Conflict and mental health: a cross-sectional epidemiological study in Nepal

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.

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.

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).

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.