Culture in psychiatric epidemiology: Using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal

Abstract

Background The causes of ethnic and caste-based disparities in mental health are poorly understood. Aim To identify mediators underlying caste-based disparities in mental health in Nepal. Subjects and methods A mixed methods ethnographic and epidemiological study of 307 adults (Dalit/Nepali, n=75; high caste Brahman and Chhetri, n=232) assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories. Results One third (33.7%) of participants were classified as depressed: Dalit/Nepali 50.0%, high caste 28.4%. One quarter (27.7%) of participants were classified as anxious: Dalit/Nepali 50.7%, high caste 20.3%. Ethnographic research identified four potential mediators: stressful life events, owning few livestock, no household income, and lack of social support. The direct effect of caste was 1.08 (95% CI -1.10—3.27) on depression score and 4.76 (95% CI 2.33—7.19) on anxiety score. All four variables had significant indirect (mediation) effects on anxiety, and all but social support had significant indirect effects on depression. Conclusion Caste-based disparities in mental health in rural Nepal are statistically mediated by poverty, lack of social support, and stressful life events. Interventions should target these areas to alleviate the excess mental health burden born by Dalit/Nepali women and men.

Impact of ethnicity, unemployment and economy on mental disorders : A study from Western Nepal

“…Study done by Banerjee et al also reported that schizophrenia is commonly found among Dalit patients. Similar findings were reported in the research conducted in the Rural Community of Nepal as well 1,17 . It is because Nepal is an under developed country having poor financial status which could lead to high prevalence of psychiatric illness.…”

“…Many Nepalese people are financially poor and therefore can't afford to have health care facility timely and in course of time it may result in various psychiatric disorders. A research conducted in Nepal by Kohrt BA et al also concluded that the caste-based disparity, poverty, lack of social support and stressful life events have adversely affected the mental health of Nepalese people 1 .…”

“…The causes of mental health problems and ethnic variation are poorly understood 1 . From Income point of view, Nepal is a poor developing country which is situated in South East Asia 2 .…”

Prevalence of Depression among Hypertensive Patients in Saudi Arabia

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“…The 21-item BDI-Ia, Nepali version [37,38], was used to assess depression in participants over the prior 2 weeks (Cronbach's alpha = 0.89). Items are scored on a four-point Likert scale with an instrument range of 0 to 62.…”