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Abstract Introduction Depression remains a significant public health issue exacerbated by geopolitical uncertainty and socioeconomic vulnerability. We conducted this study to examine the prevalence of depressive symptoms, and explore the factors influencing mental healthcare access in Kashmir. Methods We conducted a mixed-methods study employing a sequential explanatory design (quant-QUAL). A preliminary cross-sectional survey of 420 adults sampled from Budgam district, Kashmir was conducted to assess depressive symptoms using the patient health questionnaire-9 (PHQ-9). The qualitative phase followed included in-depth interviews of 17 (8 survey participants with moderate-to-severe depressive symptoms, and 9 key informants) purposively sampled participants. Survey data was descriptively analyzed, qualitative interviews were deductively coded to generate themes. Results Moderate to severe depressive symptoms were found in 14.3% of sample, and 9.3% reported thoughts of self-harm in the past two weeks. Female participants (16.4%), participants with chronic conditions (24.4%), and those reporting tobacco use (29.3%) reported higher prevalence of moderate to severe depressive symptoms. Qualitative analysis yielded four themes including (i) fear, uncertainty and trauma driving poor mental health, (ii) depression-substance use syndemic, (iii) availability and affordability of mental healthcare, (iv) stigma & lack of awareness. Conclusion Geopolitical environment coupled with poor mental healthcare access aggravates depression in Kashmir. Multi-layered interventions including building sense of security, addressing socio-economic divide, reducing stigma, strengthening mental healthcare support systems are required.
Zainab et al. (Wed,) studied this question.