INTRODUCTION:

Minor psychological disorders (MPD) come under the purview of common mental disorders including depression and anxiety. It is prevalent in large population across the world and leads to various diseases among people which cause ahigh rate of morbidity and disability.

Study of Global Burden of Diseases (2015) claimed that common mental disorders like depression and anxiety are leading drivers of disability worldwide. The report of Global Burden of Disease explores that psychiatric disorders account for 13 percent of total Disability-adjusted Life Years lost for Years Lived with Disability with depression being the leading cause (NIMHANS, 2016). Mental health of common people is going to deteriorate day by day and is caused to decrease the efficiency of life. The prevalence of psychiatric disorders is increasing swiftly in developing countries. World Health Organization estimates that depression will be the single most important cause of disability by the year 2020 in the developing world (de Silva et al., 2006).

It is estimated that in India ten percent children belonging to 5-15 year age group are having a diagnosable mental disorder and 90 percent of these disordered children are not having any specialist treatment (Duggal et al., 2014). The ratio of psychiatric disorders is comparatively very high among child rag pickers due to the nature of work they are involved in that is rag picking and also due to general living conditions. Fewer opportunities for having treatment and low treatment-seeking behavior is an additional problem among them. Vulnerabilities faced by child rag pickers create poignancy among them and mar their aspirations. Most of the psycho-social issues are associated with their nature of work and general living conditions. Child rag-pickers are the most marginalized groups of the population and often live in unauthorized slums in the poorest neighborhood (Soni, 2014). Due to filthy conditions prevailing in the places where child rag pickers live, they have fewer opportunities for work.

Child rag pickers are deprived of safe environment due to unsafe working and living conditions they are exposed to various dangers. They have to work long hours in hazardous conditions. They work on dumping sites, riverbanks, roadsides, etc. Consequently, they face direct sunlight during summer, extreme cold during winter, rains during the rainy season. Due to weather constraints, child rag pickers are exposed to excessive heat and cold. The filthy environment of workplace makes them susceptible to gases due to combustion of rags. Dogs, rats, snake, and insects at the dumping sites are challenge for them. Getting physical injuries during separation of sharp objects is routine practice for them. Occupational characteristics of rag pickers, i.e., frequent static postures, long working hours, low job satisfaction and work accidents have a negative impact on their mental health (Mote et al., 2016). Apart from hazardous working conditions and filthy environment, they are abused by elder rag pickers, municipal workers, and police. They constitute a most vulnerable segment of the population to be physically, morally, sexually and economically exploited. Resultant is their psychological vulnerability that may lead to psychological disorders among them.

Despite this all, most of them are involved in anti-social activities like drug trafficking, addiction, gambling, theft, and prostitution especially in metropolitan cities. These regular anti-social activities harm their social life altogether and consequently; they are socially ill treated which leads to heightened psychological vulnerability. Emotionally, these children are deprived of love, affection and family’s sympathy (Hussian and Sharma, 2016). Due to chaotic life of rag pickers, these children belong to either single parent or are orphan and belong to broken families or even live on the streets. Rare families of rag pickers run a harmonious life and rearing of children in such conditions is negatively affected.

Rag picking and migration are closely linked with each other. Most of the rag pickers migrate from rural areas to urban settings due to the availability of recyclable material. In the urban areas, they live in poor conditions mostly in slums. In the slums, they live in congested and poor ventilated homes without having a supply of water and drainage. They use open places for having bath and defecation. Poor housing and bad living conditions create difficulties for them. It affects their mental health also. Mental illness is interlinked with urbanization owing to the fast pace of life, complex living, mental pressure and economic burden. Mental disorders are nearly twice (13.5 percent) as much in urban population as compared to rural (6.9 percent) population (NIMHANS, 2016). Mental health being a global issue is a significant challenge before the modern world. The fast pace of life in the 21^st century as a result of industrialization and urbanization has created several problems for human life and environment. Rag pickers are a byproduct of modern urbanization and emerged as socially, economically and a psychologically vulnerable section of society. Scholars call this as the dilemma of development, it has affected the social life of such people directly and others indirectly.

It is surveyed that burden of mental disorders is high in low and middle-income countries and last two decades of research has shown a close relationship between poverty and mental disorders in these countries. Whereas variables such as housing, food insecurity, education, socio-economic status and financial stress exhibit a relatively consistent and strong association with common mental disorders, others such as income, employment, and mainly consumption are more equivocal (Lund et al., 2016). Rag pickers face all these inefficiencies because of fewer resources and opportunities. Consequently, adverse circumstances make them susceptible to poor mental health. Study of (Mote et al., 2016) explores that majority of rag pickers are suffering from depression and anxiety as a common mental disorder. The prevalence of minor psychiatric disorders is more frequent among rag pickers than other poor workers living in the same neighborhoods. The present study is an attempt to address the psycho-social problems faced by child rag pickers due to their worst job conditions. The problem has not been duly recognized in psychology, despite the fact that working in childhood has immense effect on the psychological development of child (Hobbs and Cornwell, 1986). There is, therefore, need to conduct a study on psychological problems of child laborers.

OBJECTIVES OF THE STUDY:

Broad Objective

To study the mental health or psychological problems among child rag pickers.

Specific Objectives

(1) To study the relationship between socio-demography and mental illness of child rag pickers.

(2) To investigate the common psychiatric disorders (depression and anxiety) among child rag pickers.

(3) To investigate the effect of low income and poor living and working conditions on mental disorders among child rag pickers.

(4) To examine the role of substance abuse in mental disorders among child rag pickers.

METHODOLOGY:

The present study is exploratory and based on primary data. The sample for the study was taken from Patiala district of Punjab. Total of 150 respondents was studied. List of slums was obtained from the municipal authorities of five Tehsils of district Patiala. According to respective municipal authorities, there are 12 slums in Patiala Tehsil, 14 slums in Nabha, 4 slums in Rajpura, 6 slums in Samana and 5 slums in Patran. Apart from this official record of slums, there are many unauthorized settlements in almost all the Tehsils. These unauthorized settlements were also included in the list of slums to choose the sample.150 child rag pickers were chosen through systematic random sampling, and the first respondent was chosen by lottery method. Since the sample size is of 150 respondents, therefore, 30 child rag pickers from each of the five Tehsils in the district were contacted, and desired information was obtained.

Tools of Data Collection

Two tools, one self-designed interview schedule and another SRQ-20 i.e., self-reporting questionnaire were used to collect the data for the present study. Self designed interview schedule was prepared to study the socio-economic and demographic profile of the respondents. However, SRQ-20 was used to know the prevalence of minor psychological disorders in the respondents under the study. SRQ-20 is a WHO manual generated by Harding et al. (1980) and is a cost-effective way for the screening of minor psychological disorders usually in developing countries. SRQ-20 consists of 20 questions. Out of 20, 16 questions are to find out psycho-emotional problems and 4 questions are related to physical symptoms.

Data Analysis

The collected information has been properly checked, verified, and coded accordingly. Thereafter, using the appropriate statistical technique, the data is presented in tabular form for further analysis and discussions using SPSS and MS Excel. The general profile of the respondents was observed with percentage analysis. Prevalence ratios were calculated to analyze the results, and multivariate modeling was used to identify association with MPD with the help of chi-square χ². 6 points cutoff for female and 8 points for male respondents were implemented to ascertain the prevalence of MPD.

Ethical Considerations

The researcher used identification codes to maintain the anonymity of the clients and kept all research information confidential. Consent was taken from every respondent for the interview.

Socio-demographic profile is very imperative and useful for conducting research in the discipline of social science. It includes factors of age, sex, place of birth, place of living, housing, education, income etc. of a population which is undertaken for the research. These characteristics distinct the different sub-groups of the population targeted under the study. Socio-demographic profile is helpful to analyze the data in terms of characteristics of the subjects. The current study has been conducted to investigate the prevalence of MPD among child rag pickers; therefore socio-demographic profile has been taken into account to know its relationship with MPD.

Table: 1. Socio-demographic profile and its relation with MPD

Variable	Overall %	MPD Prevalence	p value
Age			0.146
06-08	12.0	38.9
08-10	16.0	70.8
10-12	24.7	45.9
12-14	47.3	32.4
Sex
Male	78.7	39.8	0.045
Female	21.3	53.1	0.045
Residence
Local Residents	68.0	45.1	0.027
Migrated	32.0	37.5	0.027
Household Material
Poor Tin, Wood, Mud	68.0	44.2	0.046
Bricks House	32.0	39.6	0.046
Running Water
Yes	40.0	41.7	0.044
No	60.0	43.3	0.044
Electricity
Yes	70.0	40.0	0.001
No	30.0	48.9	0.001
Toilet
Yes	14.7	40.7	0.001
No	28.0	43.7	0.001
Bathroom
Yes	36.7	40.0	0.001
No	63.3	44.2	0.001

Age wise, the respondents were ranging between 6 to 14 years as highlighted in Table 1. Prevalence of MPD was not found statistically significant across all the four age groups. But it was found highest 70.8 percent among 8-10 years and lowest 32.4 percent in 12-14 years age group. Gender wise distribution of the respondents was 78.7 percent males and 21.3 percent females. Prevalence of MPD among female rag pickers was found high to be 53.1 percent and low among male counterparts as 39.8 percent with a significant difference (p=0.05). Rag picking is an activity in which along with local population, the migratory population is also involved in. Therefore, for the present study two variables of population, i.e., migrated and local child rag pickers were taken up as respondents, and it was found that prevalence of minor psychological disorders was more common among local residents i.e., 45.1 percent among local respondents than the migrated population, i.e., 37.5 percent (p=0.02).

Child rag pickers were found with a prevalence of MPD 44.2 percent significantly different who lived in poor material homes and 39.6 percent who lived in bricks homes. Running water facility at home was found in 40 percent homes of the respondents and 60 percent respondents had not. Prevalence of MPD found with the difference in the respondents who have the facility of running water at home 43.3 percent and who do not have 41.7 percent. Electricity found 70 percent in homes of child rag pickers and 30 percent families of child rag pickers were surviving without power. Non-availability of electricity at home significantly affects the prevalence of MPD among child rag picker. It was found to be 40 percent in those who had electricity at home and 48.9 percent (p<0.001) without having the power. Availability of toilet at home was found in 36 percent respondents, and 64 percent were using open places for defecation. Non-availability of the toilet at home plays a significant role in the prevalence of MPD among child rag pickers. Minor psychological disorders were found in 43.7 percent of the respondents under the study, and it was found among those respondents who were using open places for defection. However, among 40.7 percent of the respondents who were using personal toilets, minor psychological disorders were found with a significant difference (p<0.001). Similarly, the respondents who had bathroom facility at home were reported to have lesser percentage, i.e., 40 percent of minor psychological disorder as compared to those who did not have a bathroom with 44.2 percent of the respondents.

Any age group may get affected with mental disorders. However, some groups are more prone to specific problems like children with depression and elders with dementia. Interaction of biological, social, cultural, economic and environmental factors causes mental disorder in human beings. The occurrence of mental disorders appears at an early age in children. Studies have shown the occurrence of MPD among children appear at an early age. Child rag pickers who live in filthy conditions are more vulnerable to MPD as early as the age of six years. There is a high prevalence of MPD among child rag pickers in developing countries (de Silva et al., 2006). As indicated in the data shown above in table, gender also appeals the prevalence of MPD among child rag pickers. High prevalence of MPD is found among female child rag pickers than male child rag pickers in the study. It is globally evident that depression and anxiety disorders are more common among girls than boys (WHO, 2017).

Migration is a common phenomenon among rag pickers. They migrate to big cities within the state and out of state in search of rags. Most of them stay in slums because they do not have any source of housing in the mainstream areas. People living in slums often face scarcity of basic amenities such as housing, water supply, drainage, health care facilities and education. Rapid and unplanned urbanization is a global trend for most of the developing countries including India. It gives birth to worst living conditions for the urban poor population. Residence of a person plays an imperative role in the process of socialization. It affects the socio-cultural life of the individual. Migration brings new challenges for the individual, but in the present study occurrence of MPD among local population was found more than migratory population. It may be due to high involvement of local residents in the present study. Local residents were found to be 68 percent very high compared with 32 percent of the migratory population. Another prominent reason behind low prevalence of MPD among migratory population is that they do not face such adversities in the towns of Patiala district as they have to face in metro cities.

Living place of a person affects the life at large extent. Poor quality of housing and lack of facilities at home make a person psychologically vulnerable. For example, a house without electricity lacks entertainment sources and other basic things such as light in the nights and fan for extreme summers. Lack of availability of water creates difficulty in routine life. Lack of bathroom and toilet makes the person socially vulnerable. Poor quality of housing leads to poor quality of life and sometimes it is reflected in poor mental health and depression which result in pessimism and hopelessness (Hussain and Sharma, 2016). Socio-demographic profile of working children in developing countries impact their psychosocial development largely as a study conducted in Jordan on psychosocial problems of child labor has found negative impacts on their mental and social health. It also suggested that psychoeducational support and problem-solving programs for working children play positive role (Al-Gamal et al., 2013). But these programs seem to be unavailable in case of the developing or underdeveloped countries.

Table: 2. Relation of child rag pickers’ economic, behavioral, and work characteristics with MPD

Monthly income	Overall %	Prevalence	p-value
(a) Less than 2000/-	48.7	50.7	0.003
(b) 2000/- to 4000/-	51.3	35.1	0.003
Level of Education
Illiterate	23.4	45.7	0.015
Below Primary	69.3	44.2
Primary	7.3	18.2
Do You Smoke
Yes	43.3	49.2	0.012
No	56.7	37.6	0.012
Pan
Yes	63.3	44.2	0.001
No	36.7	40	0.001
Tobacco Chewing
Yes	10.7	43.8	0.001
No	89.3	42.5	0.001
Gutka
Yes	38.7	41.4	0.049
No	61.3	43.5	0.049
Do You Drink Alcohol
Yes	30.0	40.0	0.001
No	70.0	43.8	0.001
Physical Injury
Yes	93.3	45.0	0.001
No	6.7	10.0	0.001
Job Satisfaction
Yes	71.3	39.3	0.001
No	28.7	51.2	0.001

Economic status affects the social life of an individual rigorously. The researcher has taken two income groups of child rag pickers-one, who earns below Rs. 2000 per month and another one is who earns between Rs. 2000 to Rs. 4000 per month. As shown in Table 2, the prevalence of MPD was found significantly high, i.e., 50.7 percent among low-income group than 35.1 percent among high income group (p=0.003).

Like income educational level also improves the quality of life. Prevalence of MPD was found significantly different in all levels of education among the respondents in the present study. Prevalence of MPD was found more among illiterate children, i.e., 45 percent, followed by 44.2 percent among the respondents who had attained education below primary and 18.2 percent among those who had completed primary education.

Prevalence of MPD was also seen in the context of deviant behavior among respondents. Deviant behavior taken in the present study included smoking behavior, use of tobacco, gutka and drinking alcohol. Prevalence of MPD was found more among those who were indulged in smoking with 49.2 percent than non-smokers with 37.6 percent (p=0.01). Smoking behavior among child rag pickers enhances the incidence of MPD. It was 23.6 percent more among smokers than non-smokers. Pan chewing also increases the prevalence of MPD among the respondents. The prevalence of MPD was found to be 44.2 percent in those who chew pan and 40 percent (p<0.001) in those who do not. Though 89.3 percent of the respondents said no for tobacco use, yet the habit of tobacco use among child rag pickers enhances their vulnerability to MPD significantly different as it was found 43.8 percent in tobacco users and 42.5 percent in non-users. Prevalence of MPD among gutka users was found slightly low 41.4 percent than non-user 43.5 percent.

The habit of drinking alcohol was found to be 30 percent in child rag pickers, but they are not regular users. Most of them drink only during occasions or festivals. Prevalence of MPD was found high 43.8 percent in non-users than users 40 percent (p<0.001).

A large portion of child rag pickers as 93.3 percent had been injured during work. MPD among injured respondents was found extremely high as 45 percent and only 10 percent (p<0.001) among those who have not get injured. Job satisfaction also affects the prevalence of MPD among child rag pickers. Prevalence was found significant high among those who are dissatisfied with work as 51.2 percent and low as 39.3 percent who are working with satisfaction (p<0.001).

Income plays a vital role in shaping the quality of life of an individual. Sufficient earning supports for leading a good life. It is shown in the study that the prevalence of MPD differs with high and low income among child rag pickers. Rag pickers are marginalized people surviving on least resources. Their expectations about income are very low because they do not think beyond the earnings of garbage. It is seen in the opinion of collectors in Leo´n a westren city of Nicaragua, 95 dollars (about three dollars a day) is a sufficient monthly wage for a full-time job. More than half of the respondents earn less than 40 dollars a month. They expect almost double of resources they had. It was perceived that when the rag pickers were asked for sufficient amounts for leading a happy life they generally base their answers on their disposable income at that time and increase it to some extent, regardless of the absolute level of income Vázquez (2013). But low income is linked with mental disorders as a review study conducted by Lund et al. in (2016) showed a relatively consistent positive association between low income and common mental disorders.

Majority of the child rag pickers are school dropouts due to poor socio-economic status. Illiteracy among rag pickers is found around the world as findings of Vázquez (2013) has shown a low level of education among rag pickers as only 16 percent had completed primary education and 33 percent collectors were unable to read or write. It is apparent that education brings positive changes and is helpful in maintaining a good lifestyle but illiteracy deteriorates the living standard. Same is happening among the child rag pickers as the prevalence of MPD was found high among illiterate and low educated children.

Child rag pickers are involved in several deviances due to the working environment. It was observed that rag picking brought negative behavior among 87 percent of girl child rag pickers (Soni, 2014). Majority of child rag pickers are involved in bad habits of smoking, pan chewing, and gutka and tobacco chewing and even in drinking alcohol. A study conducted by G.R. Sethi (2004) with children of Delhi working on the streets shows that almost 90 percent are addicted to smoking, chewing tobacco and gutka. Ganja is the second commonest addiction. About 75 percent consume alcohol which is available in poly-packs costing Rs. 15 to 25. Addiction causes various physical and mental problems. It is observed in the study that the prevalence of MPD was found more among smokers, pan and tobacco users but was slightly low in gutka and alcohol users.

Rag picking is most unhygienic work due to which child rag pickers are prone to skin diseases, accidents, cuts and injuries of different kinds. However, no permanent disability was seen in child rag pickers other than cuts and injuries, but skin infections, respiratory problems, and body ache were prevailed amongst them. Most of the children, i.e., 75 percent in the study reported accidents during work (Soni, 2014). Physical injuries lead to mental problems as MPD prevalence was found significant high as 45 percent among injured children.

The study found 71.3 percent satisfied children with rag picking. It is observed that people involved in rag picking are usually satisfied. Study conducted by George Ann in 2015 indicated job satisfaction among women rag pickers of Kerala (India). However, the women rag pickers were engaged in the dirtiest and unfreedom job. Still, 60.3 percent respondents under the study reported rag picking as a satisfied job. The present study also shows that job satisfaction of child rag pickers decreases the incidence of MPD and dissatisfaction increases it.

CONCLUSION:

Psycho-social problems are significantly present among the child rag pickers. Minor Psychological Disorders as (MPD) are more prevalent among female rag pickers as compared to their male counterparts. Living conditions regarding the presence of household material and bathroom, toilets and electricity also significantly affect their mental ill-being. Apart from this their economic condition and exposure to bad habits lead to poor mental and physical health. Some peculiarities have found in the mental state of rag pickers of small-town vis-a-vis rag pickers of big cities. Overall we find a high prevalence of MPD among child rag pickers as compared to children in other labor activities. It makes this category of child workers as more needful to some conscientious social effort to ameliorate their condition.

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Received on 07.11.2017 Modified on 21.11.2017

Int. J. Ad. Social Sciences. 2017; 5(4):211-216.