title: Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence.
abstract: BACKGROUND
  Throughout the world, anxiety disorders are 1.5-2 times more prevalent among women than men but the reasons for this gender disparity remain elusive. Despite frequent attribution to cultural roles of men and women, data regarding gendered risk factors in non-Western settings are scant.
  
  
  OBJECTIVE
  This study evaluated the role of gender as a moderator (effect modifier) of stressful life events (SLEs) and social support on the risk of anxiety in Nepal. A cross-sectional random sampling design was employed to recruit 316 persons in a rural community. The participants completed the Beck Anxiety Inventory (BAI), Stressful Life Events Rating Scale (SLERS), and a measure of social support.
  
  
  RESULTS
  The prevalence of anxiety differed by gender: 36.9% of women versus 20.4% of men endorsed anxiety symptoms above the validated cutoff for intervention (odds ratio [OR]= 2.3, 95% confidence interval [CI]= 1.4-3.8). The number of SLEs and levels of social support did not differ by gender, nor did gender moderate the relationship between SLEs and anxiety. Gender did moderate the relationship of social support with anxiety. Men who reported low social support had 3.5 times greater odds (95% CI = 1.4-10.7) of endorsing anxiety relative to men reporting high social support. Women exhibited no association of anxiety with social support.
  
  
  CONCLUSIONS
  Women are at a greater risk of anxiety in Nepal. Social support moderates the risk of anxiety among men but not among women. Ethnography and mixed-methods research are needed to identify other forms of support that may be protective for women and such factors should be promoted in gender-focused mental health interventions.
authors.affiliation: Department of Anthropology, Emory University, Atlanta, GA 30322, USA. brandonkohrt@gmail.com
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Kohrt
authors.forename: Carol M
authors.initials: CM
authors.lastname: Worthman
mesh_terms: D000328:Adult; D001007:Anxiety / Q000208:ethnology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000208:ethnology; D012737:Sex Factors; D012944:Social Support; D013315:Stress, Psychological / Q000208:ethnology / Q000523:psychology*; D014754:Violence / Q000208:ethnology / Q000523:psychology*
references.citation: Transcult Psychiatry. 2008 Jun;45(2):142-62
references.pmid: 18562491
references.citation: JAMA. 2004 Aug 4;292(5):585-93
references.pmid: 15292084
references.citation: Soc Sci Med. 2007 Aug;65(3):467-80
references.pmid: 17462803
references.citation: J Consult Clin Psychol. 1997 Aug;65(4):599-610
references.pmid: 9256561
references.citation: World Psychiatry. 2006 Feb;5(1):25-30
references.pmid: 16757987
references.citation: Am J Psychiatry. 2001 Jun;158(6):848-56
references.pmid: 11384888
references.citation: Am J Orthopsychiatry. 2007 Oct;77(4):598-609
references.pmid: 18194039
references.citation: Ann Hum Biol. 2009 May-Jun;36(3):261-80
references.pmid: 19381985
references.citation: Soc Sci Med. 2004 Feb;58(3):471-85
references.pmid: 14652045
references.citation: Psychiatr Clin North Am. 1995 Sep;18(3):503-21
references.pmid: 8545264
references.citation: Expert Rev Neurother. 2007 Nov;7(11 Suppl):S45-58
references.pmid: 18039068
references.citation: Cult Med Psychiatry. 2008 Dec;32(4):462-91
references.pmid: 18784989
references.citation: Lancet. 1999 Mar 27;353(9158):1070
references.pmid: 10199363
references.citation: Psychol Med. 1993 May;23(2):467-74
references.pmid: 8101385
references.citation: Soc Sci Med. 2005 Aug;61(4):861-78
references.pmid: 15950096
references.citation: J Anxiety Disord. 2006;20(3):281-95
references.pmid: 16564433
references.citation: Psychol Med. 2002 Aug;32(6):991-6
references.pmid: 12214797
references.citation: Behav Res Ther. 2000 Jun;38(6):619-28
references.pmid: 10846810
references.citation: JAMA. 2004 Aug 4;292(5):575-84
references.pmid: 15292083
references.citation: Cult Med Psychiatry. 1985 Mar;9(1):27-57
references.pmid: 3987342
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Aug;40(8):672-9
references.pmid: 16021344
references.citation: Psychosom Med. 1994 Jul-Aug;56(4):296-305
references.pmid: 7972611
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2007 Dec;42(12):1012-23
references.pmid: 17721667
references.citation: JAMA. 2003 Aug 6;290(5):635-42
references.pmid: 12902367
references.citation: Am Psychol. 1983 Jul;38(7):786-92
references.pmid: 6614624
references.citation: J Biosoc Sci. 2006 Jan;38(1):57-67
references.pmid: 16266447
references.citation: Gend Med. 2007;4 Suppl B:S178-93
references.pmid: 18156102
references.citation: J Affect Disord. 2007 Sep;102(1-3):159-76
references.pmid: 17092564
references.citation: Drug Alcohol Depend. 2006 Nov 8;85(2):163-70
references.pmid: 16735099
references.citation: Am J Psychoanal. 1971;31(2):144-52
references.pmid: 5124339
references.citation: Ann Hum Biol. 2009 May-Jun;36(3):229-34
references.pmid: 19381983