MUSCAT// With her index finger, Rahma Owaisi traces a jagged scar that snakes across her left wrist and shudders as she remembers the night she nearly tried to commit suicide for a third time.
After six years of being married to a man she said abused her, Ms Owaisi, 33, a mother of two, was severely depressed.
She had already twice slashed at her wrists in the previous months.
She fidgets on her chair, smooths out her black abaya and forces a smile to show the ordeal has not left a permanent scar on her life, but her eyes suggest she has yet come to terms with her past. Hospital sees 20% rise in women
"It was then I decided there wouldn't be the third time. I just walked out of the house and asked for the divorce later," Mrs Owaisi said.
Her case, while extreme, serves to highlight the growing problem of depression among women in the sultanate known mostly for its rugged mountain ranges and slow pace of life.
Doctors at the Sultan Qaboos University Hospital announced last week that they diagnosed 2,200 women with depression last year, up from 1,800 in 2009, an increase of more than 20 per cent.
A majority of those diagnosed with depression last year - 65 per cent - complained of failed or failing marriages, said the doctors at Muscat's main teaching hospital.
Most of the others were single women between the ages of 18 and 24.
Rahma, whose husband, she said, "was angry instead of finding the cause of my problem", was one of the lucky ones.
She received help and a year later she remarried, this time to a colleague at the engineering firm where she works. She is grateful that her second husband accepted her two children, and the couple are expecting their first child together.
A psychiatry resident at the hospital, Dr Ghaniya al Ghafri, said most of the depressed patients she saw have "bad marriages or broken romances".
Divorce is still very much stigmatised in the culturally conservative sultanate, which does not keep statistics on divorce rates.
For that reason, many women, even ones who had graduated from university and consider themslves progressive, chose to remain in bad marriages, said Dr Laila al Lawati, a psychologist for the ministry of health.
"A woman gets married, produces children, looks after her husband and is stuck with him forever even if he cheats her. You are also expected to get married to a man your parents choose for you. Very few young girls dare refuse their parents."
Many, said Aisha Al Harthy, a social worker at the ministry, also feared they would struggle to find another husband.
"They would rather succumb to depression than get a divorce because their parents would not welcome them back.
"Even the working women who can look after themselves don't seek divorces because our society doesn't accept divorced women. They would find a second marriage hard to come by because Omani men preferred unmarried women with no children," she said.
Aisha Nabhani toys with her cappuccino cup with one hand and twirls her hair with another as she gazes out at the street from her seat at a roadside cafe in Muscat. She narrows her eyes and with a defiant tone just discernible above the traffic describes how she is one of few young women she knows who has dared to challenge her parents' decision to reject her choice of husband.
That was nine months ago. Doctors tell Miss Nabhani, 26, who has a degree in human resources management, that she has been clinically depressed since then.
"My parents did not want me to marry a man who was not a graduate like me and who came from a poor family," Miss Nabhani said.
"I have also rejected a man they chose for me. I am still hopeful one day I will get married to the man of my choice. How and when, I don't know."
Social workers say they are aware of the problem of depression among women, which is not altogether new. A rare study in the 1990s by Sultan Qaboos University found that more than one in five of patients admitted to emergency wards for ingesting pills in suicide attempts were married women.
The response of social workers has been to call for local community centres to establish support groups and invite psychologists to talk to women.
Jamila al Zaraée, a social worker at the ministry of social development who regularly visits women in their homes, said: "When these women get together and knowing that an expert will listen to them, say once a month, then they would know that they don't need to fight it alone.
"We can see the strenuous relationship some of these women have with their husbands which makes them unable to cope with properly raising their children. They put up with it because their parents would insist that they solve their own marital problems," Ms Zaraée said.
Faiza Zadjali, a committee member of Seeb Women Association in Muscat, said while such visits might prove useful, the underlying issue is deep-seated cultural values and expectations.
"We can have special units for visiting psychologists to talk to members but these women must overcome traditional and society challenges to avoid depression," she said.