1
|
Tiné P. Feeling social change in the gut: gyāstrik and the problematisation of domestic roles among Newar women in contemporary Nepal. Anthropol Med 2024:1-21. [PMID: 39263713 DOI: 10.1080/13648470.2024.2387502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 01/22/2024] [Accepted: 07/30/2024] [Indexed: 09/13/2024]
Abstract
Drawing upon 15 months of research conducted in 2018-2019 in Bhaktapur, Nepal, this paper examines how middle-class women experience and make sense of gyāstrik (an umbrella term for multiple gut disorders) as an embodiment of social change. Enumerating dietary injustices and distress following unmet middle-class expectations of well-being and domestic intimacy as a primary cause of the condition, these women narratively problematised social norms and found ways out through the concomitant vocalisation of physical pain and social discontent. While illness epistemologies differ (with the persistence of mind-body dichotomies on the one hand and the centrality of notions of well-being and ideals of self-care on the other), these accounts demonstrate both a passive and active role of the gut in the social change experience, inviting to take the gut as the site where somatic modes of 'attention' and 'action' enable the navigation of personal life trajectories and the negotiation of social change itself.
Collapse
Affiliation(s)
- Paola Tiné
- Victoria University of Wellington Te Herenga Waka, New Zealand
| |
Collapse
|
2
|
Rijal D, Paudel K, Adhikari TB, Bhurtyal A. Stress and coping strategies among higher secondary and undergraduate students during COVID-19 pandemic in Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001533. [PMID: 36963014 PMCID: PMC10021748 DOI: 10.1371/journal.pgph.0001533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/24/2022] [Indexed: 02/17/2023]
Abstract
Coronavirus Disease (COVID-19) pandemic has profoundly affected lives around the globe and has caused a psychological impact among students by increasing stress and anxiety. This study evaluated the stress level, sources of stress of students of Nepal and their coping strategies during the pandemic. A cross-sectional web-based study was conducted during the complete lockdown in July 2020 among 615 college students. Stress owing to COVID-19 and the lockdown was assessed using the Perceived Stress Scale (PSS), and Brief Coping Orientation to Problems Experienced (Brief COPE) was used to evaluate coping strategies. To compare the stress level among participants chi-square test was used. The Student's t-test was used to compare Brief COPE scores among participants with different characteristics. The majority of study participants were female (53%). The mean PSS score was (±SD) of 20.2±5.5, with 77.2% experiencing moderate and 10.7% experiencing a high-stress level. Moderate to high levels of stress were more common among girls (92.6%) than boys (82.7%) (P = 0.001). However, there was a significant difference in perceived stress levels disaggregated by the students' age, fields and levels of study, living status (with or away from family), parent's occupation, and family income. The mean score for coping strategy was the highest for self-distraction (3.3±0.9), whereas it was the lowest for substance use (1.2±0.5). Students with a low level of stress had a higher preference for positive reframing and acceptance, whereas those with moderate to high levels of stress preferred venting. Overall, students experienced high stress during the lockdown imposed as part of governmental efforts to control COVID-19. Therefore, the findings of our study suggest stress management programs and life skills training. Also, further studies are necessary to conduct a longitudinal assessment to analyse the long-term impact of this situation on students' psychological states.
Collapse
Affiliation(s)
- Durga Rijal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Kiran Paudel
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
- Nepal Health Frontiers, Kathmandu, Nepal
| | - Tara Ballav Adhikari
- Nepal Health Frontiers, Kathmandu, Nepal
- Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
- COBIN Project, Nepal Development Society, Bharatpur, Chitwan, Nepal
| | - Ashok Bhurtyal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| |
Collapse
|
3
|
Rai S, Awale R, Ghimire DJ, Rao D. Pathways of association between husbands’ migration and mental health of their wives who stay behind. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
4
|
Karki P, Shahi PV, Sapkota KP, Bhandari R, Adhikari N, Shrestha B. Depressive symptoms and associated factors among persons with physical disabilities in disability care homes of Kathmandu district, Nepal: A mixed method study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001461. [PMID: 36962869 PMCID: PMC10021957 DOI: 10.1371/journal.pgph.0001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023]
Abstract
Depression is one of the most common mental disorders, affecting 300 million people worldwide and 75% of these occur in low- and middle-income countries. Persons with physical disabilities are vulnerable groups and are more prone to experience depressive symptoms than the general population. This study investigated the prevalence of depressive symptoms and the associated factors among persons with a physical disability. We conducted a concurrent triangulation mixed methods design using Beck's Depression Inventory scale among 162 persons with physical disabilities in the Kathmandu district. In parallel, eight in-depth interviews were conducted with an interview guideline to collect the participants' perceptions and experiences of disability. Both quantitative and qualitative findings were integrated into the results. We found that about 77% of the participants with a physical disability had experienced depressive symptoms. Unemployment status (adjusted odds ratio (AOR) 2.7, 95% confidence interval (CI) 1.0-7.3) and comorbidity (AOR 2.5, 95% CI 1.0-6.0) had a statistically significant association with depressive symptoms. The majority of people with physical disabilities had negative experiences with societal prejudice and coping with their limitations. They were depressed as well as angry over having to stop their careers, education, and possibilities. Nevertheless, they were significantly happier and less sad than in their earlier years of life because of the possibilities, family environment, improved means of subsistence, therapeutic facilities, and supportive atmosphere at disability care homes. The policymakers should focus on preventing comorbidity and providing technical skills to persons with physical disabilities to improve their employment status and promote a healthy lifestyle.
Collapse
Affiliation(s)
- Prabin Karki
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prasant Vikram Shahi
- Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Rabindra Bhandari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Nabin Adhikari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Department of Research and Development Division, Dhulikhel Hospital, Dhulikhel, Kavrepalanchowk, Nepal
| | | |
Collapse
|
5
|
Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
Collapse
Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
| |
Collapse
|
6
|
Poudyal A, Gurung D, Kohrt BA. Evidence-based approaches for promoting gender equity in global mental health research: Study protocol for social network analysis of researchers in Nepal. SSM - MENTAL HEALTH 2021; 1:None. [PMID: 34957425 PMCID: PMC8654682 DOI: 10.1016/j.ssmmh.2021.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
There are increasing efforts for capacity building of researchers in low- and middle-income countries (LMIC) to foster local ability to conduct high quality research. However, female researchers remain underrepresented in scientific communities, particularly in LMIC where they have limited networking and mentorship opportunities. This protocol is for a Social Network Analysis (SNA) to evaluate if gender-sensitive, need-based capacity building can improve researchers' networking and mentorship opportunities in Nepal. The conceptual framework is informed by Social Cognitive Career Theory. Cross-sectional and longitudinal SNA are used to a) assess individual researchers’ network characteristics and their association with academic productivity; and b) examine if the association of network characteristics and academic productivity is mediated by self-efficacy and outcome expectations. Recruitment is designed to include early-career and senior researchers conducting mental health research, as well as students interested in pursuing a career in mental health research. The network characteristics will be mapped for approximately 150 researchers in working in Nepal. SNA characteristics in the network (individual density, homophily, and centrality) will be compared with academic productivity (total peer reviewed publications, h-index), including mediation effects via self-efficacy and outcome expectations. Ultimately, this study will generate information to design more evidence-based strategies for capacity building of a gender-equitable research workforce in global mental health.
Collapse
Affiliation(s)
- Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Dristy Gurung
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK.,Transcultural Psychosocial Organization, Balutwatar, Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA.,Transcultural Psychosocial Organization, Balutwatar, Kathmandu, Nepal
| |
Collapse
|
7
|
Gurung D, Sangraula M, Subba P, Poudyal A, Mishra S, Kohrt BA. Gender inequality in the global mental health research workforce: a research authorship scoping review and qualitative study in Nepal. BMJ Glob Health 2021; 6:e006146. [PMID: 34880061 PMCID: PMC8655556 DOI: 10.1136/bmjgh-2021-006146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Although women's health is prioritised in global research, few studies have identified structural barriers and strategies to promote female leadership and gender equality in the global health research workforce, especially in low-income and middle-income countries. METHODS We conducted a mixed-methods study to evaluate gender equality in the mental health research workforce in Nepal. The scoping review assessed gender disparities in authorship of journal publications for Nepal mental health research, using databases (PsycINFO, PubMed, Web of Science, NepJol, NepMed) for 5 years. Qualitative interviews were conducted with 22 Nepali researchers to identify structural barriers limiting women's leadership. RESULTS Of 337 articles identified, 61% were by Nepali first authors. Among Nepali first authors, 38.3% were women. Nepali women had half the odds of being first authors compared with men, when referenced against non-Nepali authors (OR 0.50, 95% CI 1.30 to 3.16). When limiting publications to those based on funded research, the odds were worse for first authorship among Nepali women (OR 0.37, 95% CI 0.19 to 0.71). The qualitative analysis supported the scoping review and identified a lack of gender-friendly organisational policies, difficulties in communication and mobility, and limited opportunities for networking as barriers to women's leadership in global health research. CONCLUSION Efforts are needed for greater representation of Nepali women in global mental health research, which will require transformative organisational policies to foster female leadership. Those in leadership need to recognise gender inequalities and take necessary steps to address them. Funding agencies should prioritise supporting organisations with gender equality task forces, policies and indicators.
Collapse
Affiliation(s)
| | - Manaswi Sangraula
- Department of Psychology, New School for Social Research, New York, New York, USA
| | | | - Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Shelly Mishra
- Division of Global Mental Health, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Karki K, Sapkota A, Jajko S, Singh DR. Socio-demographic variables related to self-esteem, psychological stress and health-related quality of life among older adults: A cross-sectional study in Kavrepalanchowk district of Nepal. SAGE Open Med 2021; 9:20503121211056437. [PMID: 34777808 PMCID: PMC8581782 DOI: 10.1177/20503121211056437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023] Open
Abstract
Objective The study aimed to assess how socio-demographic variables related to self-esteem, psychological stress and health-related quality of life among older adults in Nepal. Method A cross-sectional community-based study was conducted in the Kavrepalanchowk district of Nepal. A two-stage cluster sampling technique was used for selecting the study areas, and 239 older adult participants were selected randomly from the clusters. The interview technique was applied to gather data using validated tools. The tools used in the study were Rosenberg self-esteem scale, Perceived Stress Scale and WHOQOL-BREF scale. Scoring was carried out for self-esteem, perceived stress and WHOQOL-BREF in accordance with the procedures. Data were analyzed using descriptive statistics and inferential statistics (Chi-square, independent t-test and one-way analysis of variance). Results Among the total participants, 27.2% were 60-64 years old and more than two-thirds (69.9%) were male. The majority of participants were married (65.5%) and cannot read and write (60.7%). Half of the older adults (49.8%) were living with their partners. Self-esteem was high among the age group 70-74 years (24.80 ± 3.01), and psychological stress was high among the age group 60-64 years (17.23 ± 2.93) within the older adults. Furthermore, the mean score for the social relationship domain and physical health domain of health-related quality of life were 12.0 and 11.9, respectively. Comparing the domains of physical health, psychological health and social relationship with age and education level were statistically significant. Conclusion Self-esteem was lower among older male adults aged 60-64 years and those who attended secondary level education. An increase in participants' age increases the psychological stress and decreases the psychological domain of health-related quality of life.
Collapse
Affiliation(s)
- Kshitij Karki
- Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal.,Group for Technical Assistance, Lalitpur, Nepal
| | - Amrita Sapkota
- Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | | | - Devendra Raj Singh
- Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal.,Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| |
Collapse
|
9
|
Koirala R, Iyer Søegaard EG, Kan Z, Ojha SP, Hauff E, Thapa SB. Exploring complex PTSD in patients visiting a psychiatric outpatient clinic in Kathmandu, Nepal. J Psychiatr Res 2021; 143:23-29. [PMID: 34438200 DOI: 10.1016/j.jpsychires.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 07/25/2021] [Accepted: 08/19/2021] [Indexed: 12/01/2022]
Abstract
Decades of research on trauma patients have shown that a post-traumatic stress disorder (PTSD) diagnosis does not always cover the full spectrum of symptoms after severe trauma. Complex PTSD (CPTSD) was recently introduced in the International Classification of Diseases 11th Revision. There have been no published studies on CPTSD in the South Asian region to date. The objective of this study was to evaluate CPTSD in a sample of trauma patients in Nepal. We also examined quality of life (QOL) and mental health comorbidities and their association with CPTSD caseness. One hundred patients with a history of trauma who visited the outpatient psychiatry clinic at a hospital in Kathmandu from 2017 to 2018 were assessed. The Composite International Diagnostic Interview Version 2.1 was used to evaluate PTSD, major depressive disorder, and generalized anxiety disorder (GAD). Disturbance of self-organization symptoms from the Structured Interview for Disorders of Extreme Stress (SIDES) together with the PTSD diagnosis was used to confirm CPTSD caseness. The World Health Organization (WHO) QOL Scale Brief Version (WHOQOL-BREF) was used to assess QOL in four domains. Among the 83 patients who had PTSD, 42 also had CPTSD. CPTSD was significantly associated with major depressive disorder, GAD, female gender, and lower QOL in all four domains. CPTSD was prevalent among these patients. Having CPTSD was significantly associated with worse outcomes in terms of QOL and comorbid mental disorders, even with similar trauma. There is a need to explore CPTSD symptoms and to address trauma patients with CPTSD in this region.
Collapse
Affiliation(s)
- Rishav Koirala
- Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Norway; Brain and Neuroscience Center, Nepal.
| | - Erik Ganesh Iyer Søegaard
- Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Norway; Department of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Zhanna Kan
- Department of Mental Health and Addiction, Oslo University Hospital, Norway
| | | | - Edvard Hauff
- Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Norway; Department of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Suraj Bahadur Thapa
- Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Norway; Department of Mental Health and Addiction, Oslo University Hospital, Norway
| |
Collapse
|
10
|
A bioecocultural approach to supporting adolescent mothers and their young children in conflict-affected contexts. Dev Psychopathol 2021; 33:714-726. [PMID: 33517930 DOI: 10.1017/s095457942000156x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An estimated 12 million girls aged 15-19 years, and 777,000 girls younger than 15 give birth globally each year. Contexts of war and displacement increase the likelihood of early marriage and childbearing. Given the developmentally sensitive periods of early childhood and adolescence, adolescent motherhood in conflict-affected contexts may put a family at risk intergenerationally. We propose that the specifics of normative neuroendocrine development during adolescence, including increased sensitivity to stress, pose additional risks to adolescent girls and their young children in the face of war and displacement, with potential lifelong consequences for health and development. This paper proposes a developmental, dual-generational framework for research and policies to better understand and address the needs of adolescent mothers and their small children. We draw from the literature on developmental stress physiology, adolescent parenthood in contexts of war and displacement internationally, and developmental cultural neurobiology. We also identify culturally meaningful sources of resilience and provide a review of the existing literature on interventions supporting adolescent mothers and their offspring. We aim to honor Edward Zigler's groundbreaking life and career by integrating basic developmental science with applied intervention and policy.
Collapse
|
11
|
Yilmaz SK, Bohara AK. mHealth: Potentials and Risks for Addressing Mental Health and Well-Being Issues Among Nepali Adolescents. Front Public Health 2021; 9:563515. [PMID: 33968868 PMCID: PMC8102693 DOI: 10.3389/fpubh.2021.563515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Abstract
Adolescents are slowly being recognized as a generation, worldwide, that may require different policy approaches to improve staggering statistics on their failing well-being, including mental health. By providing the support to allow the next generation to achieve better mental health outcomes, they are going to be more economically successful and the future economic growth of nations can be better assured. Adoption of mobile-based health interventions (e.g., mHealth) has garnered a lot of attention toward this end. While mHealth interventions are growing in popularity, many researchers/policy-makers appear to have neglected assessing potential (indirect) costs/negative consequences from their use. Evidence from the developed world shows strong associations between extensive cell phone use and negative mental health outcomes, but similar research is minimal in developing world contexts. Additionally, the bulk of work on the outcomes of mobile phone use is studied using a unidirectional approach with blinders to front-end motivations. Using primary data from a large-scale, school-based survey of older adolescents in southwestern Nepal (N = 539), this work investigates such a tension between mobile/smartphone usage as a true mobile health (mHealth) opportunity in Nepal or as a potential problem, introducing additional deleterious well-being effects from over-use. Founded in Basic Psychological Needs Theory (BPNT), robust results of analyses using full structural modeling approaches (and traditional regression-based sensitivity analyses) indicate support for the BPNT framework in explaining statistically significant positive associations between bullying and anxiety, as well as, negative associations between bullying and grit, including evidence to support the mediating role of problematic mobile phone use in these relationships. More than 56% of the sample showed indicators of mild to moderate anxiety and over 10% claim experiences of bullying, coupled with over 75% of the sample scoring above the midline of a problematic mobile phone use scale, all of which motivates the relevance of our findings. Potential policy implications of these findings, and mention of other intriguing avenues for future work are further discussed.
Collapse
Affiliation(s)
- Siobhan K. Yilmaz
- Department of Economics, University of New Mexico, Albuquerque, NM, United States
| | | |
Collapse
|
12
|
Langer JA, Ramos JV, Ghimire L, Rai S, Kohrt BA, Burkey MD. Gender and Child Behavior Problems in Rural Nepal: Differential Expectations and Responses. Sci Rep 2019; 9:7662. [PMID: 31113970 PMCID: PMC6529428 DOI: 10.1038/s41598-019-43972-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/27/2019] [Indexed: 11/17/2022] Open
Abstract
Whereas epidemiologic studies consistently identify different rates and types of problematic behavior in boys and girls, there has been little research examining the ecocultural context in which these gender differences in child behavior problems develop, especially in non-Western settings. This qualitative study in rural Nepal explored how behavioral expectations differed based on gender role, gender discrimination, inequity, and treatment of children based on their gender identity. We conducted semi-structured interviews with a total of 14 parents, school workers, and community leaders from a village in rural Nepal. Interview transcripts were coded by two authors using predetermined and emergent codes to identify expectations, behavior problems, and responses to behavior problems, stratified by gender. Authors then arranged codes into categories based on emergent themes. Four major themes in the interviews were identified: (1) self-reported gender non-bias; (2) differentiated role expectations; (3) gender, "goodness", and differential thresholds for problem behaviors; and (4) boys and girls require different responses for misbehavior. Results from our study in Nepal reflect nearly universal models of gender differences in behavior. Of particular importance in South Asia, patrilocal marital practices were used to frame gender differences in expectations. To protect girls' future potential to marry, local cultural practices provide girls with lesser opportunities and less cultural space to conduct themselves in a disruptive manner than boys. Greater understanding of differential expectations and responses to disruptive behaviors by gender will be important for culturally-appropriate equitable programming in child development.
Collapse
Affiliation(s)
- Julia A Langer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Julia V Ramos
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lajina Ghimire
- Transcultural Psychosocial Organization - Nepal, Kathmandu, Nepal
| | - Sauharda Rai
- Transcultural Psychosocial Organization - Nepal, Kathmandu, Nepal
- University of Washington, Jackson School of International Studies, Seattle, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, USA
| | - Matthew D Burkey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
13
|
Kiang L, Folmar S, Gentry K. “Untouchable”? Social Status, Identity, and Mental Health Among Adolescents in Nepal. JOURNAL OF ADOLESCENT RESEARCH 2018. [DOI: 10.1177/0743558418791501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Caste is a primary basis for oppression in many parts of South Asia with individuals from low caste backgrounds commonly experiencing the degradation of untouchability and daily discrimination at both individual and systemic levels. The current study uses a mixed-methods, interdisciplinary approach to examine links between social status, identity, and mental health among 295 adolescents (51% females) from different social groups in Nepal. Quantitative surveys reveal that youth from low caste Dalit groups report more anxiety, depression, and low self-esteem compared with their counterparts from high caste (e.g., Brahmin) and ethnic indigenous (e.g., Gurung) groups. Caste identity is positively related to outcomes but does not significantly counteract the negative effects of social status. Ethnographic and interview data are used to inform, contextualize, and interpret these quantitative findings. Conceptual parallels to current race relations experienced in the United States are considered and discussed.
Collapse
Affiliation(s)
- Lisa Kiang
- Wake Forest University, Winston-Salem, NC, USA
| | | | | |
Collapse
|
14
|
An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011. J Immigr Minor Health 2017; 18:819-827. [PMID: 26758579 DOI: 10.1007/s10903-015-0326-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.
Collapse
|
15
|
Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1483-1494. [PMID: 28856382 PMCID: PMC5705471 DOI: 10.1007/s00127-017-1433-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world's burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. METHODS Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. RESULTS In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. CONCLUSIONS Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.
Collapse
Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - S Khadka
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - S Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - B Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| |
Collapse
|
16
|
Ramaiya MK, Fiorillo D, Regmi U, Robins CJ, Kohrt BA. A Cultural Adaptation of Dialectical Behavior Therapy in Nepal. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 24:428-444. [PMID: 29056846 PMCID: PMC5645023 DOI: 10.1016/j.cbpra.2016.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.
Collapse
Affiliation(s)
- Megan K. Ramaiya
- Duke Global Health Institute, 310 Trent Drive, Durham, NC
- Department of Psychology, University of Washington, Box 351525, Seattle, WA
| | - Devika Fiorillo
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Dr. NE, Atlanta, GA
| | - Upasana Regmi
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Clive J. Robins
- Department of Psychology & Neuroscience, Duke University, Box 90086, 417 Chapel Drive, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University, Box 90519 Durham, NC
| | - Brandon A. Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Department of Psychiatry and Behavioral Sciences, Duke University, Box 90519 Durham, NC
| |
Collapse
|
17
|
Luitel NP, Jordans MJD, Kohrt BA, Rathod SD, Komproe IH. Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal. PLoS One 2017; 12:e0183223. [PMID: 28817734 PMCID: PMC5560728 DOI: 10.1371/journal.pone.0183223] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 08/01/2017] [Indexed: 11/25/2022] Open
Abstract
Context There is limited research on the gap between the burden of mental disorders and treatment use in low- and middle-income countries. Objectives The aim of this study was to assess the treatment gap among adults with depressive disorder (DD) and alcohol use disorder (AUD) and to examine possible barriers to initiation and continuation of mental health treatment in Nepal. Methods A three-stage sampling technique was used in the study to select 1,983 adults from 10 Village Development Committees (VDCs) of Chitwan district. Presence of DD and AUD were identified with validated versions of the Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorder Identification Test (AUDIT). Barriers to care were assessed with the Barriers to Access to Care Evaluation (BACE). Results In this sample, 11.2% (N = 228) and 5.0% (N = 96) screened positive for DD and AUD respectively. Among those scoring above clinical cut-off thresholds, few had received treatment from any providers; 8.1% for DD and 5.1% for AUD in the past 12 months, and only 1.8% (DD) and 1.3% (AUD) sought treatment from primary health care facilities. The major reported barriers to treatment were lacking financial means to afford care, fear of being perceived as “weak” for having mental health problems, fear of being perceived as “crazy” and being too unwell to ask for help. Barriers to care did not differ based on demographic characteristics such as age, sex, marital status, education, or caste/ethnicity. Conclusions With more than 90% of the respondents with DD or AUD not participating in treatment, it is crucial to identify avenues to promote help seeking and uptake of treatment. Given that demographic characteristics did not influence barriers to care, it may be possible to pursue general population-wide approaches to promoting service use.
Collapse
Affiliation(s)
- Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu Nepal
- * E-mail:
| | - Mark J. D. Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Research and Development Department, HealthNet TPO Amsterdam, Amsterdam, the Netherlands
| | - Brandon A. Kohrt
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, United States of America
| | - Sujit D. Rathod
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ivan H. Komproe
- Research and Development Department, HealthNet TPO Amsterdam, Amsterdam, the Netherlands
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
18
|
Basnet S, Kandel P, Lamichhane P. Depression and anxiety among war-widows of Nepal: a post-civil war cross-sectional study. PSYCHOL HEALTH MED 2017. [DOI: 10.1080/13548506.2017.1338735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Syaron Basnet
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pragya Kandel
- Research and Action in Public Health, Kathmandu, Nepal
| | - Prabhat Lamichhane
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
19
|
Kohrt BA, Worthman CM, Adhikari RP, Luitel NP, Arevalo JMG, Ma J, McCreath H, Seeman TE, Crimmins EM, Cole SW. Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers. Proc Natl Acad Sci U S A 2016; 113:8156-61. [PMID: 27402736 PMCID: PMC4961140 DOI: 10.1073/pnas.1601301113] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Adverse social conditions in early life have been linked to increased expression of proinflammatory genes and reduced expression of antiviral genes in circulating immune cells-the conserved transcriptional response to adversity (CTRA). However, it remains unclear whether such effects are specific to the Western, educated, industrialized, rich, and democratic (WEIRD) cultural environments in which previous research has been conducted. To assess the roles of early adversity and individual psychological resilience in immune system gene regulation within a non-WEIRD population, we evaluated CTRA gene-expression profiles in 254 former child soldiers and matched noncombatant civilians 5 y after the People's War in Nepal. CTRA gene expression was up-regulated in former child soldiers. These effects were linked to the degree of experienced trauma and associated distress-that is, posttraumatic stress disorder (PTSD) severity-more than to child soldier status per se. Self-perceived psychological resilience was associated with marked buffering of CTRA activation such that PTSD-affected former child soldiers with high levels of personal resilience showed molecular profiles comparable to those of PTSD-free civilians. These results suggest that CTRA responses to early life adversity are not restricted to WEIRD cultural contexts and they underscore the key role of resilience in determining the molecular impact of adverse environments.
Collapse
Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708; Duke Global Health Institute, Duke University, Durham, NC 27710; Transcultural Psychosocial Organization Nepal, Kathmandu 44616, Nepal;
| | | | - Ramesh P Adhikari
- Transcultural Psychosocial Organization Nepal, Kathmandu 44616, Nepal
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu 44616, Nepal
| | - Jesusa M G Arevalo
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095; Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095
| | - Jeffrey Ma
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095; Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095
| | - Heather McCreath
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095
| | - Teresa E Seeman
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095; Department of Epidemiology, University of California, Los Angeles School of Public Health, Los Angeles, CA 90095
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089
| | - Steven W Cole
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095; Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095
| |
Collapse
|
20
|
Sabri B, Sabarwal S, Decker MR, Shrestha A, Sharma K, Thapa L, Surkan PJ. Violence Against Widows in Nepal: Experiences, Coping Behaviors, and Barriers in Seeking Help. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:1744-1766. [PMID: 25657102 DOI: 10.1177/0886260515569058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Widows are a vulnerable population in Nepal. This study examined Nepalese widows' experiences of violence, their coping strategies, and barriers faced in seeking help. Study participants were recruited from Women for Human Rights, an NGO in Nepal. A stratified purposive sampling approach was used to select 51 widows and 5 staff members for in-depth interviews. Twenty-seven women who experienced violence were included in this analysis. Data were analyzed and synthesized using a thematic analysis procedure. Widows reported a range of violent experiences perpetrated by family and community members that spanned psychological, physical, and sexual abuse. Women dealt with abusive experiences using both adaptive (e.g., attempting to move ahead, seeking social support, using verbal confrontation) and maladaptive coping strategies (e.g., suicidal thoughts or self-medication). However, they faced barriers to seeking help such as insensitivity of the police, perceived discrimination, and general lack of awareness of widows' problems and needs. Findings highlight the need for interventions across the individual, family, community, and policy levels. Avenues for intervention include creating awareness about widows' issues and addressing cultural beliefs affecting widows' lives. Furthermore, efforts should focus on empowering widows, promoting healthy coping, and addressing their individual needs.
Collapse
Affiliation(s)
- Bushra Sabri
- Community and Public Health Department, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Shrutika Sabarwal
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abina Shrestha
- Women for Human Rights, Single Women Group, Kathmandu, Nepal
| | - Kunda Sharma
- Women for Human Rights, Single Women Group, Kathmandu, Nepal
| | - Lily Thapa
- Women for Human Rights, Single Women Group, Kathmandu, Nepal
| | - Pamela J Surkan
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
Risal A, Manandhar K, Linde M, Steiner TJ, Holen A. Anxiety and depression in Nepal: prevalence, comorbidity and associations. BMC Psychiatry 2016; 16:102. [PMID: 27075664 PMCID: PMC4831105 DOI: 10.1186/s12888-016-0810-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed. METHODS A nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18-65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health. RESULTS Age- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9% respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p < 0.001) and neuroticism (AOR = 1.32; p < 0.001), and negatively with alcohol consumption (AOR = 0.71; p = 0.041). HADS-D was positively associated with marijuana use (AOR = 3.61; p = 0.017) and negatively with quality of life (QoL) (AOR = 0.86; p < 0.001). HADS-cAD was positively associated with widowhood (AOR = 2.71; p = 0.002), urban residence (AOR = 2.37; p = 0.001), living at altitude ≥2000 m (AOR = 2.32; p = 0.002) and neuroticism (AOR = 1.26; p < 0.001), and negatively with alcohol use (AOR = 0.56; p = 0.026) and QoL (AOR = 0.79; p < 0.001). CONCLUSION Depression and anxiety are important mental health conditions in Nepal, and major contributors to public ill health, being very highly prevalent, comorbid and associated with psychosocial burden. They are also linked to the unique topography, habitation and social structure of the country. High prevalence coupled with the disabling nature of these disorders establishes their health-care priority and their importance in national health policy.
Collapse
Affiliation(s)
- Ajay Risal
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, NO, 7491, Norway. .,Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
| | - Kedar Manandhar
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, NO 7491 Norway ,Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre Nepal
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, NO 7491 Norway ,Norwegian Advisory Unit on Headaches, St Olavs University Hospital, Trondheim, Norway
| | - Timothy J. Steiner
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, NO 7491 Norway ,Division of Brain Sciences, Imperial College London, London, UK
| | - Are Holen
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, NO 7491 Norway ,Pain Unit, St Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
22
|
Burnett C, Schminkey D, Milburn J, Kastello J, Bullock L, Campbell J, Sharps P. Negotiating Peril: The Lived Experience of Rural, Low-Income Women Exposed to IPV During Pregnancy and Postpartum. Violence Against Women 2015; 22:943-65. [PMID: 26612275 DOI: 10.1177/1077801215614972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study of 10 rural women examines their lived experience of intimate partner violence during pregnancy and the first 2 postpartum years. In-depth interviews occurred during pregnancy and 4 times postpartum. A Heideggerian approach revealed "negotiating peril" as the overarching theme; sub-themes were unstable environment, adaptive calibration, primacy of motherhood, and numb acceptance. Some incremental shifts in severity of abusive situations were observed. Results elucidate the ambivalence with which these women view institutions that are designed to help them. Findings highlight factors that may explain why interventions designed to help often do not appear efficacious in facilitating complete termination of an abusive situation.
Collapse
|
23
|
Abstract
Indigenous populations worldwide are experiencing social, cultural, demographic, nutritional, and psychoemotional changes that have a profound impact on health. Regardless of their geographical location or sociopolitical situation, health indicators are always poorer for indigenous populations than for nonindigenous ones. The determinants of this gap are multiple and interactive, and their analysis requires a biocultural framework. Indigenous populations suffer from lower life expectancy, high infant and child mortality, high maternal morbidity and mortality, heavy infectious disease loads, malnutrition, stunted growth, increasing levels of cardiovascular and other chronic diseases, substance abuse, and depression. The devastating effects of colonization, the loss of ancestral land, and language and cultural barriers for access to health care are among the most salient themes characterizing the poor health situation of indigenous people. Anthropology is extremely well suited to address the interplay among social, economic, and political forces that shape the local experiences of illness.
Collapse
Affiliation(s)
| | - J. Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon 97403
| |
Collapse
|
24
|
Kaiser BN, Kohrt BA, Wagenaar BH, Kramer MR, McLean KE, Hagaman AK, Khoury NM, Keys HM. Scale properties of the Kreyòl Distress Idioms (KDI) screener: association of an ethnographically-developed instrument with depression, anxiety, and sociocultural risk factors in rural Haiti. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/17542863.2015.1015580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Kohrt BA, Jordans MJD, Koirala S, Worthman CM. Designing mental health interventions informed by child development and human biology theory: a social ecology intervention for child soldiers in Nepal. Am J Hum Biol 2015; 27:27-40. [PMID: 25380194 PMCID: PMC5483323 DOI: 10.1002/ajhb.22651] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/10/2014] [Accepted: 10/18/2014] [Indexed: 01/27/2023] Open
Abstract
The anthropological study of human biology, health, and child development provides a model with potential to address the gap in population-wide mental health interventions. Four key concepts from human biology can inform public mental health interventions: life history theory and tradeoffs, redundancy and plurality of pathways, cascades and multiplier effects in biological systems, and proximate feedback systems. A public mental health intervention for former child soldiers in Nepal is used to illustrate the role of these concepts in intervention design and evaluation. Future directions and recommendations for applying human biology theory in pursuit of public mental health interventions are discussed.
Collapse
Affiliation(s)
- Brandon A Kohrt
- Department of Anthropology, Emory University, Atlanta; Transcultural Psychosocial Organization (TPO), Nepal, Kathmandu, Nepal
| | | | | | | |
Collapse
|
26
|
Niraula K, Kohrt BA, Flora MS, Thapa N, Mumu SJ, Pathak R, Stray-Pedersen B, Ghimire P, Regmi B, MacFarlane EK, Shrestha R. Prevalence of depression and associated risk factors among persons with type-2 diabetes mellitus without a prior psychiatric history: a cross-sectional study in clinical settings in urban Nepal. BMC Psychiatry 2013; 13:309. [PMID: 24238561 PMCID: PMC3833646 DOI: 10.1186/1471-244x-13-309] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes is a growing health problem in South Asia. Despite an increasing number of studies exploring causal pathways between diabetes and depression in high-income countries (HIC), the pathway between the two disorders has received limited attention in low and middle-income countries (LMIC). The aim of this study is to investigate the potential pathway of diabetes contributing to depression, to assess the prevalence of depression, and to evaluate the association of depression severity with diabetes severity. This study uses a clinical sample of persons living with diabetes sequelae without a prior psychiatric history in urban Nepal. METHODS A cross-sectional study was conducted among 385 persons living with type-2 diabetes attending tertiary centers in Kathmandu, Nepal. Patients with at least three months of diagnosed diabetes and no prior depression diagnosis or family history of depression were recruited randomly using serial selection from outpatient medicine and endocrine departments. Blood pressure, anthropometrics (height, weight, waist and hip circumference) and glycated hemoglobin (HbA1c) were measured at the time of interview. Depression was measured using the validated Nepali version of the Beck Depression Inventory (BDI-Ia). RESULTS The proportion of respondents with depression was 40.3%. Using multivariable analyses, a 1-unit (%) increase in HbA1c was associated with a 2-point increase in BDI score. Erectile dysfunction was associated with a 5-point increase in BDI-Ia. A 10 mmHg increase in blood pressure (both systolic and diastolic) was associated with a 1.4-point increase in BDI-Ia. Other associated variables included waist-hip-ratio (9-point BDI-Ia increase), at least one diabetic complication (1-point BDI-Ia increase), treatment non-adherence (1-point BDI-Ia increase), insulin use (2-point BDI-Ia increase), living in a nuclear family (2-point BDI-Ia increase), and lack of family history of diabetes (1-point BDI-Ia increase). Higher monthly income was associated with increased depression severity (3-point BDI-Ia increase per 100,000 rupees, equivalent US$1000). CONCLUSIONS Depression is associated with indicators of more severe diabetes disease status in Nepal. The association of depression with diabetes severity and sequelae provide initial support for a causal pathway from diabetes to depression. Integration of mental health services in primary care will be important to combat development of depression among persons living with diabetes.
Collapse
Affiliation(s)
- Kiran Niraula
- Department of Epidemiology and Biostatistics, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Meerjady Sabrina Flora
- Department of Epidemiology, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Narbada Thapa
- Department of Community Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Shirin Jahan Mumu
- Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Rahul Pathak
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Babill Stray-Pedersen
- Institute of Clinical Medicine, University of Oslo - Division of Women and Children, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | | | | | | | | |
Collapse
|
27
|
Luitel NP, Jordans MJD, Sapkota RP, Tol WA, Kohrt BA, Thapa SB, Komproe IH, Sharma B. Conflict and mental health: a cross-sectional epidemiological study in Nepal. Soc Psychiatry Psychiatr Epidemiol 2013; 48:183-93. [PMID: 22777395 DOI: 10.1007/s00127-012-0539-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/14/2012] [Indexed: 11/28/2022]
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.
Collapse
Affiliation(s)
- Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Kohrt BA, Hruschka DJ, Worthman CM, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Koirala S, Thapa SB, Tol WA, Jordans MJD, Robkin N, Sharma VD, Nepal MK. Political violence and mental health in Nepal: prospective study. Br J Psychiatry 2012; 201:268-75. [PMID: 22878131 PMCID: PMC3461445 DOI: 10.1192/bjp.bp.111.096222] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Post-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence. AIMS This prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal. METHOD An adult cohort completed the Beck Depression Inventory and Beck Anxiety Inventory in 2000 prior to conflict violence in their community and in 2007 after the war. RESULTS Of the original 316 participants, 298 (94%) participated in the post-conflict assessment. Depression increased from 30.9 to 40.6%. Anxiety increased from 26.2 to 47.7%. Post-conflict post-traumatic stress disorder (PTSD) was 14.1%. Controlling for ageing, the depression increase was not significant. The anxiety increase showed a dose-response association with conflict exposure when controlling for ageing and daily stressors. No demographic group displayed unique vulnerability or resilience to the effects of conflict exposure. CONCLUSIONS Conflict exposure should be considered in the context of other types of psychiatric risk factors. Conflict exposure predicted increases in anxiety whereas socioeconomic factors and non-conflict stressful life events were the major predictors of depression. Research and interventions in post-conflict settings therefore should consider differential trajectories for depression v. anxiety and the importance of addressing chronic social problems ranging from poverty to gender and ethnic/caste discrimination.
Collapse
|
29
|
Wagenaar BH, Hagaman AK, Kaiser BN, McLean KE, Kohrt BA. Depression, suicidal ideation, and associated factors: a cross-sectional study in rural Haiti. BMC Psychiatry 2012; 12:149. [PMID: 22992379 PMCID: PMC3515455 DOI: 10.1186/1471-244x-12-149] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 09/10/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Since the 2010 earthquake in Haiti, there has been increased international attention to mental health needs throughout the country. The present study represents one of the first epidemiologic studies of depression symptomatology, suicidal ideation, and associated factors in Haiti's Central Plateau. METHODS We conducted a cross-sectional, zone-stratified household survey of 408 adults in Haiti's Central Plateau. Depression symptomatology was assessed with a culturally-adapted Kreyòl version of the Beck Depression Inventory (BDI). Multivariable linear and logistic regression models were built using backward elimination, with the outcomes being continuous BDI scores and endorsing suicidal ideation, respectively. RESULTS The mean BDI score was 20.4 (95% confidence interval [CI]: 19.3-21.5), and 6.13% (N = 25) of participants endorsed current suicidal ideation. Factors associated with BDI scores were: continuous age (adjusted beta [aβ]: 0.14, CI: 0.06-0.22), female gender (aβ: 2.1, CI: 0.18-4.0), suicidal ideation (aβ: 11.1, CI: 7.3-14.9), death in family (aβ: 2.7, CI: 0.57-4.9), and prior life-threatening illness (aβ: 2.6, CI: 0.77-4.5). Education was a risk factor for depression among women but not among men, and employment was a risk factor for both genders. Factors associated with endorsing suicidal ideation were: BDI score (ten point change) (adjusted odds ratio [aOR]: 2.5, CI: 1.7-3.6), lack of care if sick (aOR: 5.5, CI: 1.1-28.6), alcohol use (aOR: 3.3, CI: 1.3-8.2), and ever having been to a Vodou priest (aOR: 3.2, CI: 1.1-9.5). CONCLUSIONS A large proportion of Haiti's Central Plateau may be experiencing high levels of depression symptomatology and/or current suicidal ideation. Screening could be conducted in biomedical, religious, and Vodou healing contexts. For prevention, poverty reduction and improved healthcare access are key elements. For treatment, general psychiatric services, psychosocial services for the medically ill and their families, and substance abuse interventions should be explored. Paradoxical associations related to education and employment require further exploration.
Collapse
Affiliation(s)
- Bradley H Wagenaar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ashley K Hagaman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bonnie N Kaiser
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Anthropology, Emory University, Atlanta, GA, USA
| | - Kristen E McLean
- Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brandon A Kohrt
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| |
Collapse
|
30
|
Kohrt BA, Jordans MJD, Tol WA, Perera E, Karki R, Koirala S, Upadhaya N. Social ecology of child soldiers: child, family, and community determinants of mental health, psychosocial well-being, and reintegration in Nepal. Transcult Psychiatry 2010; 47:727-53. [PMID: 21088102 PMCID: PMC3833694 DOI: 10.1177/1363461510381290] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study employed a social ecology framework to evaluate psychosocial well-being in a cross-sectional sample of 142 former child soldiers in Nepal. Outcome measures included the Depression Self Rating Scale (DSRS), Child Posttraumatic Stress Disorder Symptom Scale (CPSS), and locally developed measures of functional impairment and reintegration. Hierarchical linear modeling was used to examine the contribution of factors at multiple levels. At the child level, traumatic exposures, especially torture, predicted poor outcomes, while education improved outcomes. At the family level, conflict-related death of a relative, physical abuse in the household, and loss of wealth during the conflict predicted poor outcomes. At the community level, living in high caste Hindu communities predicted lack of reintegration supports. Ultimately, social ecology is well suited to identify intervention foci across ecological levels based on community differences in vulnerability and protective factors.
Collapse
Affiliation(s)
- Brandon A Kohrt
- Department of Anthropology, Emory University, 1557 Dickey Drive, Atlanta, GA 30322, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Maes KC, Kohrt BA, Closser S. Culture, status and context in community health worker pay: pitfalls and opportunities for policy research. A commentary on Glenton et al. (2010). Soc Sci Med 2010; 71:1375-8; discussion 1379-80. [PMID: 20667639 PMCID: PMC6211553 DOI: 10.1016/j.socscimed.2010.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 06/03/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Kenneth C Maes
- Department of Anthropology, Emory University, 1557 Dickey Drive, Atlanta, GA, USA.
| | | | | |
Collapse
|
32
|
Kohrt BA, Hruschka DJ. Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Cult Med Psychiatry 2010; 34:322-52. [PMID: 20309724 PMCID: PMC3819627 DOI: 10.1007/s11013-010-9170-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.
Collapse
Affiliation(s)
- Brandon A. Kohrt
- Department of Anthropology, Department of Psychiatry, Emory University, 1557 Dickey Drive, Atlanta, GA 30322, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal, , 404-895-1643
| | - Daniel J. Hruschka
- School of Human Evolution and Social Change, Arizona State University, SHESC 233, P.O. Box 872402, Tempe, AZ 85287-2402,
| |
Collapse
|
33
|
Vulnerable social groups in postconflict settings: a mixed methods policy analysis and epidemiology study of caste and psychological morbidity in Nepal. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2009. [DOI: 10.1097/wtf.0b013e3283346426] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|