Skip to main content

Advertisement

SpringerLink
Log in

Conflict and mental health: a cross-sectional epidemiological study in Nepal

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this epidemiological study was to identify prevalence rates of mental health problems, factors associated with poor mental health and protective and risk factors in a post-conflict situation in Nepal.

Methods

This cross-sectional study was conducted among 720 adults in 2008. A three-stage sampling procedure was used following a proportionate stratified random sampling strategy. The outcome measures used in the study were locally validated with Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Post-Traumatic Stress Disorder (PTSD)—Civilian Version (PCL-C) and locally constructed function impairment scale, resources and coping.

Results

Of the sample, 27.5 % met threshold for depression, 22.9 % for anxiety, and 9.6 % for PTSD. Prevalence rates were higher among women (depression, OR 2.14 [1.52–3.47]; anxiety, OR 2.30 [1.45–3.17] and PTSD, OR 3.32 [1.87–5.89]) and older age categories (depression, OR 1.02 [1.01–1.04]; anxiety, OR 1.04 [1.03–1.05] and PTSD, OR 1.02 [1.0–1.03]). Respondents who perceived more negative impact of the conflict (e.g., hampered the business/industry; hindered in getting medical treatment, etc.) in their communities were more at risk for depression (OR 1.1 [1.06–1.14]), anxiety (OR 1.05 [1.01–1.09]) and PTSD (OR 1.09 [1.04–1.14]). Other risk factors identified in the study were ethnicity, district of residence and poverty (lack of clothing, medicine and information via radio at home).

Conclusion

Overall, the prevalence rates of depression and anxiety in the sample are comparable to, or lower than, other studies conducted with populations affected by conflict and with refugees. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict rural Nepal, especially for marginalized populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thapa D, Sijapati B (2004) A kingdom under siege: Nepal’s Maoist insurgency 1996 to 2003. The Print house, Kathmandu

    Google Scholar 

  2. Tol WA, Kohrt BA, Jordans MJD, Thapa SB, Pettigrew J, Upadhaya N, de Jong JTVM (2010) Political violence and mental health: a multi-disciplinary review of the literature on Nepal. Soc Sci Med 70:35–44

    Article  PubMed  Google Scholar 

  3. International Crisis Group Nepal (2010) Peace and Justice Crisis Group Asia Report N 184. ICGN, Katmandu

    Google Scholar 

  4. Singh S, Dahal K, Mills E (2005) Nepal’s war on human rights: a summit higher than Everest. Int J Equity Health 4:9. doi:10.1186/1475-9276-4

    Article  PubMed  Google Scholar 

  5. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al (2007) No health without mental health. Lancet 370:859–877

    Article  PubMed  Google Scholar 

  6. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, Van Ommeren M (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302:537–549

    Article  PubMed  CAS  Google Scholar 

  7. Van Ommeren M, De Jong JTVM, Sharma B, Komproe IH, Thapa SB, Cardena E (2001) Psychiatric disorders among tortured Bhutanese refugees in Nepal. Arch Gen Psychiat 58:475–482

    Article  PubMed  Google Scholar 

  8. Shrestha NM, Sharma B, Van Ommeren M, Regmi S, Makaju R, Komproe IH et al (1998) Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal. JAMA 280:443–448

    Article  PubMed  CAS  Google Scholar 

  9. De Jong JTVM, Komproe IH, Van Ommeren M (2003) Common mental disorders in four post-conflict settings. Lancet 361:2128–2130

    Article  PubMed  Google Scholar 

  10. Cardozo BL, Bilukha OO, Gotway CA, Shaikh I, Wolfi MI et al (2004) Mental health, social functioning, and disability in postwar Afghanistan. JAMA 292:575–584

    Article  PubMed  Google Scholar 

  11. Roberts B, Ocaka KF, Browne J, Oyok T, Sondorp E (2008) Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC Psychiatry 8:38

    Article  PubMed  Google Scholar 

  12. Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N et al (2009) Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol 36:261–280

    Article  PubMed  Google Scholar 

  13. Thapa SB, Hauff E (2005) Psychological distress among displaced persons during an armed conflict in Nepal. Soc Psychiatry Psychiatr Epidemiol 40:672–679

    Article  PubMed  Google Scholar 

  14. Tol WA, Komproe IH, Thapa SB, Jordans MJD, Sharma B, De Jong JTVM (2007) Disability associated with psychiatric symptoms among torture survivors in rural Nepal. J Nerv Ment Dis 195:463–469

    Article  PubMed  Google Scholar 

  15. Kohrt BA, Jordans MJD, Tol WA, Speckman RA, Maharjan SM, Worthman CM, Komproe IH (2008) Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. JAMA 300:691–702

    Article  PubMed  CAS  Google Scholar 

  16. World Health Organization (WHO) (2006) Mental health system in Nepal. Ministry of Health and Population Nepal, Kathmandu

    Google Scholar 

  17. INSEC. Fact Sheet: Number of Victims Killed by State and Maoist in Connection with the “People’s War” (12 Feb 1996–31 Dec 2006). 2008; 2009 (April 1). http://www.inseconline.org/

  18. Bista DB, Nepal (1967) People of Nepal (lst edn.) Department of Publicity, Ministry of Information and Broadcasting, Kathmandu

  19. Kohrt BA, Kunz RD, Koirala NR, Sharma VD, Nepal MK (2002) Validation of a Nepali version of the Beck Depression Inventory. Nepalese J Psychiatry 2:123–130

    Google Scholar 

  20. Kohrt BA, Kunz RD, Koirala NR, Sharma VD, Nepal MK (2003) Validation of the Nepali version of the Beck Anxiety Inventory. J Institute Med 25:1–4

    Google Scholar 

  21. WHO (2001) Disability Assessment Schedule II (WHODAS II). http://www.who.int/icidh/whodas/ index.html (Accessed: 25-03-2011)

  22. Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiat 4:561–571

    Article  PubMed  CAS  Google Scholar 

  23. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psych 56:893–897

    Article  CAS  Google Scholar 

  24. Weathers F, Litz BT, Huska IA, Keane TM (1994) The PTSD Checklist-Civilian Version (PCL-C). The National Center for PTSD, Boston VA Medical Center

  25. Bolton P, Tang AM (2002) An alternative approach to cross-cultural function assessment. Soc Psychiatry Psychiatr Epidemiol 37:537–543

    Article  PubMed  Google Scholar 

  26. Kohrt BA, Hruschka DJ, Worthman CM, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Koirala S, Thapa S, Tol WA, Jordans MJD, Robkin N, Sharma VD, Nepal MK (2012) Political violence and mental health in Nepal: prospective study. Br J Psychiatry. doi:10.1192/bjp.bp.111.096222

  27. Somasundaram D, Jamunanatha CS (2002) Psychosocial consequences of war: northern Sri Lankan experience. Mass violence and mental health: recent epidemiological findings. Int Rev Psychiatr 19:183–192

    Google Scholar 

  28. Danielle Rodin, Van Ommeren M (2009) Commentary: explaining enormous variations in rates of disorder in trauma-focused psychiatric epidemiology after major emergencies. Int J Epidemiol 38:1045–1048

    Article  Google Scholar 

  29. Kohrt BA, Hruschka DJ (2010) Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Cult Med Psychiat 34:322–352

    Article  Google Scholar 

  30. Murthy SR, Lakshminarayani R (2006) Mental health consequences of war: a brief review of research findings. World Psychiatry 5:25–32

    PubMed  Google Scholar 

  31. Farhood L, Dimassi H (2012) Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon. Soc Psychiatry Psychiatr Epidemiol 47:639–649

    Article  PubMed  Google Scholar 

  32. Kohrt BA, Worthman CM (2009) Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence. CNS Neurosci Ther 15:237–248

    Article  PubMed  Google Scholar 

  33. Human Rights Watch (2004) Between a rock and a hard place: Civilians struggle to survive in Nepal’s civil war, pp 26–55

  34. Ministry of Health and Population (MOHP) (2009) Nepal Maternal Mortality and Morbidity Study, 2008/09. MOHP, Kathmandu

    Google Scholar 

  35. Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR (2008) Social determinants of psychological distress in a nationally-reprehensive sample of South African adults. Soc Sci Med 66:1828–1840

    Article  PubMed  Google Scholar 

  36. Kohrt BA (2009) Vulnerable social groups in post-conflict settings: a mixed-methods policy analysis and epidemiology study of caste and psychological morbidity in Nepal. Intervention 7:239–264

    Article  Google Scholar 

  37. Informal Sector Service Centre (INSEC) (2011) http://www.docstoc.com/docs/45776520/Informal-Sector-Service-Centre(INSEC)-PO-Box-2726-Kathmandu-Nepal (Accessed: 25-03-2011)

  38. Emmelkamp J, Komproe IH, Van Ommeren M, Schagen S (2002) The relation between coping, social support and psychological and somatic symptoms among torture survivors in Nepal. Psychol Med 32:1465–1470

    Article  PubMed  CAS  Google Scholar 

  39. Mollica RF, Caridad KR, Massagli MP (2007) Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees. J Nerv Ment Dis 195:572–579

    Article  PubMed  Google Scholar 

  40. Eytan A, Guthmiller A et al (2011) Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 46:953–963

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was implemented through a partnership between Transcultural Psychosocial Organization (TPO) Nepal and Centre for Victim of Torture (CVICT). We thank Dr. Duncan Pederson and Dr. Laurence Kirmayer for their contributions to this study. We also thank Mr. Nawaraj Upadhaya, Santosh K. Shah and the research staff of TPO Nepal and CVICT Nepal for their support. This study has been made possible with the financial support from Douglas Mental Health University Institute Canada.

Conflict of interest

The authors declare that they have no competing interest.

Author information

Authors and Affiliations

  1. Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal

    Nagendra P. Luitel, Mark J. D. Jordans & Brandon A. Kohrt

  2. Department of Research and Development, Healthnet TPO, Amsterdam, The Netherlands

    Mark J. D. Jordans, Wietse A. Tol & Ivan H. Komproe

  3. Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK

    Mark J. D. Jordans

  4. Centre for Victims of Torture (CVICT), Kathmandu, Nepal

    Ram P. Sapkota & Bhogendra Sharma

  5. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA

    Wietse A. Tol

  6. Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine, Washington, DC, USA

    Brandon A. Kohrt

  7. Institute of Psychiatry, University of Oslo, Oslo, Norway

    Suraj B. Thapa

  8. Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands

    Ivan H. Komproe

Authors
  1. Nagendra P. Luitel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark J. D. Jordans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ram P. Sapkota
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wietse A. Tol
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brandon A. Kohrt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suraj B. Thapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ivan H. Komproe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bhogendra Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nagendra P. Luitel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luitel, N.P., Jordans, M.J.D., Sapkota, R.P. et al. Conflict and mental health: a cross-sectional epidemiological study in Nepal. Soc Psychiatry Psychiatr Epidemiol 48, 183–193 (2013). https://doi.org/10.1007/s00127-012-0539-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-012-0539-0

Keywords

Search

Navigation