Prevalence of maternal depression and anxiety symptoms and associations with child mental health outcomes in rural Nepal.

OBJECTIVES: This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well-understood in rural, community-based settings in low- and middle-income countries (LMIC). METHODS: A sample of 347 women with children under 5 years was recruited in September 2019 for a cross-sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. RESULTS: In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1-3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02-5.84). In contrast, there was no association between maternal anxiety and child outcomes. CONCLUSIONS: Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low-resourced and community-based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post-infancy, emphasising the importance of improving maternal mental health in the early years of a child's life.

Participatory mental health interventions in low-income and middle-income countries: a realist review protocol.

INTRODUCTION: The launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation of communities and people with lived experience of mental health problems is argued as essential to successful interventions. However, there remains a lack of conceptual clarity around 'participation' in mental health interventions with the specific elements of participation rarely articulated. Our review responds to this gap by exploring how 'participation' is applied, what it means and what key mechanisms contribute to change in participatory interventions for mental health in LMICs. METHODS AND ANALYSIS: A realist review methodology will be used to identify the different contexts that trigger mechanisms of change, and the resulting outcomes related to the development and implementation of participatory mental health interventions, that is: what makes participation work in mental health interventions in LMICs and why? We augment our search with primary data collection in communities who are the targets of global mental health initiatives to inform the production of a programme theory on participation for mental health in LMICs. ETHICS AND DISSEMINATION: Ethical approval for focus group discussions (FGDs) was obtained in each country involved. FGDs will be conducted in line with WHO safety guidance during the COVID-19 crisis. The full review will be published in an academic journal, with further papers providing an in-depth analysis on community perspectives on participation in mental health. The project findings will also be shared on a website, in webinars and an online workshop.

Life after armed group involvement in Nepal: A clinical ethnography of psychological well-being of former "child soldiers" over time.

Little is known about the longitudinal effects of early age involvement of young people in armed groups and their well-being as they return to strongly affected, politicised communities. Current research and policy are often driven by the assumption of a causal relationship between participation in this war experience and psychological damage. This article explores the role of young people's armed group experience during the Nepal People's War, compared with post-conflict stressors, in shaping intra-psychic impact and distress, and which processes enable well-being and resilient functioning. Findings are reported from an 18-month clinical ethnography of a cohort of 17 Nepalese young subjects, where participant-observation methods were used to explore their daily lives after exiting the armed group and follow-up research conducted six years later. The findings highlighted limited evidence for on-going intra-psychic impact and distress related directly to their armed group experience; when such distress occurred, it appeared to be generated more by the structural violence of their environments. The key constituents determining their well-being included: a sense of closeness through emotional connectedness with their family, ideological proximity with the values of the armed group, closeness in their bond with the community, and the social-emotional-economic capital available to them to navigate the harsh structural constraints of post-conflict life. These data further challenge the prevailing assumption that this war experience inevitably leads to psychological damage, and the article argues that structural violence often plays a predominant role in cases where psychological distress does arise.