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

@article{citeulike:4493738, abstract = {<i>Background</i>: The causes of ethnic and caste-based disparities in mental health are poorly understood. <i>Aim</i>: The study aimed to identify mediators underlying caste-based disparities in mental health in Nepal. <i>Subjects and methods</i>: A mixed methods ethnographic and epidemiological study of 307 adults (<i>Dalit/Nepali</i>, <i>n</i>=75; high caste <i>Brahman</i> and <i>Chhetri</i>, <i>n</i>=232) was assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories. <i>Results</i>: 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. <i>Conclusion</i>: 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.}, author = {Kohrt, Brandon A. and Speckman, Rebecca A. and Kunz, Richard D. and Baldwin, Jennifer L. and Upadhaya, Nawaraj and Acharya, Nanda R. and Sharma, Vidya D. and Nepal, Mahendra K. and Worthman, Carol M.}, citeulike-article-id = {4493738}, citeulike-linkout-0 = {http://dx.doi.org/10.1080/03014460902839194}, doi = {10.1080/03014460902839194}, journal = {Annals of Human Biology}, keywords = {culture, epidemiology, methods, population-health, scale-development}, number = {3}, pages = {261--280}, posted-at = {2009-05-08 14:40:30}, priority = {3}, publisher = {Informa Healthcare}, title = {Culture in psychiatric epidemiology: Using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal}, url = {http://dx.doi.org/10.1080/03014460902839194}, volume = {36}, year = {2009} }

TY - JOUR ID - citeulike:4493738 L3 - citeulike-article-id:4493738 N2 - <i>Background</i>: The causes of ethnic and caste-based disparities in mental health are poorly understood. <i>Aim</i>: The study aimed to identify mediators underlying caste-based disparities in mental health in Nepal. <i>Subjects and methods</i>: A mixed methods ethnographic and epidemiological study of 307 adults (<i>Dalit/Nepali</i>, <i>n</i>=75; high caste <i>Brahman</i> and <i>Chhetri</i>, <i>n</i>=232) was assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories. <i>Results</i>: 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. <i>Conclusion</i>: 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. IS - 3 JF - Annals of Human Biology EP - 280 TI - Culture in psychiatric epidemiology: Using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal PB - Informa Healthcare VL - 36 SP - 261 KW - culture KW - epidemiology KW - methods KW - population-health KW - scale-development AU - Kohrt, Brandon AU - Speckman, Rebecca AU - Kunz, Richard AU - Baldwin, Jennifer AU - Upadhaya, Nawaraj AU - Acharya, Nanda AU - Sharma, Vidya AU - Nepal, Mahendra AU - Worthman, Carol PY - 2009/// UR - http://dx.doi.org/10.1080/03014460902839194 ER -