Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 10, pp 1537–1545 | Cite as

Associations between the social organization of communities and psychiatric disorders in rural Asia

  • William G. AxinnEmail author
  • Dirgha J. Ghimire
  • Nathalie E. Williams
  • Kate M. Scott
Original Paper



We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health.


Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level-controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders.


Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups.


Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population.


Anxiety disorders Depression Post-traumatic stress disorder (PTSD) Intermittent explosive disorder (IED) Mental health Rural Asia Social organization 



Funding was provided by the University of Michigan (UM) Population Studies Center Small Grant program, the UM Global Health Research and Training Initiative (Grant #5 R25 TW007496-03) and NICHD (R24 HD041028). The authors thank Cathy Sun and Nancy Sampson for assistance creating analysis files, constructing measures and conducting analyses. The authors also thank Jennifer Mamer, Austin Kozlowski and Armani Hawes for assistance in preparing this manuscript, ISER-N staff, and residents of the Western Chitwan Valley for their contributions to the research reported here. The authors alone remain responsible for any errors or omissions.

Conflict of interest

Dr. Ghimire is also the Director of the Institute for Social and Environmental Research in Nepal (ISER-N) that collected the data for the research reported here. Dr. Ghimire’s conflict of interest management plan is approved and monitored by the Regents of the University of Michigan.

Ethical standard

Ethical approval for the protection of human subjects was received from UM’s Internal Review Board (FWA00004969) and from ISER-N’s Institutional Review Board (IRB00002109 and Federal Wide Assurance FWA00004864).


  1. 1.
    Herrman H, Swartz L (2007) Promotion of mental health in poorly resourced countries. Lancet 370(9594):1195–1197CrossRefPubMedGoogle Scholar
  2. 2.
    Kessler RC, Üstün TB (2008) The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, New YorkGoogle Scholar
  3. 3.
    Neria Y, Galea S, Norris FH (2009) Mental health and disasters. Cambridge University Press, Cambridge, MAGoogle Scholar
  4. 4.
    Frankenberg E, Friedman J, Gillespie T, Ingwersen N, Pynoos R, Rifai IU, Sikoki B, Steinberg A, Sumantri C, Suriastini W (2008) Mental health in Sumatra after the tsunami. Am J Public Health 98(9):1671–1677PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Gureje O, Uwakwe R, Oladeji B, Makanjuola VO, Esan O (2010) Depression in adult Nigerians: results from the Nigerian survey of mental health and well-being. J Affect Disord 120:158–164CrossRefPubMedGoogle Scholar
  6. 6.
    Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN, Nasser SC, Chatterji S, Kessler RC (2008) Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war. PLoS Med 5(4):e61PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Cardozo BL, Bilukha OO, Crawford CAG, Shaikh I, Wolfe MI, Gerber ML, Anderson M (2004) Mental health, social functioning, and disability in postwar Afghanistan. J Am Med Assoc 292(5):575–584CrossRefGoogle Scholar
  8. 8.
    Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR (2008) Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med 66(8):1828–1840PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Sonis J, Gibson JL, de Jong JTVM, Field NP, Hean S, Komproe I (2009) Probable posttraumatic stress disorder and disability in Cambodia: associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials. J Am Med Assoc 302(5):527–536CrossRefGoogle Scholar
  10. 10.
    Williams SL, Williams DR, Stein DJ, Seedat S, Jackson PB, Moomal H (2007) Multiple traumatic events and psychological distress: the South Africa stress and health study. J Trauma Stress 20(5):845–855PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Coleman JS (1990) Foundations of social theory. Harvard University Press, Cambridge, MAGoogle Scholar
  12. 12.
    Durkheim E (1897/1951) Suicide: a study in sociology. Free Press, New YorkGoogle Scholar
  13. 13.
    Haidt J (2006) The happiness hypothesis: finding modern truth in ancient wisdom. Basic Books, New YorkGoogle Scholar
  14. 14.
    Axinn WG, Yabiku ST (2001) Social change, the social organization of families, and fertility limitation. Am J Sociol 106(5):1219–1261CrossRefGoogle Scholar
  15. 15.
    De Silva MJ, McKenzie K, Harpham T, Huttly SR (2005) Social capital and mental illness: a systematic review. J Epidemiol Community Health 59(8):619–627PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    House JS (1981) Work, stress and social support. Addison Wesley, Reading, MAGoogle Scholar
  17. 17.
    Turner RJ (1981) Social support as a contingency in psychological well-being. J Health Soc Behav 22(4):357–367CrossRefGoogle Scholar
  18. 18.
    Turner JR, Frankel GB, Levin DM (1983) Social support: conceptualization, measurement, and implications for mental health. Res Community Ment Health 3:67–111Google Scholar
  19. 19.
    Leslie E, Cerin E (2008) Are perceptions of the local environment related to neighbourhood satisfaction and mental health in adults? Prev Med 47(3):273–278CrossRefPubMedGoogle Scholar
  20. 20.
    De Silva MJ, Huttly SR, Harpham T, Kenward MG (2007) Social capital and mental health: a comparative analysis of four low income countries. Soc Sci Med 64(1):5–20CrossRefPubMedGoogle Scholar
  21. 21.
    Smith-Greenaway E (2013) Maternal reading skills and child mortality in Nigeria: a reassessment of why education matters. Demography 50(5):1551–1561PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Axinn WG, Barber JS (2001) Mass education and fertility transition. Am Sociol Rev 66(4):481–505CrossRefGoogle Scholar
  23. 23.
    Barber JS, Axinn WG (2004) New ideas and fertility limitation: the role of mass media. J Marriage Fam 66(5):1180–1200CrossRefGoogle Scholar
  24. 24.
    Ghimire Dirgha J, Axinn William G, Yabiku Scott T, Thornton A (2006) Social change, premarital nonfamily experience, and spouse choice in an arranged marriage society. Am J Sociol 111(4):1181–1218CrossRefGoogle Scholar
  25. 25.
    Yabiku ST (2005) The effect of non-family experiences on age of marriage in a setting of rapid social change. Popul Stud 59(3):339–354CrossRefGoogle Scholar
  26. 26.
    Yabiku ST (2004) Marriage timing in Nepal: organizational effects and individual mechanisms. Soc Forces 83(2):559–586CrossRefGoogle Scholar
  27. 27.
    Axinn WG, Ghimire DJ (2011) Social organization, population, and land use. Am J Sociol 117(1):209PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Williams NE, Ghimire DJ, Axinn WG, Jennings EA, Pradhan MS (2012) A micro-level event-centered approach to investigating armed conflict and population responses. Demography 49(4):1521–1546PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Axinn WG, Ghimire DJ, Williams NE, Scott KM (2013) Gender, traumatic events, and mental health disorders in a rural Asian setting. J Health Soc Behav 54(4):444–461PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Ghimire DJ, Chardoul S, Kessler RC, Axinn WG, Adhikari BP (2013) Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal. Int J Methods Psychiatr Res 22(1):71–81PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Axinn WG, Barber JS, Ghimire DJ (1997) The neighborhood history calendar: a data collection method designed for dynamic multilevel modeling. Sociol Methodol 27(1):355–392CrossRefPubMedGoogle Scholar
  32. 32.
    Axinn WG, Pearce LD (2006) Mixed method data collection strategies. Cambridge University Press, New YorkCrossRefGoogle Scholar
  33. 33.
    Horwitz AV, White HR, Howell-White S (1996) Becoming married and mental health: a longitudinal study of a cohort of young adults. J Marriage Fam 58(4):895–907CrossRefGoogle Scholar
  34. 34.
    Lamb KA, Lee GR, DeMaris A (2003) Union formation and depression: selection and relationship effects. J Marriage Fam 65(4):953–962CrossRefGoogle Scholar
  35. 35.
    Simon RW (2002) Revisiting the relationships among gender, marital status, and mental health. Am J Sociol 107(4):1065–1096CrossRefPubMedGoogle Scholar
  36. 36.
    Stack S, Eshleman JR (1998) Marital status and happiness: a 17-nation study. J Marriage Fam 60(2):527–536CrossRefGoogle Scholar
  37. 37.
    Williams K (2003) Has the future of marriage arrived? A contemporary examination of gender, marriage, and psychological well-being. J Health Soc Behav 44(4):470–487PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Dressler WW (1985) Extended family relationships, social support, and mental health in a southern black community. J Health Soc Behav 26(1):39–48CrossRefPubMedGoogle Scholar
  39. 39.
    Mowbray CT, Bybee D, Hollingsworth L, Goodkind S, Oyserman D (2005) Living arrangements and social support: effects on the well-being of mothers with mental illness. Social Work Res 29(1):41–55CrossRefGoogle Scholar
  40. 40.
    Barber JS, Pearce LD, Chaudhury I, Gurung S (2002) Voluntary associations and fertility limitation. Soc Forces 80(4):1369–1401CrossRefGoogle Scholar
  41. 41.
    Brauner-Otto SR, Axinn WG, Ghimire DJ (2007) The spread of health services and fertility transition. Demography 44(4):747–770CrossRefPubMedGoogle Scholar
  42. 42.
    Yabiku ST (2006) Neighbors and neighborhoods: effects on marriage timing. Popul Res Policy Rev 25(4):305–327CrossRefGoogle Scholar
  43. 43.
    Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Aguilar-Gaxiola S, Alhamzawi AO, Alonso J, Angermeyer M (2010) Childhood adversities and adult psychopathology in the WHO world mental health surveys. Br J Psychiatry 197(5):378–385PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Scott KM, Von Korff M, Angermeyer MC, Benjet C, Bruffaerts R, de Girolamo G, Haro JM, Lepine J-P, Ormel J, Posada-Villa J (2011) Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry 68(8):838–844PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Scott K, Kokaua J, Baxter J (2011) Does having a chronic physical condition affect the likelihood of treatment seeking for a mental health problem and does this vary by ethnicity. Int J Psychiatry Med 42(4):421–436PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere K, de Girolamo G, Haro JM, Jin R (2009) Cross-national associations between gender and mental disorders in the WHO world mental health surveys. Arch Gen Psychiatry 66(7):785–795PubMedCentralCrossRefPubMedGoogle Scholar
  47. 47.
    Axinn WG, Scott KM, Chardoul SA (Forthcoming) The demography of mental health. In: Friedman H (ed) Encyclopedia of mental health, 2nd edn. Academic Press, New YorkGoogle Scholar
  48. 48.
    Barber JS, Murphy SA, Axinn WG, Maples JJ (2000) Discrete-time multilevel hazard analysis. Sociol Methodol 30(1):201–235CrossRefGoogle Scholar
  49. 49.
    Maples JJ, Murphy SA, Axinn WG (2002) Two-level proportional hazards models. Biometrics 58(4):754–763CrossRefPubMedGoogle Scholar
  50. 50.
    Ghimire DJ, Axinn WG (2013) Impact of the spread of mass education on domestic violence against wives. Paper presented at International Union for the Scientific Study of Population, August 26–31, Busan, Republic of KoreaGoogle Scholar
  51. 51.
    Thornton A, Lin H-S (1994) Social change and the family in Taiwan. University of Chicago Press, Chicago, ILGoogle Scholar
  52. 52.
    Ogburn WF, Tibbits C (1934) The family and its function. In: Ross EA (ed) The principles of sociology. Holt, New York, NYGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • William G. Axinn
    • 1
    Email author
  • Dirgha J. Ghimire
    • 2
  • Nathalie E. Williams
    • 3
  • Kate M. Scott
    • 4
  1. 1.Survey Research Center, College of Literature, Science, and the Arts, Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  2. 2.Survey Research Center, Population Studies Center, Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  3. 3.Department of SociologyUniversity of WashingtonSeattleUSA
  4. 4.Department of Psychological MedicineOtago UniversityDunedinNew Zealand

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