Culture in Psychiatric Epidemiology: Using Ethnography and Multiple Mediator Models to Assess the Relationship of Caste with Depression and Anxiety in Nepal
Identifieur interne : 000478 ( Main/Curation ); précédent : 000477; suivant : 000479Culture in Psychiatric Epidemiology: Using Ethnography and Multiple Mediator Models to Assess the Relationship of Caste with Depression and Anxiety in Nepal
Auteurs : Brandon A. Kohrt [Népal] ; Rebecca A. Speckman [États-Unis] ; Richard D. Kunz [États-Unis] ; Jennifer L. Baldwin [États-Unis] ; Nawaraj Upadhaya [Népal] ; Nanda Raj Acharya [Népal] ; Vidya Dev Sharma [Népal] ; Mahendra K. Nepal [Népal] ; Carol M. WorthmanSource :
- Annals of human biology [ 0301-4460 ] ; 2009.
Abstract
The causes of ethnic and caste-based disparities in mental health are poorly understood.
To identify mediators underlying caste-based disparities in mental health in Nepal.
A mixed methods ethnographic and epidemiological study of 307 adults (
One third (33.7%) of participants were classified as depressed: Dalit/Nepali 50.0%, high caste 28.4%. One quarter (27.7%) of participants were classified as anxious: Dalit/Nepali 50.7%, high caste 20.3%. Ethnographic research identified four potential mediators: stressful life events, owning few livestock, no household income, and lack of social support. The direct effect of caste was 1.08 (95% CI -1.10—3.27) on depression score and 4.76 (95% CI 2.33—7.19) on anxiety score. All four variables had significant indirect (mediation) effects on anxiety, and all but social support had significant indirect effects on depression.
Caste-based disparities in mental health in rural Nepal are statistically mediated by poverty, lack of social support, and stressful life events. Interventions should target these areas to alleviate the excess mental health burden born by Dalit/Nepali women and men.
Url:
DOI: 10.1080/03014460902839194
PubMed: 19381985
PubMed Central: 3907946
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">The causes of ethnic and caste-based disparities in mental health are poorly understood.</p>
</sec>
<sec id="S2"><title>Aim</title>
<p id="P2">To identify mediators underlying caste-based disparities in mental health in Nepal.</p>
</sec>
<sec id="S3"><title>Subjects and methods</title>
<p id="P3">A mixed methods ethnographic and epidemiological study of 307 adults (<italic>Dalit/Nepali</italic>
, n=75; high caste <italic>Brahman</italic>
and <italic>Chhetri</italic>
, n=232) assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">One third (33.7%) of participants were classified as depressed: Dalit/Nepali 50.0%, high caste 28.4%. One quarter (27.7%) of participants were classified as anxious: Dalit/Nepali 50.7%, high caste 20.3%. Ethnographic research identified four potential mediators: stressful life events, owning few livestock, no household income, and lack of social support. The direct effect of caste was 1.08 (95% CI -1.10—3.27) on depression score and 4.76 (95% CI 2.33—7.19) on anxiety score. All four variables had significant indirect (mediation) effects on anxiety, and all but social support had significant indirect effects on depression.</p>
</sec>
<sec id="S5"><title>Conclusion</title>
<p id="P5">Caste-based disparities in mental health in rural Nepal are statistically mediated by poverty, lack of social support, and stressful life events. Interventions should target these areas to alleviate the excess mental health burden born by Dalit/Nepali women and men.</p>
</sec>
</div>
</front>
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