Totally 380 people who were attending holy water took part in the quantitative study; this made the response rate 95.5%. In the qualitative study, fifteen participants (five religious leaders and ten holy water visitors) were recruited for the in-depth interview.
Socio-economic characteristics: The mean age (standard deviation) of participants was 30 (+12.8) years with a range of 18 to 90 years. About 28.7% of the participants were young who lie in the age group of 20 to 24 years. In addition, 63.9% and 81.6% were females and urban dwellers, respectively. (Table 1)
Common Mental Disorders: About 147 participants screened positive on SRQ; thus the prevalence of screened common mental disorders was 38.7% (95% CI (33.8% - 43.2%)). The prevalence was 81%, 62.8% and 61.4% among divorced, rural and illiterate participants respectively. Among the 20 symptoms screened, the most commonly reported were a headache (57.6%), a feeling of easily tired (45.3%) and nervousness (43.2%). [Fig 1 and 2]
In the in-depth interview, however, the commonest symptoms described by holy water visitors as clinical features of mental illness were abnormal/disorganized behaviour, disorganized speech, talking and laughing alone, poor self-care practice and social withdrawal.
Bio-psycho-social Factors: About 23.7%, 38.7%, and 11.6% lived out of their family (alone or with the relatives), had poor social support and had a chronic physical illness, respectively. In addition, 5.5% were currently using alcohol (Table 2).
Perceived causes of mental illness: More than half of the participants believed on traditional beliefs as a cause of mental illness. From thus, poor or absence of religious rituals, an evil spirit and personal sin accounted 63.7%, 60.8%, and 55.3% respectively (Fig 3). From the qualitative study, two participants (priests aged 38 years and 43 years old) who provided holy water service said mental illness could be a result of a sinful act. And such sinful acts, according to the priests, are due to poor religious rituals of people.
Help seeking behaviour: all people preferred healing with holy water to mental health problems, and 77% had sought other modes of treatment besides holy water. The mean duration of follow-up was 61 days. Among those screened positive to CMD, 86.3% were following the holy water from home, and the holy water provides institutionalized service to 13.4%.
In the in-depth interview, most participants said holy water had superior efficacy to treat common mental disorders than modern treatment. And they insisted not to take modern treatment together with holy water treatment. Because, they believed taking medication together with the holy water might show the individual's poor belief in God's power to treatment.
But, a 50 years old priest disagrees with the above statement. He said, "combining both modern treatment and a spiritual help has no problem.” Because, he added “God can use different mechanisms to help people; one mechanism could be modern approaches.” This priest stated, “Apostle Luke was a physician who treated people using medications, so, we can't say taking medicine is a sinful behavior."
Another priest, age 40 years, described that the help sought from spiritual areas differed from a medical help. He said, "Medical help can benefit a person who develops stress following a known stressor. A spiritual help, on the other hand, can be more beneficial for a person who involved in a sinful act and who become depressed.”
Reported reasons to visit the holy water were a religious purpose, a physical illness and a mental illness for 68.7%, 19.2%, and 12.1% respectively. Among those who reported having a mental health problem, with the holy water service 19.6% stated having no progress; whereas about 34.8% and 45.6% of the participants stated good and very good progress, respectively. On the in-depth interview, all priests reported that common mental disorders had become the commonest reason to visit the holy water.
Factors Associated with Common mental disorders
Those variables with a p-value of 0.2 and less in the binary logistic regression were selected for multivariate analysis. The final analysis reveals that lower educational level showed significant association with common mental disorders as compared to tertiary and above level of education ((no formal education, (AOR=3.2, 95% CI; 1.28, 6.91)); (can read and write, AOR= 2.8(95% CI; 1.0, 7.07)).
Participants who had a serious conflict in the family in one-year period (to data collection time) were more likely to develop common mental disorders (AOR= 3.82 (95% CI; 1.89, 7.68)). Also those who believed poor/no religious rituals can cause mental illness were twice more likely to develop common mental disorders (AOR= 2.33(95% CI; 1.43, 3.79)). Women were more likely to develop common mental disorders than males (AOR= 1.68 (95% CI; 1.04, 2.72)) [Table 3].