London, Nov 30 (IANS): Inequality and social exclusion are the primary factors driving mental health problems in Uttarakhand, says a study by a researcher at Umea University in Sweden.

The survey of nearly 1,000 households in the Indian state showed that six percent of adults were identified as depressed.

People were two or three times more likely to be depressed if they were from the most socially oppressed castes, had taken a recent loan, lived in poor quality housing or had not completed primary school, said the study by mental health researcher Kaaren Mathias.

Mathias has focused over the last four years on how communities in the northern Indian states of Uttarakhand and Uttar Pradesh can promote, prevent and treat mental health.

"I was surprised to find such a strong relationship between social disadvantage and mental illness," said Mathias, who lives in India, where she works as a mental health programme manager with the New Delhi-based non-profit Emmanuel Hospital Association.

"People who had not completed primary school were nearly four times more likely to be depressed than those who had completed high school," Mathias said in a statement released by Umea University.

The study found that nearly all people with mental distress had experienced social exclusion and many had experienced economic, verbal and physical violence.

Gender inequality is one of the most significant social factors impacting mental health competency as it leads to a heavier load in caregiving, impoverishment and experiences of violence for women caregivers, the study said.

"Bringing together the findings from this research, I picture community mental health competence using the picture of a tree, where all parts are organically connected. The roots are the many social factors affecting mental health," Mathias said.