Depression and anxiety among war-widows of Nepal: a post-civil war cross-sectional study

Abstract

Thousands of Nepalese women were widowed as a consequence of a decade (1996–2006) long civil war in Nepal. These women are at grave risk of mental health problems due to both traumatic experiences and violation of natural order of widowhood. The present study explores the depression and anxiety among war-widows. In 2012, a cross-sectional study was designed to interview 358 war-widows using validitated Beck Depression Inventory and Beck Anxiety Inventory in four districts of Nepal – Bardiya, Surkhet, Sindhupalchowk and Kavrepalanchowk with history of high conflict intensity. The prevalence of depression and anxiety was 53% and 63% respectively. Financial stress was significantly associated with depression (2.67, 95% CI: 1.40–5.07) and anxiety (2.37, 95% CI: 1.19–4.72). High autonomy of women as compared to low autonomy, high social support as compared to low social support and literacy as opposed to illiteracy was associated with less likelihood of depression and anxiety. Our results suggest high magnitude of depression and anxiety among war-widows in Nepal. Future policy efforts should be directed at providing mental health services to identify mental health issues among conflict affected individuals with focus on education, employment and activities to promote social support and autonomy at community.

Keywords:

• War-widows
• women
• conflict
• depression
• anxiety
• Nepal

Abbreviations:

• WHO: World Health Organisation
• DALYs: Disability-adjusted life years
• PTSD: Post-Traumatic Stress Disorder
• BDI: Beck-Depression Inventory
• BAI: Beck Anxiety Inventory
• WHR: Women Health Rights
• DDC: District Development Committee
• SNV: Netherlands development organisation
• SIRF: Social Inclusion Research Fund
• ORs: Odds ratios
• CIs: Confidence intervals
• UnOR: Unadjusted odds ratios
• AOR: Adjusted odds ratios
• HGRF: Harka Gurung Research Fellowship

Acknowledgements

The authors would thank Ms Sumaya Rai, Lecturer of Psychology, Department of Psychology, Tribhuvan University for her inputs during the study design and implementation. Our sincere thanks are also to the enumerators and participants from the four study districts. At last, we would also like to thank Dr Vidya Dev Sharma, MD Psychiatry, Department of Psychiatry & Mental Health of Tribhuvan University, Institute of Medicine, for providing us with translated and validated BDI and BAI.