Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal.
BACKGROUND
The causes of ethnic and caste-based disparities in mental health are poorly understood.


OBJECTIVE
The study aimed to identify mediators underlying caste-based disparities in mental health in Nepal.


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.


CONCLUSIONS
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.
Kohrt
Brandon A
BA
Department of Anthropology, Emory University, Atlanta, GA 30322, USA. brandonkohrt@gmail.com
Speckman
Rebecca A
RA
Kunz
Richard D
RD
Baldwin
Jennifer L
JL
Upadhaya
Nawaraj
N
Acharya
Nanda Raj
NR
Sharma
Vidya Dev
VD
Nepal
Mahendra K
MK
Worthman
Carol M
CM
D000328:Adult; D000367:Age Factors; D000822:Animal Husbandry; D000884:Anthropology, Cultural / Q000379:methods*; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008393:Marriage; D008960:Models, Psychological; D009390:Nepal / Q000453:epidemiology; D010555:Personality Inventory; D011203:Poverty; D011581:Psychological Tests; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology