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Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal.

Publication ,  Journal Article
Kohrt, BA; Speckman, RA; Kunz, RD; Baldwin, JL; Upadhaya, N; Acharya, NR; Sharma, VD; Nepal, MK; Worthman, CM
Published in: Ann Hum Biol
2009

BACKGROUND: The causes of ethnic and caste-based disparities in mental health are poorly understood. AIM: The study aimed to identify mediators underlying caste-based disparities in mental health in Nepal. SUBJECTS AND METHODS: A mixed methods ethnographic and epidemiological study of 307 adults (Dalit/Nepali, n=75; high caste Brahman and Chhetri, n=232) was assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories. RESULTS: 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. CONCLUSION: 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.

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Published In

Ann Hum Biol

DOI

EISSN

1464-5033

Publication Date

2009

Volume

36

Issue

3

Start / End Page

261 / 280

Location

England

Related Subject Headings

  • Stress, Psychological
  • Socioeconomic Factors
  • Social Support
  • Social Class
  • Sex Factors
  • Risk Factors
  • Psychological Tests
  • Poverty
  • Personality Inventory
  • Nepal
 

Citation

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MLA
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Kohrt, B. A., Speckman, R. A., Kunz, R. D., Baldwin, J. L., Upadhaya, N., Acharya, N. R., … Worthman, C. M. (2009). Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol, 36(3), 261–280. https://doi.org/10.1080/03014460902839194
Kohrt, Brandon A., Rebecca A. Speckman, Richard D. Kunz, Jennifer L. Baldwin, Nawaraj Upadhaya, Nanda Raj Acharya, Vidya Dev Sharma, Mahendra K. Nepal, and Carol M. Worthman. “Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal.Ann Hum Biol 36, no. 3 (2009): 261–80. https://doi.org/10.1080/03014460902839194.
Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, et al. Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol. 2009;36(3):261–80.
Kohrt, Brandon A., et al. “Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal.Ann Hum Biol, vol. 36, no. 3, 2009, pp. 261–80. Pubmed, doi:10.1080/03014460902839194.
Kohrt BA, Speckman RA, Kunz RD, Baldwin JL, Upadhaya N, Acharya NR, Sharma VD, Nepal MK, Worthman CM. Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Ann Hum Biol. 2009;36(3):261–280.

Published In

Ann Hum Biol

DOI

EISSN

1464-5033

Publication Date

2009

Volume

36

Issue

3

Start / End Page

261 / 280

Location

England

Related Subject Headings

  • Stress, Psychological
  • Socioeconomic Factors
  • Social Support
  • Social Class
  • Sex Factors
  • Risk Factors
  • Psychological Tests
  • Poverty
  • Personality Inventory
  • Nepal