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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Kohrt, BA; Speckman, RA; Kunz, RD; Baldwin, JL; Upadhaya, N; Acharya, NR; Sharma, VD; Nepal, MK; Worthman, CM

Published Date

  • May 2009

Published In

Volume / Issue

  • 36 / 3

Start / End Page

  • 261 - 280

PubMed ID

  • 19381985

Pubmed Central ID

  • PMC3907946

Electronic International Standard Serial Number (EISSN)

  • 1464-5033

Digital Object Identifier (DOI)

  • 10.1080/03014460902839194


  • eng

Conference Location

  • England