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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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).

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Correspondence to William G. Axinn.

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Axinn, W.G., Ghimire, D.J., Williams, N.E. et al. Associations between the social organization of communities and psychiatric disorders in rural Asia. Soc Psychiatry Psychiatr Epidemiol 50, 1537–1545 (2015). https://doi.org/10.1007/s00127-015-1042-1

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Keywords

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