Disability, discrimination and mental health concerns among young women living in urban poverty: empirical analyses of the TOPOWA study

Discrimination against individuals with disabilities are increasingly recognized as a major global health concern, especially in low-resource settings like the urban slums of Uganda, where access to mental health services is limited. This study aimed to assess the prevalence of disability, its association with experiences of discrimination and mental health concerns among young women living in urban slums. The goal was to identify the need for community-based mental health interventions and support systems for women with disabilities. Data from the 2023 baseline assessment from the ongoing “The Onward Project On Wellbeing and Adversity” (TOPOWA) cohort was analyzed. This study of 300 young women, aged 18 to 24 years in Kampala’s urban slums, assesses mental health concerns in relation to social determinants and their lived experiences. Women were recruited from three study sites: Banda, Bwaise, and Makindye. Data collection included disability status, experiences of discrimination and key mental health outcomes including anxiety, psychological distress, and suicidal ideation, along with overall quality of life ratings. Cross-sectional bivariate analyses and multivariable linear regression were conducted to investigate the associations between disability and discrimination with mental health outcomes and quality of life. Overall, 14% of women in the study reported having a disability, with 66.7% of those women experiencing limitations in daily activities for fewer than 7 days in the past month. Emotional impacts of health issues were the most severe form of disability reported, while physical limitations like difficulty dressing were the least prevalent. Women with disabilities were more likely to report discrimination across various domains, including unfair treatment in the neighborhood and employment, and experienced higher levels of suicidal ideation and lower quality of life. Women who experienced major discrimination had lower quality of life, higher anxiety, psychological distress, and more suicidal ideation. The strong association between disability and discrimination is linked to mental health concerns, particularly anxiety, psychological distress, and suicidality, and overall quality of life. These findings emphasize the urgent need for targeted interventions that simultaneously address major discrimination, reduce stigma, promote mental health, and enhance quality of life for women living with disabilities in Kampala’s urban slums.