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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)
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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 

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