Prevalence of anxiety, depression and post-traumatic stress disorder in the Kashmir Valley

Abstract

BackgroundFollowing the partition of India in 1947, the Kashmir Valley has been subject to continual political insecurity and ongoing conflict, the region remains highly militarised. We conducted a representative cross-sectional population-based survey of adults to estimate the prevalence and predictors of anxiety, depression and post-traumatic stress disorder (PTSD) in the 10 districts of the Kashmir Valley.MethodsBetween October and December 2015, we interviewed 5519 out of 5600 invited participants, ≥18 years of age, randomly sampled using a probability proportional to size cluster sampling design. We estimated the prevalence of a probable psychological disorder using the Hopkins Symptom Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ-16). Both screening instruments had been culturally adapted and translated. Data were weighted to account for the sampling design and multivariate logistic regression analysis was conducted to identify risk factors for developing symptoms of psychological distress.FindingsThe estimated prevalence of mental distress in adults in the Kashmir Valley was 45% (95% CI 42.6 to 47.0). We identified 41% (95% CI 39.2 to 43.4) of adults with probable depression, 26% (95% CI 23.8 to 27.5) with probable anxiety and 19% (95% CI 17.5 to 21.2) with probable PTSD. The three disorders were associated with the following characteristics: being female, over 55 years of age, having had no formal education, living in a rural area and being widowed/divorced or separated. A dose–response association was found between the number of traumatic events experienced or witnessed and all three mental disorders.InterpretationThe implementation of mental health awareness programmes, interventions aimed at high risk groups and addressing trauma-related symptoms from all causes are needed in the Kashmir Valley.

The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar

“…Compared with other countries, the prevalence of mental distress in the present study was lower than reported in Canada [15], Malaysia [14], Cambodia [11] and Kashmir Valley in India [35]. The longitudinal community survey from Canada [11] which included 2433 men and women aged 15 to 65 years used the K-10 scale for mental distress while the Malaysian National Health and Morbidity Survey (2015) [14] used the General Health Questionnaires (GHQ-12) in a sample of individuals older than 15 years.…”

“…The longitudinal community survey from Canada [11] which included 2433 men and women aged 15 to 65 years used the K-10 scale for mental distress while the Malaysian National Health and Morbidity Survey (2015) [14] used the General Health Questionnaires (GHQ-12) in a sample of individuals older than 15 years. The Cambodia study [15] and the Kashmir study [35] applied the Hopkins Symptoms Checklist-25 (HSCL-25) in adult populations. Variations in design, instruments and/or included ages across studies make comparison of prevalence of mental distress difficult.…”

“…We report a higher prevalence of mental distress among women than men, which is in line with several other studies undertaken in other countries [11-15, 35, 37-39]. It is possible that women are more vulnerable to Table 1 Prevalence of mental distress a and median HSCL-10 score by socio-demographic and selected health-related factors among men and women 18-49-year-old citizens of Yangon Region, Myanmar (Continued) the socio-cultural risks, for example, a cultural belief that men have higher status relative to women, which have led to more depression among women [35,37,38]. In Myanmar, men have a dominated role as head of household, primary breadwinner and legal representative of the family [39].…”

“…In Myanmar, men have a dominated role as head of household, primary breadwinner and legal representative of the family [39]. Furthermore, women carry a heavier burden of household responsibility than men and that may predispose them to an increased risk of mental distress, for example, when the household has economic problems [35,38]. Hormonal differences between sexes has also been suggested as being one of the contributing factors of higher prevalence of mental distress in women when compared with men [40,41].…”

Psychological Distress Among First Year Students in a Medical College in J and K, India

“…[16,17] High prevalence of depression has also been reported in general Kashmiri population. [18] This may be due to the fact that people living in conflict are at a higher risk of developing psychological distress. [19] Double and triple co-existent illnesses were reported in 22.0% and 41.8% of participants, respectively.…”