Political violence and mental health in Nepal: Prospective study

Department of Psychiatry and Behavioral Sciences, The George Washington University, 2150 Pennsylvania Avenue, 8th Floor, Washington, DC 20037, USA. .
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.34). 08/2012; 201(4):268-75. DOI: 10.1192/bjp.bp.111.096222
Source: PubMed

ABSTRACT Post-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence.
This prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal.
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.
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.
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.

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    • "We developed this tool within a task-sharing initiative in a low-income, non-Western cultural setting. Nepal, a post-conflict country in South Asia with high prevalence of depression (Kohrt et al., 2012a) and suicide (Jordans et al., 2014), is participating in the Programme to Improve Mental Health Care (PRIME), an initiative in LMICs to develop mental health care in primary and community health settings (Jordans, Luitel, Tomlinson, & Komproe, 2013; Lund et al., 2012). In Nepal's Chitwan District, primary care and community health workers are being trained with a locally developed Mental Health Care Package (Jordans, Luitel, Pokharel, & Patel, in press), which includes the mental health Gap Action Programme—Intervention Guide (mhGAP-IG) (WHO, 2010), psychosocial skills modules, and brief modified versions of behavior activation (the Healthy Activity Program, HAP) and motivational interviewing (Counseling for "
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