Political violence and mental health in Nepal: prospective study

Brandon A Kohrt; Daniel J Hruschka; Carol M Worthman; Richard D Kunz; Jennifer L Baldwin; Nawaraj Upadhaya; Nanda Raj Acharya; Suraj Koirala; Suraj B Thapa; Wietse A Tol; Mark J D Jordans; Navit Robkin; Vidya Dev Sharma; Mahendra K Nepal

doi:10.1192/bjp.bp.111.096222

Political violence and mental health in Nepal: prospective study

Brandon A Kohrt, Daniel J Hruschka, Carol M Worthman, Richard D Kunz, Jennifer L Baldwin, Nawaraj Upadhaya, Nanda Raj Acharya, Suraj Koirala, Suraj B Thapa, Wietse A Tol, Mark J D Jordans, Navit Robkin, Vidya Dev Sharma, Mahendra K Nepal

Health Service & Population Research

Research output: Contribution to journal › Article › peer-review

80 Citations (Scopus)

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.

Original language	English
Pages (from-to)	268-75
Number of pages	8
Journal	The British journal of psychiatry : the journal of mental science
Volume	201
Issue number	4
DOIs	https://doi.org/10.1192/bjp.bp.111.096222
Publication status	Published - Oct 2012

Keywords

Adolescent
Adult
Anxiety
Depression
Female
Humans
Male
Middle Aged
Nepal
Politics
Poverty
Prospective Studies
Psychiatric Status Rating Scales
Risk Factors
Stress Disorders, Post-Traumatic
Violence

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1192/bjp.bp.111.096222

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Kohrt, B. A., Hruschka, D. J., Worthman, C. M., Kunz, R. D., Baldwin, J. L., Upadhaya, N., Acharya, N. R., Koirala, S., Thapa, S. B., Tol, W. A., Jordans, M. J. D., Robkin, N., Sharma, V. D., & Nepal, M. K. (2012). Political violence and mental health in Nepal: prospective study. The British journal of psychiatry : the journal of mental science, 201(4), 268-75. https://doi.org/10.1192/bjp.bp.111.096222

@article{2f0e0e8f78434651a0c407354e8865d7,

title = "Political violence and mental health in Nepal: prospective study",

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.",

keywords = "Adolescent, Adult, Anxiety, Depression, Female, Humans, Male, Middle Aged, Nepal, Politics, Poverty, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Stress Disorders, Post-Traumatic, Violence",

author = "Kohrt, {Brandon A} and Hruschka, {Daniel J} and Worthman, {Carol M} and Kunz, {Richard D} and Baldwin, {Jennifer L} and Nawaraj Upadhaya and Acharya, {Nanda Raj} and Suraj Koirala and Thapa, {Suraj B} and Tol, {Wietse A} and Jordans, {Mark J D} and Navit Robkin and Sharma, {Vidya Dev} and Nepal, {Mahendra K}",

year = "2012",

month = oct,

doi = "10.1192/bjp.bp.111.096222",

language = "English",

volume = "201",

pages = "268--75",

journal = "The British journal of psychiatry : the journal of mental science",

issn = "0007-1250",

publisher = "Cambridge University Press",

number = "4",

}

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 2012, 'Political violence and mental health in Nepal: prospective study', The British journal of psychiatry : the journal of mental science, vol. 201, no. 4, pp. 268-75. https://doi.org/10.1192/bjp.bp.111.096222

TY - JOUR

T1 - Political violence and mental health in Nepal

T2 - prospective study

AU - Kohrt, Brandon A

AU - Hruschka, Daniel J

AU - Worthman, Carol M

AU - Kunz, Richard D

AU - Baldwin, Jennifer L

AU - Upadhaya, Nawaraj

AU - Acharya, Nanda Raj

AU - Koirala, Suraj

AU - Thapa, Suraj B

AU - Tol, Wietse A

AU - Jordans, Mark J D

AU - Robkin, Navit

AU - Sharma, Vidya Dev

AU - Nepal, Mahendra K

PY - 2012/10

Y1 - 2012/10

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Anxiety

KW - Depression

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Nepal

KW - Politics

KW - Poverty

KW - Prospective Studies

KW - Psychiatric Status Rating Scales

KW - Risk Factors

KW - Stress Disorders, Post-Traumatic

KW - Violence

U2 - 10.1192/bjp.bp.111.096222

DO - 10.1192/bjp.bp.111.096222

M3 - Article

C2 - 22878131

SN - 0007-1250

VL - 201

SP - 268

EP - 275

JO - The British journal of psychiatry : the journal of mental science

JF - The British journal of psychiatry : the journal of mental science

IS - 4

ER -

Political violence and mental health in Nepal: prospective study

Abstract

Keywords

UN SDGs

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