Skip to main content

Advertisement

SpringerLink
Log in

Psychological distress among displaced persons during an armed conflict in Nepal

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

Abstract

Objective

Most internally displaced persons (IDPs) live in low-income countries experiencing a war; their psychosocial health has not been well addressed. We carried out a comprehensive assessment of traumatic experiences, distress symptomatology, and factors independently associated with distress among IDPs in Nepal.

Methods

A cross-sectional survey was conducted among 290 IDPs in Nepal during June–July 2003. We used the Hopkins Symptom Checklist-25 (HSCL-25) to assess depression and anxiety symptoms, and the Posttraumatic Stress Disorder (PTSD) Checklist—Civilian Version (PCL-C) to assess PTSD symptoms. All these instruments were validated against local corresponding syndromes and diagnoses of Composite International Diagnostic Interviews (CIDIs) as well.

Results

Almost everyone reported trauma and 53.4% had PTSD symptomatology. The rates of anxiety and depression symptomatology were 80.7 and 80.3%, respectively. Factors independently associated with anxiety symptomatology were illiteracy and feeling miserable on arrival at a new place. Female gender, age 41–50, and feeling miserable on arrival at a new place were associated with depression symptomatology. On the other hand, experiencing greater than three traumatic events and feeling miserable on arrival at a new place were associated with PTSD symptomatology, whereas evacuation after a weeklong preparation and lower caste appeared as protective factors.

Conclusions

High rates of psychological distress and associated factors were identified among highly traumatized IDPs in Nepal, thereby underlining the need for collective assistance, not only for refugees, but also for IDPs. Risk and protective factors that we have identified can thus be utilized for any kind of psychosocial interventions among these IDPs.

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. Bolton P (2001) Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard. J Nerv Ment Dis 189:238–242

    Article  PubMed  Google Scholar 

  2. de Jong JP, Scholte WF, Koeter MW, Hart AA (2000) The prevalence of mental health problems in Rwandan and Burundese refugee camps. Acta Psychiatr Scand 102:171–177

    Article  PubMed  Google Scholar 

  3. de Jong JT, Komproe IH, Van Ommeren M, El Masri M, Araya M, Khaled N, van De Put W, Somasundaram D (2001) Lifetime events and posttraumatic stress disorder in 4 postconflict settings. JAMA 286:555–562

    Article  PubMed  Google Scholar 

  4. Forty-eighth World Medical Assembly (1997) The Declaration of Helsinki: recommendations guiding physicians in biomedical research involving human subjects. JAMA 277:925–926

    Article  PubMed  Google Scholar 

  5. Harlem Brundtland G (2000) Mental health of refugees, internally displaced persons and other populations affected by conflict. Acta Psychiatr Scand 102:159–161

    Article  PubMed  Google Scholar 

  6. Hauff E, Vaglum P (1994) Chronic posttraumatic stress disorder in Vietnamese refugees. A prospective community study of prevalence, course, psychopathology, and stressors. J Nerv Ment Dis 182:85–90

    PubMed  Google Scholar 

  7. Hauff E, Vaglum P (1995) Organised violence and the stress of exile. Predictors of mental health in a community cohort of Vietnamese refugees three years after resettlement. Br J Psychiatry 166:360–367

    PubMed  Google Scholar 

  8. Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J (2002) Measuring trauma and health status in refugees: a critical review. JAMA 288:611–621

    Article  PubMed  Google Scholar 

  9. Lavik NJ, Hauff E, Skrondal A, Solberg O (1996) Mental disorder among refugees and the impact of persecution and exile: some findings from an out-patient population. Br J Psychiatry 169:726–732

    PubMed  Google Scholar 

  10. Lipman RS, Covi L, Shapiro AK (1979) The Hopkins Symptom Checklist (HSCL)-factors derived from the HSCL-90. J Affect Disord 1:9–24

    Article  PubMed  Google Scholar 

  11. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J (1992) The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis 180:111–116

    PubMed  Google Scholar 

  12. Mollica RF, McInnes K, Poole C, Tor S (1998) Dose–effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. Br J Psychiatry 173:482–488

    PubMed  Google Scholar 

  13. Mollica RF, Sarajlic N, Chernoff M, Lavelle J, Vukovic IS, Massagli MP (2001) Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. JAMA 286:546–554

    Article  PubMed  Google Scholar 

  14. Mumford DB, Nazir M, Jilani FU, Baig IY (1996) Stress and psychiatric disorder in the Hindu Kush: a community survey of mountain villages in Chitral, Pakistan. Br J Psychiatry 168:299–307

    PubMed  Google Scholar 

  15. Patel V, Kleinman A (2003) Poverty and common mental disorders in low-income countries. Bull World Health Organ 81:609–615

    PubMed  Google Scholar 

  16. Patel V, Simunyu E, Gwanzura F, Lewis G, Mann A (1997) The Shona Symptom Questionnaire: the development of an indigenous measure of common mental disorders in Harare. Acta Psychiatr Scand 95:469–475

    PubMed  Google Scholar 

  17. Piccinelli M, Wilkinson G (2000) Gender differences in depression. Critical review. Br J Psychiatry 177:486–492

    Article  PubMed  Google Scholar 

  18. Sabin M, Lopes Cardozo B, Nackerud L, Kaiser R, Varese L (2003) Factors associated with poor mental health among Guatemalan refugees living in Mexico 20 years after civil conflict. JAMA 290:635–642

    Article  PubMed  Google Scholar 

  19. Sandanger I, Moum T, Ingebrigtsen G, Dalgard OS, Sorensen T, Bruusgaard D (1998) Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc Psychiatry Psychiatr Epidemiol 33:345–354

    Article  PubMed  Google Scholar 

  20. Saxon AJ, Davis TM, Sloan KL, McKnight KM, McFall ME, Kivlahan DR (2001) Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans. Psychiatr Serv 52:959–964

    Article  PubMed  Google Scholar 

  21. Shrestha NM, Sharma B, Van Ommeren M, Regmi S, Makaju R, Komproe I, Shrestha GB, de Jong JT (1998) Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal. JAMA 280:443–448

    Article  PubMed  Google Scholar 

  22. SPSS Inc (1999) Statistical package for the social sciences (computer software program)

  23. Summerfield D (1999) A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Soc Sci Med 48:1449–1462

    Article  PubMed  Google Scholar 

  24. Tabachnick BG, Fidell LS (1996) Using multivariate statistics. Harper-Collins, New York

    Google Scholar 

  25. Thapa SB, Van Ommeren M, Sharma B, de Jong JT, Hauff E (2003) Psychiatric disability among tortured Bhutanese refugees in Nepal. Am J Psychiatry 160:2032–2037

    Article  PubMed  Google Scholar 

  26. The Global IDP Project (2003) Available at: http://www.idpproject.org/training/reports/Nepal_workshop_final.pdf. Accessed on October 3, 2004

  27. The Global IDP Project (2004) Available at: http://www.idpproject.org/global_overview.htm, vol. Accessed on October 3, 2004

  28. Van Ommeren M (2003) Validity issues in transcultural epidemiology. Br J Psychiatry 182:376–378

    Article  PubMed  Google Scholar 

  29. Van Ommeren M, Thapa S, Makaju R, Prasain D, Bhattarai R, de Jong JT (1999) Preparing instruments for transcultural research: use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcult Psychiatry 36:285–301

    Google Scholar 

  30. Van Ommeren M, de Jong JT, Sharma B, Komproe I, Thapa SB, Cardena E (2001) Psychiatric disorders among tortured Bhutanese refugees in Nepal. Arch Gen Psychiatry 58:475–482

    Article  PubMed  Google Scholar 

  31. Weathers F, Litz BT, Huska IA, Keane TM (1994) The PTSD Checklist-Civilian Version (PCL-C): scale available from the National Center for PTSD, Boston VA Medical Center

  32. World Health Organization (1997) Composite International Diagnostic Interview (CIDI) Version 2.1

Download references

Acknowledgements

We would like to thank Dr. Bhogendra Sharma and Dr. Bidur Osti, CVICT, Nepal; Dr. Mark Van Ommeren, World Health Organization, Geneva; and Mr. Subodh Raj Pyakurel, INSEC, Nepal, for their supports. We would like to acknowledge the financial assistance provided by the Psychosocial Center for Refugees, University of Oslo, which enabled this study to be conducted.

Author information

Authors and Affiliations

  1. Center for Public Health Research and Services, Katmandu, Nepal

    Suraj Bahadur Thapa MBBS, MPhil

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

    Suraj Bahadur Thapa MBBS, MPhil & Edvard Hauff MD, PhD

  3. Department of International Health, Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0317, Oslo, Norway

    Suraj Bahadur Thapa MBBS, MPhil

  4. Ullevål University Hospital, Oslo, Norway

    Edvard Hauff MD, PhD

Authors
  1. Suraj Bahadur Thapa MBBS, MPhil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edvard Hauff MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suraj Bahadur Thapa MBBS, MPhil.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thapa, S.B., Hauff, E. Psychological distress among displaced persons during an armed conflict in Nepal. Soc Psychiat Epidemiol 40, 672–679 (2005). https://doi.org/10.1007/s00127-005-0943-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-005-0943-9

Key words

Search

Navigation