Resilience to mental disorders in a low-income, non-Westernized setting

Parental depression and their children's marriage timing: The long-term consequences of parental mental disorders

Although decades of research documents powerful associations between parents' characteristics and their children's marital behaviors, the role of parental mental health has largely been ignored, despite the high prevalence of mental disorders and their strong potential to shape multiple dimensions of family life. Many studies examine other consequences of mothers' mental disorders, particularly for young children, but rarely do studies investigate the consequences of fathers' mental disorders, especially the potential for long-term consequences. We construct a theoretical framework for the study of intergenerational influences on family formation behaviors, integrating parental mental health, and emphasizing the potential for father's disorders to shape their children's lives. To investigate these associations, we use new intergenerational panel data featuring clinically validated diagnostic measures of parental mental health for both mothers and fathers, assessed independently. Results demonstrate that fathers' major depressive disorder is associated with significantly earlier marriage timing among sons. These important new findings provide insights into key priorities for social research on family formation processes and intergenerational influences across many domains.

Community exposure to armed conflict and subsequent onset of alcohol use disorder

AIMS

To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict.

DESIGN

A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence.

SETTING

Chitwan, Nepal.

PARTICIPANTS

Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%).

MEASUREMENTS

Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022.

FINDINGS

Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings.

CONCLUSIONS

Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.

Alcohol use and internal migration in Nepal: a cross-sectional study

BACKGROUND

Alcohol use is a leading cause of disease. Although low- and middle-income countries (LMICs) have lower per capita alcohol consumption, the alcohol-attributable disease burden is high in these settings with consumption increasing. LMICs are also experiencing unprecedented levels of internal migration, potentially increasing mental stress, changing social restrictions on drinking, and increasing alcohol availability. We assessed the relationship between internal migration, opportunity to drink, and the transition from first use to regular alcohol use and alcohol use disorders (AUD) in Nepal, a low-income, South Asian country.

METHODS

A representative sample of 7435 individuals, aged 15-59 from Nepal were interviewed in 2016-2018 (93% response rate) with clinically validated measures of alcohol use and disorders and life history calendar measures of lifetime migration experiences. Discrete-time hazard models assessed associations between migration and alcohol use outcomes.

RESULTS

Net of individual sociodemographic characteristics, internal migration was associated with increased odds of opportunity to drink (OR 1.32, 95% CI 1.14 to 1.53), onset of regular alcohol use given lifetime use (OR 1.29, 95% CI 1.13 to 1.48) and AUD given lifetime use (OR 1.24, 95% CI 0.99 to 1.57). The statistically significant association between internal migration and opportunity to drink was specific to females, whereas the associations between migration and regular use and disorder were statistically significant for males.

CONCLUSIONS

Despite high rates of internal migration worldwide, most research studying migration and alcohol use focuses on international migrants. Findings suggest that internal migrants are at increased risk to transition into alcohol use and disorders. Support services for internal migrants could prevent problematic alcohol use among this underserved population.

The impact of family income and parental factors on children's resilience and mental well-being

Although there is robust evidence on the intergenerational transmission of trauma-related distress, much less is known about the relation of family income and parental resilience on the resilience and mental well-being of traumatized children. We aimed to determine the association between parental resilience and perceived financial stability, and the resilience and depression of their children among Syrian refugees in Jordan. We carried out a survey of 363 parent-child dyads from a refugee clinic in Northern Jordan. Measures of resilience, trauma, symptoms of mental illnesses, and demographics were reported by the mother and child. We evaluated the associations between parental resilience and their children's mental health. Resilience was highest among parents who reported that their income met their financial needs, (65.77 [standard deviation (SD) 15.96]), and lower for those who reported less income or who stated that their income met their needs only fairly well (62.77 [SD 17.56]). Resilience was lowest for those who reported that that income met their needs poorly (48.02 [SD 23.24]). Parent resilience was positively correlated with child resilience (β = 0.076 [95% confidence interval 0.035-0.12], p < 0.001). Depression and resilience of parents were most closely correlated with the depression and resilience scores of their children, among parents who reported the highest financial stability. Income plays a modifying role in the parent-child resilience and depression associations, with this association being least pronounced within those families who were financially less secure. These findings can help develop interventions to target parental transgenerational impacts according to income status.

The transition to parenthood, opportunity to drink, drinking, and alcohol use disorder

BACKGROUND

This study used life histories from a setting of near universal marriage and childbearing (Nepal) to identify associations between both marital transitions and the transition into parenthood and alcohol use and disorder (AUD).

METHODS

A retrospective, cross-sectional survey using life history calendars documented lifetime marital and childbearing histories of 4876 men and 5742 women aged 15-59 in 2016-18. The clinically validated, Nepal-specific Composite International Diagnostic Interview assessed first alcohol use opportunity, use, and disorder.

RESULTS

Being never married increased the odds of having the opportunity to drink for men (OR=1.30, 95% CI=1.14 - 1.48, p < 0.001) and women (OR=1.24, 95% CI=1.08 - 1.43, p = 0.003) compared to being married. While men were never married, widowed, or divorced they were at a greater risk of developing AUD. The transition to parenthood significantly increased the odds of AUD onset for men (OR=1.71, 95% CI=1.12 - 2.61, p = 0.013), independent of marital transitions. For women in this setting, becoming divorced increased the odds of having their first drink (OR=1.77, 95% CI=1.14 - 2.75, p = 0.011). Giving birth to a first child also increased the odds of first opportunity to drink for women (OR=1.30, 95% CI=1.07 - 1.57, p = 0.008).

CONCLUSIONS

We found associations between marital transitions and AUD that are consistent with findings worldwide. In this setting of near universal childbearing, the transition into fatherhood increased the odds of postpartum AUD among men.

Designing the Well-Being of Romanians by Achieving Mental Health with Digital Methods and Public Health Promotion

Taking care of mental health is a state of mind. Amid the challenges of the current context, mental health has become one of the problems with the greatest impact on citizens and the evolution of any economy. Due to the COVID-19 pandemic, people have become more anxious, solitary, preoccupied with themselves, and depressed because their entire universe has changed, by restricting their social and professional life; the increase in concern caused by a possible illness of them or those close to them made to isolate themselves. Two qualitative (group and in-depth interviews) and one survey-based quantitative research were carried out, which allowed the quantification of the opinions, perceptions, and attitudes of Romanians regarding the effectiveness of policies for the prevention and treatment of depression. Quantitative research revealed that most of the subjects had never participated in a mental health assessment, and a quarter of them had visited a mental health specialist more than two years ago. Based on the results, proposals were elaborated, which have been addressed both to the specialists from the Ministry of Health and to those from the academic environment, that may have an impact on the elaboration of some public mental health programs.

Women's employment and Children's education: Longitudinal evidence from Nepal

This study examines how maternal employment is related to children's school enrollment in rural Nepal. Using the Chitwan Valley Family Study we combine over 30 years (1974-2008) of yearly data on mother's employment and their children's education. Results reveal heterogeneity by gender, social status, and type of work. Children from historically disadvantaged social groups were more likely to be in school when their mothers started working. This was largely driven by mothers with jobs that allowed them to more easily combine work and family tasks (i.e., those self-employed in the home). In fact, maternal self-employment outside the home was associated with boys dropping out of school. Additionally, we find evidence that some of the observed relationship between maternal wage labor and children's school enrollment is due to household-level selection effects on mother's work.

Common perinatal mental disorders and post‐infancy child development in rural Ethiopia: a population‐based cohort study

Objective

To investigate whether maternal common mental disorders (CMD) in the postnatal period are prospectively associated with child development at 2.5 and 3.5 years in a rural low‐income African setting.

Methods

This study was nested within the C‐MaMiE (Child outcomes in relation to Maternal Mental health in Ethiopia) population‐based cohort in Butajira, Ethiopia, and conducted from 2005 to 2006. The sample comprised of 496 women who had recently given birth to living, singleton babies with recorded birth weight measurements, who were 15 to 44 years of age, and residing in six rural sub‐districts. Postnatal CMD measurements were ascertained 2 months after delivery. Language, cognitive, and motor development were obtained from the child 2.5 and 3.5 years after birth using a locally adapted version of the Bayley Scales of Infant Development (3rd Ed). Maternal CMD symptoms were measured using a locally validated WHO Self‐Reporting Questionnaire. A linear mixed‐effects regression model was used to analyze the relationship between postnatal CMD and child development.

Results

After adjusting for confounders, there was no evidence for an association between postnatal CMD and overall child development or the cognitive sub‐domain in the preschool period. There was no evidence of effect modification by levels of social support, socioeconomic status, stunting, or sex of the child.

Conclusions

Previous studies from predominantly urban and peri‐urban settings in middle‐income countries have established a relationship between maternal CMD and child development, which contrasts with the findings from this study. The risk and protective factors for child development may differ in areas characterized by high social adversity and food insecurity. More studies are needed to investigate maternal CMD’s impact on child development in low‐resource and rural areas.

Gut Hormones as Potential Therapeutic Targets or Biomarkers of Response in Depression: The Case of Motilin

Recent research has identified the gut–brain axis as a key mechanistic pathway and potential therapeutic target in depression. In this paper, the potential role of gut hormones as potential treatments or predictors of response in depression is examined, with specific reference to the peptide hormone motilin. This possibility is explored through two methods: (1) a conceptual review of the possible links between motilin and depression, including evidence from animal and human research as well as clinical trials, based on a literature search of three scientific databases, and (2) an analysis of the relationship between a functional polymorphism (rs2281820) of the motilin (MLN) gene and cross-national variations in the prevalence of depression based on allele frequency data after correction for potential confounders. It was observed that (1) there are several plausible mechanisms, including interactions with diet, monoamine, and neuroendocrine pathways, to suggest that motilin may be relevant to the pathophysiology and treatment of depression, and (2) there was a significant correlation between rs2281820 allele frequencies and the prevalence of depression after correcting for multiple confounding factors. These results suggest that further evaluation of the utility of motilin and related gut peptides as markers of antidepressant response is required and that these molecular pathways represent potential future mechanisms for antidepressant drug development.

Marital Experiences and Depression in an Arranged Marriage Setting

Understanding the consequences of marital experiences for individual mental health provides insight into how social relationships shape individual wellbeing. Using newly available, clinically validated diagnostic interviews with more than 10,000 respondents integrated with the longitudinal Chitwan Valley Family Study (CVFS), we assess the associations between marital experiences, intimate partner violence (IPV), and mental health and how they differ by gender in a setting of universal marriage-Nepal. Particularly novel, we integrate measures of arranged marriage, IPV, and marital quality into a single comprehensive analysis of the marital experiences shaping subsequent depression. This study reveals that becoming married can be positively associated with major depressive disorder (MDD) for women. IPV is a strong and independent risk factor for depression, but it only mediates a small portion of the consequences of marriage on depression. Among women, having no say at all in the selection of a spouse is also a strong and independent risk factor for depression, and IPV can only mediate a small portion of the consequences of arranged marriage on depression. We also investigate the associations between the positive (i.e., husband-wife emotional bond) and negative (i.e., spousal criticism and disagreement) dimensions of marital quality and depression. Frequent spousal disagreement significantly increases depression for women, but strong husband-wife emotional bond is not significantly associated with depression. Overall, the associations between marital experiences and mental health should be understood as contingent on both gender and the social contexts of marriage. Depending on these factors, specific marital experiences have the potential to increase transitions to depression, not just protect from depression.

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

AIMS

To disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio-demographic correlates for the opportunity to drink and transitions into life-time alcohol use, regular use and alcohol use disorder.

DESIGN

A retrospective, cross-sectional population survey within a family panel study.

SETTING

Chitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol.

PARTICIPANTS

A total of 10 714 individuals aged 15-59 years (response rate = 93%).

MEASUREMENTS

The Nepal-specific Composite International Diagnostic Interview assessed life-time alcohol use opportunity, any use, regular use, disorder and socio-demographic characteristics.

FINDINGS

Seventy per cent [95% confidence interval (CI) = 69.08-70.82%] of the population had the opportunity to drink, 38.06% (95% CI = 37.14-38.99%) had life-time alcohol use, 32.37% (95% CI = 31.48-33.27%) had regular alcohol use and 6.04% (95% CI = 5.60-6.50%) developed an alcohol use disorder. Compared with high-caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI = 1.16-1.47 to 1.98, 95% CI = 1.81-2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR = 5.71, 95% CI = 5.41-6.03) to development of disorder (OR = 1.95, 95% CI = 1.35-2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR = 4.86, 95% CI = 4.47-5.29) to development of disorder (OR = 9.34, 95% CI = 6.88-12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR = 0.77, 95% CI = 0.71-0.83) to the development of disorder (OR = 0.73, 95% CI = 0.59-0.89)].

CONCLUSIONS

The prevalence of life-time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio-demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life-time use, regular use), but not later transitions (use and regular use to disorder).

Exposure to Armed Conflict in Childhood vs Older Ages and Subsequent Onset of Major Depressive Disorder

Importance

This study offers a rare opportunity to evaluate life-course differences in the likelihood of developing major depressive disorder (MDD) after exposure to georeferenced neighborhood-level violence during an armed conflict.

Objective

To examine age cohort (age <11 vs ≥11 years) differences in associations of neighborhood-level violence with subsequent depression onset, independently of individual exposure and other key characteristics.

Design, Setting, and Participants

The Chitwan Valley Family Study is a population-representative panel study (1995 to present) conducted in Western Chitwan in Nepal, a low-income country that experienced a medium-intensity armed conflict from 2000 to 2006. Data for violent events were collected during the armed conflict and were linked to lifetime histories of MDD (collected in 2016-2018). The present cohort study analyzes 10 623 participants within 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15 to 59 years at MDD assessment were eligible (response rate, 93%). Data analysis was performed from May 2019 to July 2020.

Exposures

Georeferenced number of armed conflict-related physical beatings within 1 km of residential neighborhood.

Main Outcomes and Measures

The main outcome was onset of MDD, as defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), during or after the conflict, stratified by children (aged <11 years) and older individuals (aged ≥11 years), assessed by the Nepal-specific World Mental Health-Composite International Diagnostic Instrument 3.0 with a life history calendar.

Results

In total, 10 623 participants (5745 female [54.08%]; 4074 [38.35%] aged <11 years at the conflict start) contributed 171 899 person-years of exposure to the risk of MDD. Two or more beatings occurred within 1 km of 15 neighborhoods (9.9%). Discrete-time survival models showed that children (but not older individuals) living in neighborhoods with 2 or more beatings had a higher likelihood of developing MDD than those who lived in a community with no beatings (odds ratio, 1.82; 95% CI, 1.17-2.84; P = .008); there was also a significant interaction between age group and neighborhood beatings (odds ratio, 1.85; 95% CI, 1.27-2.70; P = .001). A confirmatory, multivariable, multilevel matching analysis showed a neighborhood association for children (z = -2.66; P = .008), but not older individuals (z = -0.454; P = .65). The mean (SE) incidence of MDD among children living in neighborhoods with 2 or more beatings nearby was 12.69% (2.37%) vs 5.08% (1.56%) in the matched unexposed sample.

Conclusions and Relevance

The youngest individuals may be the most at risk during times of violence, with mental health consequences lasting long after conflicts have subsided and should be a priority for population-level interventions. Future research should consider other disorders, other types of violence, and elderly individuals.