Hostname: page-component-745bb68f8f-b6zl4 Total loading time: 0 Render date: 2025-02-04T00:31:29.124Z Has data issue: false hasContentIssue false
  • English
  • Français

Mental health and psychosocial problems in the aftermath of the Nepal earthquakes: findings from a representative cluster sample survey

Published online by Cambridge University Press:  09 January 2017

J. C. Kane Open the ORCID record for J. C. Kane [Opens in a new window] ,
N. P. Luitel ,
M. J. D. Jordans ,
B. A. Kohrt ,
I. Weissbecker  and
W. A. Tol
J. C. Kane*
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
N. P. Luitel
Affiliation:
Research Department, Transcultural Psychosocial Organization (TPO), Nepal
M. J. D. Jordans
Affiliation:
Research Department, Transcultural Psychosocial Organization (TPO), Nepal Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
B. A. Kohrt
Affiliation:
Duke Global Health Institute, Duke University, Durham, NC, USA
I. Weissbecker
Affiliation:
International Medical Corps, Washington, D.C., USA
W. A. Tol
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Peter C. Alderman Foundation, Bedford, NY, USA
*
*Address for correspondence: J. C. Kane, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA. (Email: jkane29@jhu.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

Two large earthquakes in 2015 caused widespread destruction in Nepal. This study aimed to examine frequency of common mental health and psychosocial problems and their correlates following the earthquakes.

Methods.

A stratified multi-stage cluster sampling design was employed to randomly select 513 participants (aged 16 and above) from three earthquake-affected districts in Nepal: Kathmandu, Gorkha and Sindhupalchowk, 4 months after the second earthquake. Outcomes were selected based on qualitative preparatory research and included symptoms of depression and anxiety (Hopkins Symptom Checklist-25); post-traumatic stress disorder (PTSD Checklist-Civilian); hazardous alcohol use (AUDIT-C); symptoms indicating severe psychological distress (WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS)); suicidal ideation (Composite International Diagnostic Interview); perceived needs (Humanitarian Emergency Settings Perceived Needs Scale (HESPER)); and functional impairment (locally developed scale).

Results.

A substantial percentage of participants scored above validated cut-off scores for depression (34.3%, 95% CI 28.4–40.4) and anxiety (33.8%, 95% CI 27.6–40.6). Hazardous alcohol use was reported by 20.4% (95% CI 17.1–24.3) and 10.9% (95% CI 8.8–13.5) reported suicidal ideation. Forty-two percent reported that ‘distress’ was a serious problem in their community. Anger that was out of control (symptom from the WASSS) was reported by 33.7% (95% CI 29.5–38.2). Fewer people had elevated rates of PTSD symptoms above a validated cut-off score (5.2%, 95% CI 3.9–6.8), and levels of functional impairment were also relatively low. Correlates of elevated symptom scores were female gender, lower caste and greater number of perceived needs. Residing in Gorkha and Sindhupalchowk districts and lower caste were also associated with greater perceived needs. Higher levels of impaired functioning were associated with greater odds of depression and anxiety symptoms; impaired functioning was less strongly associated with PTSD symptoms.

Conclusions.

Four months after the earthquakes in Nepal, one out of three adults experienced symptoms of depression and distressing levels of anger, one out of five engaged in hazardous drinking, and one out of ten had suicidal thoughts. However, posttraumatic stress symptoms and functional impairment were comparatively less frequent. Taken together, the findings suggest that there were significant levels of psychological distress but likely low levels of disorder. The findings highlight the importance of indicated prevention strategies to reduce the risk of distress progressing to disorder within post-disaster mental health systems of care.

Keywords

Disastershumanitarian settinglow- and middle-income countriespsychiatric epidemiology
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 3 , June 2018 , pp. 301 - 310
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bera, G (2016). Devastating earthquake in Nepal (2015): A geographical appraisal. International Journal of Research in Applied, Natural and Social Sciences 4, 75–86.Google Scholar
Bolton, P, Tang, AM (2002). An alternative approach to cross-cultural function assessment. Social Psychiatry and Psychiatric Epidemiology 37, 537–543.CrossRefGoogle ScholarPubMed
Bradley, KA, Bush, KR, Epler, AJ, Dobie, DJ, Davis, TM, Sporleder, JL, Maynard, C, Burman, ML, Kivlahan, DR (2003). Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Archives of Internal Medicine 163, 821–829.Google Scholar
Central Bureau of Statistics, Government of Nepal (2012). National Population and Housing Census 2011(National Report).Google Scholar
Cerdá, M, Paczkowski, M, Galea, S, Nemethy, K, Péan, C, Desvarieux, M (2013). Psychopathology in the aftermath of the Haiti earthquake: a population-based study of posttraumatic stress disorder and major depression. Depression and Anxiety 30, 413–424.Google Scholar
Derogatis, LR, Lipman, RS, Rickels, K, Uhlenhuth, EH, Covi, L (1974). The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behavioral Science 19, 1–15.Google Scholar
Gautam, R (2009). Intergenerational social support, conflict and mental health of older adults in Nepal: evidence of synergic effects. Gerontologist 49, 380.Google Scholar
Jordans, MJD, Komproe, IH, Tol, WA, Kohrt, BA, Luitel, NP, Macy, RD, de Jong, JTVM (2010). Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial. Journal of Child Psychology and Psychiatry 51, 818–826.Google Scholar
Jordans, MJD, Semrau, M, Thornicroft, G, van Ommeren, M (2012). Role of current perceived needs in explaining the association between past trauma exposure and distress in humanitarian settings in Jordan and Nepal. British Journal of Psychiatry 201, 276–281.CrossRefGoogle ScholarPubMed
Jordans, MJD, Luitel, NP, Pokhrel, P, Patel, V (2016). Development and pilot testing of a mental healthcare plan in Nepal. British Journal of Psychiatry 208, s21–s28.CrossRefGoogle ScholarPubMed
Kane, JC, Ventevogel, P, Spiegel, P, Bass, JK, van Ommeren, M, Tol, WA (2014). Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps. BMC Medicine 12, 228.Google Scholar
Kessler, RC, Ustün, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.Google Scholar
Kohrt, B (2009). Vulnerable social groups in post-conflict settings: a mixed methods policy analysis. Intervention 7(3), 239–264.Google Scholar
Kohrt, BA, Hruschka, DJ (2010). Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Culture, Medicine, and Psychiatry 34, 322–352.Google Scholar
Kohrt, BA, Jordans, MJD, Tol, WA, Speckman, RA, Maharjan, SM, Worthman, CM, Komproe, IH (2008). Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. Journal of the American Medical Association 300, 691–702.Google Scholar
Kohrt, BA, Speckman, RA, Kunz, RD, Baldwin, JL, Upadhaya, N, Acharya, NR, Sharma, VD, Nepal, MK, Worthman, CM (2009). Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Annals of Human Biology 36(3), 261–280.Google Scholar
Kohrt, B, Perera, E, Jordans, M, Koirala, S, Karki, Ro, Karki, Ra, Shrestha, P, Tol, W, Upadhaya, N (2010). Psychosocial Support Model for Children Associated with Armed Forces and Armed Groups in Nepal (ed. Kohrt, B, Kathmandu, Perera E). Transcultural Psychosocial Organization: Nepal.Google Scholar
Kohrt, BA, Jordans, MJ, Tol, WA, Luitel, NP, Maharjan, SM, Upadhaya, N (2011). Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal. BMC Psychiatry 11, 127.CrossRefGoogle ScholarPubMed
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. British Journal of Psychiatry 201, 268–275.Google Scholar
Kohrt, BA, Jordans, MJD, Koirala, S, Worthman, CM (2015 a). Designing mental health interventions informed by child development and human biology theory: a social ecology intervention for child soldiers in Nepal. American Journal of Human Biology 27, 27–40.CrossRefGoogle ScholarPubMed
Kohrt, BA, Jordans, MJD, Rai, S, Shrestha, P, Luitel, NP, Ramaiya, MK, Singla, DR, Patel, V (2015 b). Therapist competence in global mental health: development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale. Behaviour Research and Therapy 69, 11–21.Google Scholar
Kohrt, BA, Worthman, CM, Adhikari, RP, Luitel, NP, Arevalo, JMG, Ma, J, McCreath, H, Seeman, TE, Crimmins, EM, Cole, SW (2016). Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers. Proceedings of the National Academy of Sciences of the United States of America 113, 8156–8161.Google Scholar
Luitel, NP, Jordans, MJD, Sapkota, RP, Tol, WA, Kohrt, BA, Thapa, SB, Komproe, IH, Sharma, B (2013 a). Conflict and mental health: a cross-sectional epidemiological study in Nepal. Social Psychiatry and Psychiatric Epidemiology 48, 183–193.Google Scholar
Luitel, NP, Jordans, M, Murphy, A, Roberts, B, McCambridge, J (2013 b). Prevalence and patterns of hazardous and harmful alcohol consumption assessed using the AUDIT among Bhutanese refugees in Nepal. Alcohol and Alcoholism 48, 349–355.Google Scholar
Luitel, NP, Jordans, MJ, Adhikari, A, Upadhaya, N, Hanlon, C, Lund, C, Komproe, IH (2015). Mental health care in Nepal: current situation and challenges for development of a district mental health care plan. Conflict and Health 9, 3.Google Scholar
Mrazek, P, Haggerty, R (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. National Academy Press: Washington, DCGoogle Scholar
Murray, LK, Dorsey, S, Haroz, E, Lee, C, Alsiary, MM, Haydary, A, Weiss, WM, Bolton, P (2014). A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cognitive and Behavioral Practice 21, 111–123.Google Scholar
Pensuksan, WC, Taneepanichskul, S, Williams, MA (2010). A peer-drinking group motivational intervention among Thai male undergraduate students. International Journal of Drug Policy 21(5), 432–436.Google Scholar
Qi, W, Gevonden, M, Shalev, A (2016). Prevention of post-traumatic stress disorder after Trauma: current evidence and future directions. Current Psychiatry Reports 18, 20.Google Scholar
Rodin, D, van Ommeren, M (2009). Commentary: explaining enormous variations in rates of disorder in trauma-focused psychiatric epidemiology after major emergencies. International Journal of Epidemiology 38, 1045–1048.Google Scholar
Ruggiero, KJ, Ben, KD, Scotti, JR, Rabalais, AE (2003). Psychometric properties of the PTSD checklist—Civilian version. Journal of Traumatic Stress 16, 495–502.Google Scholar
Sakuma, A, Takahashi, Y, Ueda, I, Sato, H, Katsura, M, Abe, M, Nagao, A, Suzuki, Y, Kakizaki, M, Tsuji, I, Matsuoka, H, Matsumoto, K (2015). Post-traumatic stress disorder and depression prevalence and associated risk factors among local disaster relief and reconstruction workers fourteen months after the Great East Japan Earthquake: a cross-sectional study. BMC Psychiatry 15, 58.Google Scholar
Shrestha, NM, Sharma, B, van Ommeren, M, Regmi, S, Makaju, R, Komproe, I, Shrestha, GB, de Jong, JT (1998). Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal. JAMA 280, 443–448.Google Scholar
StataCorp (2013). Stata Statistical Software: Release 13. StataCorp LP: College Station, TX.Google Scholar
Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, R, van Ommeren, M (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. Journal of the American Medical Association 302, 537–549.Google Scholar
Thapa, SB, Hauff, E (2005). Psychological distress among displaced persons during an armed conflict in Nepal. Social Psychiatry and Psychiatric Epidemiology 40, 672–679.Google Scholar
Tol, WA, Komproe, IH, Thapa, SB, Jordans, MJD, Sharma, B, De Jong, JTVM (2007). Disability associated with psychiatric symptoms among torture survivors in rural Nepal. Journal of Nervous and Mental Disease 195, 463–469.Google Scholar
Tol, WA, van Ommeren, M (2012). Evidence-based mental health and psychosocial support in humanitarian settings: gaps and opportunities. Evidence-based Mental Health 15, 25–26.Google Scholar
Tol, WA, Rees, SJ, Silove, DM (2013). Broadening the scope of epidemiology in conflict-affected settings: opportunities for mental health prevention and promotion. Epidemiology and Psychiatric Sciences 22, 197–203.Google Scholar
van Ommeren, M, de Jong, JT, Sharma, B, Komproe, I, Thapa, SB, Cardeña, E (2001). Psychiatric disorders among tortured Bhutanese refugees in Nepal. Archives of General Psychiatry 58, 475–482.Google Scholar
van Zoonen, K, Buntrock, C, Ebert, DD, Smit, F, Reynolds, CF III, Beekman, AT, Cujpers, P (2014). Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International Journal of Epidemiology 43(2), 318–329.Google Scholar
World Health Organization & King's College London (2011). The Humanitarian Emergency Settings Perceived Needs Scale (HESPER): Manual with Scale. World Health Organization: Geneva.Google Scholar
World Health Organization (2011). Global Status Report on Alcohol and Health. World Health Organization: Geneva.Google Scholar
World Health Organization and United Nations High Commissioner for Refugees (2012). Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings. World Health Organization: Geneva.Google Scholar
Wu, Z, Xu, J, He, L (2014). Psychological consequences and associated risk factors among adult survivors of the 2008 Wenchuan earthquake. BMC Psychiatry 14, 126.CrossRefGoogle ScholarPubMed
Supplementary material: File

Kane supplementary material

Figure S1 and Tables S1-S3

Download Kane supplementary material(File)
File 2.5 MB