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Resilience to mental disorders in a low-income, non-Westernized setting

Published online by Cambridge University Press:  01 June 2020

Kate M. Scott*
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Yang Zhang
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
Stephanie Chardoul
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
Dirgha J. Ghimire
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
Jordan W. Smoller
Department of Psychiatry and Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston Massachusetts, USA Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
William G. Axinn
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
Author for correspondence: Kate M. Scott, E-mail:



Cross-national studies have found, unexpectedly, that mental disorder prevalence is higher in high-income relative to low-income countries, but few rigorous studies have been conducted in very low-income countries. This study assessed mental disorders in Nepal, employing unique methodological features designed to maximize disorder detection and reporting.


In 2016–2018, 10714 respondents aged 15–59 were interviewed as part of an ongoing panel study, with a response rate of 93%. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) measured lifetime and 12-month prevalence of selected anxiety, mood, alcohol use, and impulse control disorders. Lifetime recall was enhanced using a life history calendar.


Lifetime prevalence ranged from 0.3% (95% CI 0.2–0.4) for bipolar disorder to 15.1% (95% CI 14.4–15.7) for major depressive disorder. The 12-month prevalences were low, ranging from 0.2% for panic disorder (95% CI 0.1–0.3) and bipolar disorder (95% CI 0.1–0.2) to 2.7% for depression (95% CI 2.4–3.0). Lifetime disorders were higher among those with less education and in the low-caste ethnic group. Gender differences were pronounced.


Although cultural effects on reporting cannot be ruled out, these low 12-month prevalences are consistent with reduced prevalence of mental disorders in other low-income countries. Identification of sociocultural factors that mediate the lower prevalence of mental disorders in low-income, non-Westernized settings may have implications for understanding disorder etiology and for clinical or policy interventions aimed at facilitating resilience.

Original Article
Copyright © The Author(s) 2020. Published by Cambridge University Press

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