title: Political violence and mental health in Nepal: prospective study.
abstract: BACKGROUND
  Post-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence.
  
  
  OBJECTIVE
  This prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal.
  
  
  METHODS
  An adult cohort completed the Beck Depression Inventory and Beck Anxiety Inventory in 2000 prior to conflict violence in their community and in 2007 after the war.
  
  
  RESULTS
  Of the original 316 participants, 298 (94%) participated in the post-conflict assessment. Depression increased from 30.9 to 40.6%. Anxiety increased from 26.2 to 47.7%. Post-conflict post-traumatic stress disorder (PTSD) was 14.1%. Controlling for ageing, the depression increase was not significant. The anxiety increase showed a dose-response association with conflict exposure when controlling for ageing and daily stressors. No demographic group displayed unique vulnerability or resilience to the effects of conflict exposure.
  
  
  CONCLUSIONS
  Conflict exposure should be considered in the context of other types of psychiatric risk factors. Conflict exposure predicted increases in anxiety whereas socioeconomic factors and non-conflict stressful life events were the major predictors of depression. Research and interventions in post-conflict settings therefore should consider differential trajectories for depression v. anxiety and the importance of addressing chronic social problems ranging from poverty to gender and ethnic/caste discrimination.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The George Washington University, 2150 Pennsylvania Avenue, 8th Floor, Washington, DC 20037, USA. brandonkohrt@gmail.com
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Kohrt
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Hruschka
authors.forename: Carol M
authors.initials: CM
authors.lastname: Worthman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Kunz
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Baldwin
authors.forename: Nawaraj
authors.initials: N
authors.lastname: Upadhaya
authors.forename: Nanda Raj
authors.initials: NR
authors.lastname: Acharya
authors.forename: Suraj
authors.initials: S
authors.lastname: Koirala
authors.forename: Suraj B
authors.initials: SB
authors.lastname: Thapa
authors.forename: Wietse A
authors.initials: WA
authors.lastname: Tol
authors.forename: Mark J D
authors.initials: MJ
authors.lastname: Jordans
authors.forename: Navit
authors.initials: N
authors.lastname: Robkin
authors.forename: Vidya Dev
authors.initials: VD
authors.lastname: Sharma
authors.forename: Mahendra K
authors.initials: MK
authors.lastname: Nepal
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011057:Politics; D011203:Poverty / Q000523:psychology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D014754:Violence / Q000523:psychology*