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Political violence and mental health in Nepal: prospective study

  • Brandon A. Kohrt (a1), Daniel J. Hruschka (a2), Carol M. Worthman (a3), Richard D. Kunz (a4), Jennifer L. Baldwin (a5), Nawaraj Upadhaya (a6), Nanda Raj Acharya (a7), Suraj Koirala (a7), Suraj B. Thapa (a8), Wietse A. Tol (a9), Mark J. D. Jordans (a10), Navit Robkin (a11), Vidya Dev Sharma (a12) and Mahendra K. Nepal (a12)...
Abstract
Background

Post-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence.

Aims

This prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal.

Method

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.

Results

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.

Conclusions

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 postconflict 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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Copyright
Corresponding author
Brandon A. Kohrt, Department of Psychiatry and Behavioral Sciences, The George Washington University, 2150 Pennsylvania Avenue, 8th Floor, Washington, DC 20037, USA. Email: brandonkohrt@gmail.com
Footnotes
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Paper presented in part as the John P. Spiegel Fellowship Lecture for the Society for the Study of Psychiatry and Culture 2011 Annual Meeting, Seattle, Washington, USA.

See editorial, pp. 255–257, this issue.

Declaration of interest

None.

Footnotes
References
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Political violence and mental health in Nepal: prospective study

  • Brandon A. Kohrt (a1), Daniel J. Hruschka (a2), Carol M. Worthman (a3), Richard D. Kunz (a4), Jennifer L. Baldwin (a5), Nawaraj Upadhaya (a6), Nanda Raj Acharya (a7), Suraj Koirala (a7), Suraj B. Thapa (a8), Wietse A. Tol (a9), Mark J. D. Jordans (a10), Navit Robkin (a11), Vidya Dev Sharma (a12) and Mahendra K. Nepal (a12)...
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eLetters

Political violence and mental health

Manjeet S. Bhatia
05 December 2012

The article by Brandson et al gives an important information in the change in psychiatric morbidity in the community facing a prolonged political turmoil.However, there are a number of factors which influence the limit the interpretation of results e.g. lack of cohort group from a population far from capital city;comparison with other studies affected byprolonged political conflict; change in population pattern; gender and seasonal differences; use of alcohol or other drugs;change in sale of psychotropics in the period of turmoil. Inspite of limitations, the study is useful for future studies in population affected by political disturbances.

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Conflict of interest: None declared

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