life events (Olstad et al., 2001; Paykel, 1994; Thoits, 1995; Wade & Kendler,
2000). Also, socio-economic and education levels have repeatedly shown an inverse relation to
DS (Kahn et al., 2000; Medina-Mora et al., 2005; Skapinakis et al., 2006; Weich et al., 2001).
Age and number of children have also been proposed as related to DS, although this relationship is
less clear (Brown & Harris, 1978; Piccinelli & Wilkinson, 2000).
In this study we tested these associations with a conceptual frame schematized in Figure 1. This
follows on Cervantes and Castro (1985), according to whom the effect of stressors is lessened
by compensating and mediating factors, both internal and external. The first hypothesis in this
study was that partner’s international migration (a stressing life event) would be associated with
more DS among women staying in the communities of origin. The second hypothesis was that
women with a migrant partner would benefit from more autonomy, which in turn would be related
to less DS.
METHOD
The information was collected as part of a wider project to study the associations between
international migration and health in a poor rural area in Mexico (Proyecto Mixteca). A cross-
sectional study was conducted in three municipalities with high scores in the marginality
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index of CONAPO and in the migratory-intensity index by the same institution (CONAPO, 2002).
The three municipalities were in the Mixteca Baja – an area located in the states of Guerrero, Oaxaca
and Puebla. All these municipalities were essentially rural, with all but one of their localities having
fewer than 2,500 inhabitants, according to the 2000 census (INEGI, web page).
Sampling design
The sample needed for the Proyecto Mixteca was calculated as 708 households. The sampling design
included stratification on municipalities, with a sample size for each municipality proportional to
its population. Within municipalities, localities were selected with a probability of selection pro-
portional to the expected number of households, giving localities with more households a higher
probability of selection. In this way, a list of 21 localities was obtained. Within the localities, a
systematic sampling by blocks – and households within blocks – was conducted.
In each household one woman was selected for interview. Following the inclusion criteria of
Proyecto Mixteca
, women had to be of reproductive age (15–49 years) and having delivered at least
one live-born child. When more than one woman in the household was eligible for interviewing,
the selection was made on the basis of the closest birth date. If the selected woman was not present,
one more visit was made to the house. If the second visit failed to achieve an interview – or when
the woman did not wish to participate – it was coded as ‘No Response’ and no other woman was
selected in the household.
All participants were informed of the study objectives and the voluntary nature of their partici-
pation was remarked. A signed informed-consent form was obtained before conducting the inter-
views. The project was approved by the Ethics Committee of the National Institute of Public
Health, Mexico.
Instruments
A series of questions regarding the characteristics of the premises and the family were asked in
each household. The respondent of these questions could or could not be the woman of reproductive
Figure 1. Conceptual framework
Based upon Brown & Harris, 1978; Cervantes & Castro, 1985
BOJORQUEZ ET AL.: DEPRESSIVE SYMPTOMS AMONG WOMEN FROM A MEXICAN RURAL AREA
309
age surveyed. In 33% of the households, the same woman answered the Household Questionnaire
and the Women’s Questionnaire.
Interviews were conducted by previously trained persons, with at least a junior high school edu-
cational level. Periodical supervision was conducted in the field by the research team. The capture
of information from paper to electronic format was supervised through double-capture of a sample
of questionnaires. The instruments for the evaluation of the main variables are described below.
Depressive symptoms
The scale used to measure DS was the Centre for Epidemiological Studies – Depression (CES-D)
(Radloff, 1977), previously validated in Mexico for women in a rural area (Salgado de Snyder &
Maldonado, 1994). CES-D includes 20 items representing six mood and somatic aspects of de-
pression: depressed mood; guilt and worthlessness; helplessness and hopelessness; psychomotor
retardation; loss of appetite; and sleep disturbance. Response options correspond to the number of
days of the previous week that each symptom was present. The possible range of scores is 0 to 60,
with a higher score corresponding to a greater number and frequency of DS. CES-D has shown
both concurrent validity with other scales for the measurement of DS and its ability to discrim-
inate between general population and patients with a diagnosis of depression. It is also sensitive to
improvement of symptoms in depressed patients (Weissman et al., 1977), and reliable according to
test-retest (Bowling, 1995). The suggested cut-off point for clinically significant DS is 16 (Weissman
et al
., 1977). The instrument is not intended to provide a diagnosis of depression, but to detect the
presence and intensity of component symptoms of depression. The statistical analysis considered
the score in CES-D both as a numerical variable (total score) and as a binary variable (score equal
or over 16 considered as clinically significant DS).
Partner’s migration
Participants were asked about their partner’s habitual place of residence and their place of residence
at the time of the interview. Other questions included frequency and means of contact with partners
in the USA, and if remittances were received. Place of residence was categorized as: living in the
locality; living in other place within Mexico; living in the USA but currently visiting the locality;
living in the USA and staying there at the moment of the interview. A variable of ‘Recent Migration’
was computed as a partner’s first departure for the USA occurring during the previous year, when
the partner was presently in the USA. Information to compute this variable was available for
only 68% of women with a migrant partner, so it was not included in the final statistical models.
As a sensitivity analysis, models including this variable were also tested. The crude association
between recent migration and DS is also reported.
Autonomy
Autonomy has been defined as the capacity of self-determination after a process of self-reflection
(Friedman, 2003). A series of dimensions of autonomy have been proposed as relevant for women:
knowledge (having the information required to choose and act); decision-making power; move-
ment (the capacity to move in and interact with the world outside home and immediate family);
emotional autonomy; economic autonomy (employment and property rights); political or social
autonomy (the capacity to engage in collective action or take part in collective decision making
beyond the private sphere); and corporeal autonomy (the capacity to control one’s own health
and sexuality) (Dyson & Morre, referred to in Pallitto & O’Campo, 2005; Govindasamy &
Malhotra, 1996; Jejeebhoy, 1995). Questions included in the questionnaire assessed autonomy in
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four aspects. First, decision-making power was assessed as the participation of women in making
everyday decisions such as how much to spend on food, and major decisions such as buying a
new piece of land or making house improvements. Second, movement autonomy was assessed by
asking women if they had to ask for someone’s permission in order to do activities that ranged from
visiting friends or family members, to looking for a job. Third, political autonomy was evaluated
through the report of participation in organized collective activities, such as neighborhood or other
local organizations, parental or religious groups, and explicitly political organizations. Fourth,
economic autonomy was evaluated through asking women if they had property rights over land or
house, if they received a salary, or if they had been a recipient of credit by a bank or governmental
agency. The questions were based on those in the Encuesta Nacional sobre la Dinámica de las
Relaciones en los Hogares 2003
(National Survey of Household Relationships 2003) (Casique,
2004), and also on work reported by Bloom et al. (2001) and Govindasamy and Malhotra (1996).
Individual items were re-codified so that a higher score represented more autonomy, and combined
in indexes through robust principal components analysis (PCA) suitable for categorical data
(Kolenikov & Angeles, 2004) with the help of SPSS 13.0 software (SPSS Inc).
Social support
Participants were asked if they did or did not receive moral support, spiritual support, com-
panionship, and alimentary or other material support, and if it came from friends, neighbours or
family. Binary variables were computed for both perceived emotional support (moral, spiritual or
companionship support) and material support (either alimentary or material).
Socio-economic level (SEL)
An index was computed, through robust PCA, from information on housing characteristics (material
of roof and floors) and services (drinking-water source, electricity), number of people per room,
appliances, cattle and chicken, possession of cultivable land, and vehicle ownership. A higher
score in the index represented a higher SEL.
Educational level
The highest educational level reached was categorized in the following way: without formal edu-
cation, primary school, junior high school, and high school and over.
Statistical analysis
A bivariate analysis was conducted for the association between each independent variable and DS
as a continuous measure. A logistic regression model was adjusted, with clinically significant DS
(score at or over 16 in CES-D) as a dependent variable. Goodness of fit was evaluated through
the Hosmer-Lemeshow test (Hosmer & Lemeshow, 1989). In order to account for the sampling
design, the standard errors were adjusted with the Taylor linearized variance estimation using the
statistical software Stata 8.0 (Stata Corporation, 2003).
RESULTS
Out of 708 households to be surveyed, information was obtained in 698 (98.6% response rate); and
a woman was interviewed in 468 households. Of these 468 women, 418 (89%) were married or
BOJORQUEZ ET AL.: DEPRESSIVE SYMPTOMS AMONG WOMEN FROM A MEXICAN RURAL AREA
311
had a permanent partner. Since the purpose of this study was to analyze the association of partner’s
migration and women’s DS, the sample for this report was composed of 418 women (Table 1).
Depressive symptoms
Only 311 of the 418 women answered all the items of CES-D. Their mean score was 11 (SD = 8.8),
with a range of 0–51. The prevalence of DS above the cut-off point was 23.2%. Women who did not
answer all the items were different to those with complete sets of answers: they were less educated,
had a lower SEL score, and had less autonomy and more children.
Partner’s migration
The partners of 142 (34%) of the participants were international migrants. Of them, 48% kept in
touch with their wife at least once a week, and 49% every two to four weeks. The partners of 2% of
the women never communicated with them. Telephone was the means of communication for 98% of
the participants. Remittances were sent by 98% of the partners. At the time of the interview, 27%
of the migrant partners were visiting in the locality. Information on the year of the partner’s first
and last migrations was available for 70 women. Of them, 13 were considered as recent migration
(first departure in the year previous to the survey, partner still in the USA).
Autonomy
A gender division was observed in autonomy: when compared to men, women show lower decision-
making power regarding major purchasing decisions. Movement autonomy was also limited, as
most participants had to ask for permission before visiting relatives or friends, attending a party or
looking for a job. The minority of them owned property, or had a personal income to support their
economic autonomy (Table 2).
Against the hypothesis, partner’s migration was not associated with scores in the index of
decision-making power, collective participation (political autonomy), or economic autonomy.
Table 1
Characteristics of respondents in three Mixteca-Baja municipalities (n = 418)
+
Total
Women with migrant
partner (n = 142)
Women with non-migrant
partner (n = 274)
Age (years) (mean, SD)
34.8 (8.3)
32.9 (8.4)
35.8 (8.1)
Number of children (mean, SD)
4.0 (2.4)
3.8 (2.3)
4.1 (2.4)
Educational level (%)
No formal education
Primary school
Junior high school
High school and over
15.9
65.3
13.0
5.8
14.3
68.6
11.4
5.7
16.1
64.1
13.9
5.9
Employed (%)
22.5
16.9
24.9
Socio-economic level (%)*
Low
Middle
High
26.8
30.7
42.5
36.4
35.2
28.4
+
Two women had missing information on partner’s migratory status
* Tercile in the distribution of the SEL index.
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Table 2
Responses to autonomy items
Total
Women with
migrant partner
(n = 142)
Women with non-
migrant partner
(n = 274)
Decision-making power
Who decides…
n (%)
n (%)
n (%)
how much to spend on food?
You
Your partner
Both
164
30
218
(40)
(7)
(53)
65
3
32
(65)
(3)
(32)
70
25
164
(27)
(10)
(63)
how much to spend on medical attention or medicines?
You
Your partner
Both
106
58
248
(26)
(14)
(60)
62
4
36
(61)
(4)
(35)
30
48
180
(12)
(19)
(70)
whether to improve the house?
You
Your partner
Both
39
113
249
(10)
(28)
(62)
19
26
53
(19)
(27)
(54)
14
67
172
(6)
(26)
(68)
whether to buy new land?
You
Your partner
Both
9
99
275
(2)
(26)
(71)
2
28
66
(2)
(29)
(69)
3
54
181
(1)
(23)
(76)
whether to buy a vehicle for transport or work?
You
Your partner
Both
5
102
273
(1)
(27)
(72)
1
35
59
(1)
(37)
(62)
2
51
184
(1)
(22)
(78)
what to plant in a field?
You
Your partner
Both
11
151
208
(3)
(41)
(56)
7
42
43
(8)
(46)
(47)
2
94
6
(1)
(41)
(55)
when to buy clothes for yourself?
You
Your partner
Both
200
41
174
(48)
(10)
(42)
72
6
24
(71)
(6)
(24)
101
34
125
(39)
(13)
(48)
Movement autonomy
To attend a party
You don’t do it
You have to ask for permission
You don’t have to ask for permission
50
263
79
(13)
(67)
(20)
18
53
27
(18)
(54)
(27)
23
183
39
(9)
(75)
(16)
To visit family or friends
You don’t do it
You have to ask for permission
You don’t have to ask for permission
22
256
119
(6)
(65)
(30)
9
57
34
(9)
(57)
(34)
10
177
67
(4)
(69)
(27)
To have a job or look for one
You don’t do it
You have to ask for permission
You don’t have to ask for permission
60
263
60
(16)
(69)
(16)
14
60
19
(15)
(64)
(20)
38
172
34
(16)
(70)
(14)
(Continued)
BOJORQUEZ ET AL.: DEPRESSIVE SYMPTOMS AMONG WOMEN FROM A MEXICAN RURAL AREA
313
Women whose partner was in the USA were high scorers in movement autonomy, with a median
of –0.58 (inter-quartile range (IQR) -0.69–1.27); those whose partner was in the locality had a
median score of -0.69 (IQR -0.69–0.35); and those whose partner was in other place within Mexico
had a median of 0.45 (IQR -0.69–0.88); while those whose partner had migrated but was currently
in the locality had a median of -0.69 (IQR -0.69–0.44) (p = 0.005, Kruskall-Wallis test).
Education was not associated with decision-making power. However, a higher educational
level was associated with more movement autonomy (p < 0.001) and economic autonomy
(p < 0.001). On the contrary, a higher educational level was associated with less collective
participation (p = 0.011, Kruskall-Wallis test).
Socio-economic level
The variables that explained more variance, aggregated in the first component for the SEL index,
were the house roof and floor materials, and having appliances such as a refrigerator, a stove or
a washing machine. Households containing a woman who had a migrant partner had a better
SEL (p = 0.0001, Mann-Whitney Test). Women in households with a higher SEL also showed
higher scores in decision-making power (Spearman’s r = 0.09, p = 0.032), economic autonomy
(Spearman’s r = 0.16, p = 0.001), and movement autonomy (Spearman’s r = 0.26, p < 0.001).
Variables associated with depressive symptoms
More DS were observed among women with a migrant partner (Table 3). Out of the 13 women
with a recently migrated partner, eight (62%) had CES-D scores above the cut-off point (not shown
in table). As for the autonomy indexes, CES-D score was associated only with decision-making
power (
ρ = –0.12, p = 0.039). Receiving emotional social support was associated with lower
CES-D scores. There was a tendency for DS to be less at higher education levels. No association
was observed with age or number of children.
The final logistic regression model included the following independent variables: partner’s
migration, decision-making power, economic autonomy, emotional social support, SEL, and
education. The interaction of each autonomy index and partner’s migration did not reach statis-
tical significance and was not included in the final model. The same happened for the interaction
Total
Women with
migrant partner
(n = 142)
Women with non-
migrant partner
(n = 274)
Political autonomy
Takes part in…
school parent’s meetings
church meetings
community meetings
meetings of political associations
306
132
77
30
(74)
(32)
(19)
(7)
82
30
26
11
(80)
(29)
(25)
(11)
185
88
43
16
(72)
(34)
(17)
(6)
Economic autonomy
Has received credit
Has a paid employment
The family’s properties are registered in her name
37
94
58
(10)
(23)
(15)
13
18
19
(14)
(17)
(20)
15
64
30
(6)
(25)
(12)
Table 2 (Continued)
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between social support and partner’s migration. The interaction observed between SEL and partner’s
migration was included (Table 4).
According to the model, having a partner who had migrated to the USA was associated with
higher odds for DS, even among those whose partner was visiting in the locality and after controlling
for other social factors. Decision-making power was not associated with DS, after controlling for
the other variables in the model; while economic autonomy was directly associated with those
symptoms. Emotional social support was inversely associated with DS. A higher education was
associated with less DS. A negative-sign interaction was observed between SEL and partner’s
international migration, showing that among women whose partner was a migrant a better SEL
was associated with less DS.
DISCUSSION
According to the results, almost one quarter of surveyed women had experienced significant DS
during the previous week (a score of 16 or more in CES-D). This proportion is similar to those
found in rural women in other third world countries (Bolton et al., 2004; Patel & Kleinman, 2003),
and in women of low SEL in the USA (Kahn et al., 2000), using the same instrument and cut-off
point. In this way, the prevalence observed is concordant with a population in conditions of social
and economical disadvantage.
Table 3
Social factors and their relationship with depressive symptoms
Variable
CES-D score
(mean, SD)
Variable
CES-D score
(Spearman’s r)
Partner’s migratory condition
Living in the community
Somewhere else in Mexico
Migrant, visiting community
Living in the USA
9.9 (8.3)
10.7 (7.9)
12.5 (8.5)
13.2 (10.1)
p
= 0.030
+
Score in autonomy indexes
Decision-making power
Economic autonomy
Movement autonomy
Political autonomy
r
= –0.12
r
= 0.07
r
= 0.04
r
= –0.02
p
= 0.039
p
= 0.248
p
= 0.469
p
= 0.683
Emotional social support
Receives support
Does not receive support
9.7 (8.2)
12.2 (9.3)
p
= 0.013
++
Score in socio-economic
level index
r
= –0.07 p = 0.203
Material social support
Receives support
Does not receive support
11.5 (9.1)
10.8 (8.8)
p
= 0.613
++
Age
r
= 0.03 p = 0.649
Educational level
No formal education
Primary school
Junior high school
High school and over
14.0 (8.0)
10.3 (8.1)
11.2 (11.5)
10.7 (9.8)
p
= 0.001
+
Number of children
r
= 0.08 p = 0.183
+
ANOVA
++
t
test
BOJORQUEZ ET AL.: DEPRESSIVE SYMPTOMS AMONG WOMEN FROM A MEXICAN RURAL AREA
315
In this sample, the expected association between partner’s migration and DS was confirmed. In
comparison to the women whose partner lived in the locality, those women whose partner was in the
USA or visiting in the locality had more DS. Among the former, DS could be partly a result of the
stressing situation of the partner’s migration. Among the latter, it is possible that family relationships
and arrangements that had evolved to cope with the man’s departure were challenged and reversed
when he came back. Also, women in this situation would know that their partners were bound to
leave again relatively soon. This process could also result in a stressful situation. It is worthwhile
to notice that many of the women whose partner was a recent migrant had CES-D scores above the
cut-off point, showing that the effect of migration over DS might be stronger in the first stages of
the migratory process. In this study the effect of migration on DS in those who stay was demon-
strated, as it has been shown in previous research (Salgado & Maldonado, 1992). Nevertheless, the
results also signal the need for further analyzing of the specific conditions of the migratory process
that are more strongly associated to DS and other common mental-health problems.
As for the relationship between partner’s migration and female autonomy, the hypothesis that
men’s migration would increase the autonomy of the women who stayed behind was not clearly
confirmed. In the sample, women whose partner was in the USA had more movement autonomy,
but their scores in the other three dimensions were similar to those of women whose partner lived
in the locality. It is possible that male migration in this area has not brought forth an increase in
decision-making power, economic autonomy or political participation for women. This subject
has been discussed by Ariza (2000). Contrary to the observations of previous authors such as
Table 4
Logistic regression model for depressive symptoms (n = 297)*
OR
95% IC
p value
Partner
Living in the community
Somewhere else in Mexico
Migrant, visiting
Living in the USA
1
0.86
8.33
3.77
0.06,
2.61,
1.92,
11.75
26.58
7.43
0.907
0.001
0.001
Decision-making power
0.90
0.67, 1.21
0.482
Economic autonomy
1.45
1.04, 2.02
0.029
Receiving emotional social support
0.36
0.21, 0.64
0.002
Socioeconomic level (score in index)
1.33
0.87, 2.04
0.177
Educational level
No formal education
Primary school
Junior high school
High school and over
1
0.33
0.26
0.45
0.12,
0.07,
0.16,
0.92
1.01
1.23
0.035
0.052
0.112
Interaction
Somewhere else in Mexico/SEL**
Migrant, visiting/SEL
Living in the USA/SEL
2.45
0.25
0.48
0.15,
0.10,
0.23,
39.44
0.62
1.03
0.504
0.005
0.059
p
> F = 0.079
* Dependent variable: CES-D score
≥ 16
** SEL: socio-economic level
316
INTERNATIONAL JOURNAL
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SOCIAL PSYCHIATRY 55(4)
D’Aubeterre (1995) and Chant (1992), who took migration to be an empowering force in the lives
of women, this author suggests that male migration increases the burden of responsibilities carried
by women, but only in a temporary manner. When men come back the responsibilities return to
them, without a permanent change in gender equity. If this were the case in our study, the observed
increase in movement autonomy for women with migrant partners would not necessarily mean
more equitable gender relations, a subject worthy of further study. Furthermore, the experience
of increased movement autonomy during the partner’s absence, followed by a decrease at the
husband’s return, might also help to explain the high prevalence of DS among women whose partner
was a migrant temporarily visiting the familiy.
Only one of the four dimensions of autonomy considered in this study (decision-making power)
was associated with DS in the crude analysis. The negative association observed was in accord with
the hypothesis of autonomy as a protective factor. In the multivariate analysis, the association lost
statistical significance but maintained its direction. Economic autonomy, contrary to expectation,
was positively associated with DS in the multivariate analysis. Neither movement nor political
autonomy showed an association with DS. In this way, the expected clear-cut relationship between
higher autonomy and less DS was not apparent in the sample. A number of reasons for this, and
the need for further studies to clarify the question, are suggested below.
The inverse association of decision-making power with DS is in accord with the findings of
Chen et al. in the USA (Chen et al., 2005). Those authors studied the contextual effect of autonomy
over DS at the state level and at the individual level. They found that women who lived in states
with more female autonomy had lower average scores in CES-D. Also, in a survey of women in
India, less decision-making power was associated with a higher prevalence of common mental
disorders (Patel et al., 2006). In this sense, our results were as expected.
However, in our study more economic autonomy was associated with a higher CES-D score.
Contrary to this, the classic work by Brown & Harris (1978) stated that not being employed was
a risk factor for DS. However, as pointed out by Govindasamy & Malhotra (1996), for some
women in the developing world, having a paid job is not a matter of choice but of necessity, and
might not be experienced as a liberating condition. Women in our sample might feel that having
to work outside of the home is the result of a lack of support, an observation already made in the
context of Mexico–USA migration (Salgado & Maldonado, 1993). The double burden of work and
household tasks could also explain the direction of this association (Kuehner, 2003; Piccinelli
& Wilkinson, 2000).
The findings of this study are an invitation to discuss the autonomy construct and its oper-
ationalization among women in a context of social disadvantage. The definition of autonomy included
in the theoretical frame (Friedman, 2003) is part of a conception of individual self-determination
and consequent action as a fundamental good. Autonomy in this view is considered essential for
well-being, in as much as it allows the individual to choose and act in a way that is in accord
with her best interests (Nussbaum, 2002). However, it has been discussed before that, in certain
settings, individual decision-making power and freedom of movement might not be the main assets
that allow a person to follow her chosen course of action or to achieve her more cherished goals.
In a more traditional social milieu, the strength of social networks might be more determinant
of an individual’s action capacity (Govindasamy & Malhotra, 1996). So, if we consider that the
positive effect of autonomy over mental health is the result of an autonomous person being able to
achieve her ends, maybe social ties would constitute a more relevant dimension to consider in the
context of these rural women.
BOJORQUEZ ET AL.: DEPRESSIVE SYMPTOMS AMONG WOMEN FROM A MEXICAN RURAL AREA
317
Also, the meaning of the situations taken as indicators of autonomy ought to be different in
different cultural contexts (Casique, 2001). According to Brown (1998) and Cervantes & Castro
(1985), the effect of provoking factors over DS depends on the meaning people assign to them. The
effect of a certain condition, taken as an indicator of autonomy by the researcher, might depend on
the woman’s perception of it as a liberating circumstance or, on the contrary, as an inappropriate
situation. In this sense, if having a job is experienced as a burden, or as inappropriate according to
gender expectations for women, this indicator of economic autonomy would also be an indicator
of a less protected situation that might be putting the woman at greater stress.
Following this, in further studies it would be convenient to explore other aspects such as inter-
personal relationships and the experience of collectivity, and their association with DS. Definition
and operationalization of constructs are not minor issues, and the findings of this study show
the need of further discussion on both aspects in the relationship between autonomy and DS. A
recommendation in this sense is that different aspects of autonomy could be important for each
specific problem; so that, for empirical research, specific aspects should be addressed (Govindasamy
& Malhotra, 1996). Also, the meaning of each of those aspects in a specific social and cultural
context should be investigated.
It has been proposed that social support buffers the effect of stressing life events over DS (Olstad
et al
., 2001; Paykel, 1994; Stansfeld et al., 1998; Thoits, 1995; Wade & Kendler, 2000). We did
not observe such an interaction in our study, maybe because the support we evaluated was not
specifically directed to the difficulties that accompany migration. In our assessment of perceived
social support the independent association we observed between support and DS could be a reverse
causality phenomena, where depressed women might report receiving less emotional support.
After controlling for SEL, an association was observed between education and DS. As other
studies conducted in developing countries have found (Araya et al., 2003; Husain et al., 2004), SEL
did not show an independent association with DS. It is possible that, in our sample, SEL did not
vary enough for associations to be observed. On the other hand, the observed interaction of SEL
and partner’s migration showed that a better SEL mitigates the effect of migration on DS.
An interesting finding of this study is the difference between women with complete and incom-
plete sets of responses to the CES-D items. On average, women with incomplete responses were
less educated, had a lower SEL and less movement autonomy, and had more children. Showing
these characteristics, and according to our theoretical framework, these women, as a group,
should be more affected by DS. Leaving them outside of the analysis might underestimate the pre-
valence of DS in our sample.
A weakness of this study is the cross-sectional design, which precludes the estimation of
causal relationships. However, a reverse causality phenomenon – with women’s DS influencing
the partner’s migration – is not likely. An additional difficulty arises regarding the temporality of
CES-D. This instrument asks about DS during the previous week, preventing the evaluation of the
temporal relation of symptoms and partner’s departure. Thus, we cannot know if DS appeared right
after the partner’s departure, if they were already present, or if they increased or diminished after
the study. A possible incidence-prevalence bias (Szklo & Nieto, 2003) could also have occurred,
in which CES-D high scorers would be those women with a tendency to chronicity of DS, related
to unmeasured factors; while women who presented acute DS after a partner’s departure were not
detected in our study. Even with these considerations, partner’s migration could still represent a
risk factor with an effect on susceptible persons. The observation of more clinically significant
DS among women with a recently migrated partner supports the proposed association.
318
INTERNATIONAL JOURNAL
OF
SOCIAL PSYCHIATRY 55(4)
A number of issues raised in this study merit further investigation through different methods.
The use of qualitative research techniques, such as in-depth interviews, focus groups or life stories,
would help clarify how specific aspects of the migratory process, such as family characteristics,
the woman’s social position, and others, mediate the impact of the husband’s migration. Also,
the meaning and subjective experience associated with taking care of a number of activities and
decisions should be explored, in order to understand the apparently paradoxical results on auto-
nomy indicators and DS.
According to the observed results, international migration of the partner is associated with more
DS among women who stay in Mexico. This relationship should be considered when evaluating
the general effects of international migration, and in the development of policies. The effect of
migration on the health of those who stay in the original communities is a field in need of further
investigation. Representative samples of wider populations and longitudinal designs will allow
us to understand the effects of migration on the mental health of those who stay behind.
ACKNOWLEDGMENTS
Proyecto Mixteca
was supported by the Wellcome Trust, grant number 042789MF. The first author
was supported by the National Council for Science and Technology (CONACYT) during this
research project. The authors want to thank the people of Tlapa, Guerrero, Huajuapan, Oaxaca
and Acatlan, Puebla, for their participation in this study.
NOTE
A previous version of this paper was presented at the Latin American Studies Association (LASA) 2007 International
Congress.
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Correspondence to: ietzabojorquez@gmail.com
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