Factors associated with depressive symptoms among returnee migrants and non-migrants working adults in Madi municipality in Nepal: a community-based cross-sectional study.

BACKGROUND: Mental health is a growing concern worldwide. It is not well understood whether international labour migrants from Nepal who return to Nepal are at higher risk of developing mental health problems. The purpose of our study was to determine the prevalence of and examine the associated factors for depressive symptoms among returnee migrants and non-migrant working male adults in Nepal. METHODS: A cross-sectional survey of a probability-based sample of 725 participants was conducted in February 2020. The sample was comprised of two groups based on migration status: returning migrants and non-migrants. The 21-item Beck Depression Inventory (BDI-21) questionnaire was used to assess depressive symptoms. Logistic regression was applied to investigate factors associated with symptoms of depression. RESULTS: The overall prevalence of depressive symptoms was 10.1%. However, the prevalence of depressive symptoms was lower (7%) among returnee migrants compared to non-migrants (13.7%). Men in the lower income group had a higher chance of having depressive (AOR = 5.88, 95% CI: 2.17-15.96) than those in the higher income group. Similarly, Buddhists and Christians were more likely to be depressed (AOR = 2.20, 95% CI: 1.03-4.68) than Hindus. Participants with more than two children had a higher chance of having of depressive symptoms (AOR = 4.80, 95% CI: 1.15-20.05) compared with those without children. Unmarried men were more likely to be depressed (AOR = 4.07, 95%, CI:1.11-14.92) than those who were married. CONCLUSION: The working Nepali adult male population in Nepal, including returning migrants, is at risk of depressive symptoms, but this association was lower in those in the higher income group, returnee migrants, those who were married, Hindus and those with no children. Our results highlight the need to monitor and develop national policies to ensure the mental health of the Nepali male adult population, including returnee migrants.

COVID-19 worries, concerns and mitigation behaviours: A snapshot of Nepal during the first wave.

OBJECTIVES: To understand COVID-19 worries and how they influence COVID-19 mitigation behaviours, especially in communities prior to case surges, in Nepal. METHODS: Data related to COVID-19 impacts on life disruptions were collected from households in the Chitwan Valley Family Study, a 25-year community panel study, during February-April 2021. COVID-19 worry was measured by the extent of respondent concern for themselves or household members getting COVID-19 in the prior 2 weeks. 11 items examined COVID-19 mitigation behaviours. Logistic regression models assessed associations between socio-demographic characteristics and COVID-19 worry and then the influence of worry on any mitigation behaviour and behaviour type adjusting for age, education, sex, ethnicity and COVID-19 exposure, accounting for neighbourhood clustering. RESULTS: Of 2,678 households with a responding adult, ages 18-88, 394 (14.7%) reported moderate-to-extreme COVID-19 worry and 1,214 (45.3%) engaged in three or more mitigation behaviours. Prevalence of mitigation behaviours was higher among those with COVID-19 worry (e.g. avoided crowds: 62.7% versus 40.5% in those with minimal worry). Respondents self-reporting COVID-19 had higher odds of worry (adjusted odds ratio [aOR]: 2.73, 95% confidence interval [CI]: 1.13, 6.57). Odds of any mitigation behaviour were higher among those with COVID-19 worry compared to those with minimal worry (aOR: 6.19, 95% CI = 1.88, 20.35). CONCLUSIONS: COVID-19 mitigation behaviours were more common in people with COVID-19 worry. To address current and potential future waves of the pandemic, public health efforts should include informational campaigns about mitigation behaviours particularly for those unconcerned with COVID-19 risks.

How Do Women Learn They Are Pregnant? The Introduction of Clinics and Pregnancy Awareness in Nepal.

The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and infant's health. This paper examines how women learn about their pregnancy status and measures how access to pregnancy tests affects earlier pregnancy knowledge. Using 10 years of individual-level monthly panel data in Nepal, we find that, on average, women learn they are pregnant in their 4.6th month of pregnancy. Living approximately a mile further from a clinic offering pregnancy tests increases the time a woman knows she is pregnant by one week (5 percent increase) and decreases the likelihood of knowing in the first trimester by 4.5 percentage points (16 percent decrease). Women with prior pregnancies experience the most substantial effects of distance within the first two trimesters, while, for women experiencing their first pregnancy, distance does not affect knowledge. These results suggest that, while access to clinics can increase pregnancy awareness for women who recognize pregnancy symptoms, other complementary policies are needed to increase pregnancy awareness of women in their first pregnancy.

Women's employment and Children's education: Longitudinal evidence from Nepal.

This study examines how maternal employment is related to children's school enrollment in rural Nepal. Using the Chitwan Valley Family Study we combine over 30 years (1974-2008) of yearly data on mother's employment and their children's education. Results reveal heterogeneity by gender, social status, and type of work. Children from historically disadvantaged social groups were more likely to be in school when their mothers started working. This was largely driven by mothers with jobs that allowed them to more easily combine work and family tasks (i.e., those self-employed in the home). In fact, maternal self-employment outside the home was associated with boys dropping out of school. Additionally, we find evidence that some of the observed relationship between maternal wage labor and children's school enrollment is due to household-level selection effects on mother's work.

Drought and migration: An analysis of the effects of drought on temporary labor and return migration from a migrant-sending area in Nepal.

Although the relationship between drought - a dimension of climate change - and migration has been explored in a number of settings, prior research has largely focused on out-migration and has not considered climate factors at the migrant destination. However, drought may impact not only out-migration, but also return migration, particularly in settings where temporary labor migration and agricultural reliance are common. Thus, considering drought conditions at origin and destinations is necessary to specify the effects of climate on migrant-sending populations. Using detailed data from the Chitwan Valley Family Study, a household panel study in a migrant-sending area in Nepal, we analyze the effect of drought at the neighborhood level on individual-level out-migration and drought at the origin district on return migration among adults from 2011 to 2017, assessing these associations among males and females separately. In mixed-effect discrete-time regressions, we find that neighborhood drought is positively associated with out-migration and return migration, both internally and internationally among males. Among females, drought is positively associated with internal out-migration and return migration, but not international migrations. We did not find an association between drought at the origin and return migration independent of drought status at the destination. Taken together, these findings contribute to our understanding of the complexity of the impacts of precipitation anomalies on population movement over time.

Resilience to mental disorders in a low-income, non-Westernized setting.

BACKGROUND: Cross-national studies have found, unexpectedly, that mental disorder prevalence is higher in high-income relative to low-income countries, but few rigorous studies have been conducted in very low-income countries. This study assessed mental disorders in Nepal, employing unique methodological features designed to maximize disorder detection and reporting. METHODS: In 2016-2018, 10714 respondents aged 15-59 were interviewed as part of an ongoing panel study, with a response rate of 93%. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) measured lifetime and 12-month prevalence of selected anxiety, mood, alcohol use, and impulse control disorders. Lifetime recall was enhanced using a life history calendar. RESULTS: Lifetime prevalence ranged from 0.3% (95% CI 0.2-0.4) for bipolar disorder to 15.1% (95% CI 14.4-15.7) for major depressive disorder. The 12-month prevalences were low, ranging from 0.2% for panic disorder (95% CI 0.1-0.3) and bipolar disorder (95% CI 0.1-0.2) to 2.7% for depression (95% CI 2.4-3.0). Lifetime disorders were higher among those with less education and in the low-caste ethnic group. Gender differences were pronounced. CONCLUSIONS: Although cultural effects on reporting cannot be ruled out, these low 12-month prevalences are consistent with reduced prevalence of mental disorders in other low-income countries. Identification of sociocultural factors that mediate the lower prevalence of mental disorders in low-income, non-Westernized settings may have implications for understanding disorder etiology and for clinical or policy interventions aimed at facilitating resilience.

The Child PTSD Symptom Scale: Psychometric Properties among Earthquake Survivors.

Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.

Social Change, Out-migration, and Exit from Farming in Nepal.

Though international out-migration is widespread, little evidence exists regarding the consequences for economic change in sending countries, particularly in the densely populated agricultural areas of Asia. We examine associations between labor out-migration, remittances, and agricultural change in Nepal. Existing studies of this important population-environment relationship generally ignore the role of local community context, which is known to shape demographic behavior and likely exit from farming as well. Research offers opposing views of the consequences of out-migration for agricultural change - (1) loss of farm labor reduces engagement in agriculture, versus (2) loosening credit constraints from remittances increases engagement in agriculture - and indicates that both mechanisms likely operate simultaneously. Both of these mechanisms are likely to be shaped by changes in local context. Using multilevel dynamic models, we estimate associations between out-migration and remittances by household members and subsequent exit from farming, controlling for variations in community context. Results suggest international out-migration is associated with higher odds of exit from farming and simultaneously remittances are associated with lower odds of exit from farming. Results are robust against several key variations in model specification, including controls for household characteristics and local community context. However, local community context exerts an important independent influence on the hazard of exit from farming.

Using life history calendars to improve measurement of lifetime experience with mental disorders.

BACKGROUND: Retrospective reports of lifetime experience with mental disorders greatly underestimate the actual experiences of disorder because recall error biases reporting of earlier life symptoms downward. This fundamental obstacle to accurate reporting has many adverse consequences for the study and treatment of mental disorders. Better tools for accurate retrospective reporting of mental disorder symptoms have the potential for broad scientific benefits. METHODS: We designed a life history calendar (LHC) to support this task, and randomized more than 1000 individuals to each arm of a retrospective diagnostic interview with and without the LHC. We also conducted a careful validation with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. RESULTS: Results demonstrate that-just as with frequent measurement longitudinal studies-use of an LHC in retrospective measurement can more than double reports of lifetime experience of some mental disorders. CONCLUSIONS: The LHC significantly improves retrospective reporting of mental disorders. This tool is practical for application in both large cross-sectional surveys of the general population and clinical intake of new patients.

Parents' Marital Quality and Children's Transition to Adulthood.

Unique longitudinal measures from Nepal allow us to link both mothers' and fathers' reports of their marital relationships with a subsequent long-term record of their children's behaviors. We focus on children's educational attainment and marriage timing because these two dimensions of the transition to adulthood have wide-ranging, long-lasting consequences. We find that children whose parents report strong marital affection and less spousal conflict attain higher levels of education and marry later than children whose parents do not. Furthermore, these findings are independent of each other and of multiple factors known to influence children's educational attainment and marriage timing. These intriguing results support theories pointing toward the long-term intergenerational consequences of variations in multiple dimensions of parents' marriages.

Fear of violence during armed conflict: Social roles and responsibilities as determinants of fear.

This article investigates the prevalence and determinants of fear as a consequence of living through armed conflict. We use survey data from Nepal during the armed conflict (1996-2006) to examine how trauma, sex and gender, age, marriage, and household size affect fear of violence. We also disaggregate types of worry, and find substantial variance on whether respondents were more concerned about livelihood consequences of conflict than physical danger. We supplement quantitative analyses with discussion of in-depth interviews from the study area on these same topics. Overall, our results highlight the enduring impact of gender roles in Nepal and that conflict might disproportionately affect those who are already vulnerable and have greater social responsibilities. This article provides a unique comparison between fear of violence during armed conflict in a low-income country to the fear of crime literature based in high-income countries.

Emotional Variation and Fertility Behavior.

Emotional influences on fertility behaviors are an understudied topic that may offer a clear explanation of why many couples choose to have children even when childbearing is not economically rational. With setting-specific measures of the husband-wife emotional bond appropriate for large-scale population research matched with data from a long-term panel study, we have the empirical tools to provide a test of the influence of emotional factors on contraceptive use to limit fertility. This article presents those tests. We use long-term, multilevel community and family panel data to demonstrate that the variance in levels of husband-wife emotional bond is significantly associated with their subsequent use of contraception to avert births. We discuss the wide-ranging implications of this intriguing new result.

Postmarital Living Arrangements in Historically Patrilocal Settings: Integrating Household Fission and Migration Perspectives.

This study integrates theory and research on household fission (or partition) and migration to better understand living arrangements following marriage, especially in historically patrilocal and primarily agricultural settings. Using panel data from the Chitwan Valley Family Study to analyze the sequential decision-making process that influences men's living arrangements subsequent to first marriage, we demonstrate the importance of distinguishing among extended family living, temporary migration, and the establishment of an independent household. We find that community economic characteristics, such as access to markets or employment, as well as household wealth affect the initial decision to leave the natal home. Household resources and use of farmland, along with the young men's own education, media exposure, travel, and marital behavior, influence the decision to make the departure from the natal home permanent. Our findings explain why previous results regarding household fission and those focused on migration have provided such mixed results, and we establish a new framework for thinking about how families and individuals manage living situations.

Social context of first birth timing in a rapidly changing rural setting.

This article examines the influence of social context on the rate of first birth. Drawing on socialization models, I develop a theoretical framework to explain how different aspects of social context (i.e., neighbors), may affect the rate of first birth. Neighbors, who in the study setting comprise individuals' immediate social context, have an important influence on the rate of first birth. To test my hypotheses, I leverage a setting, measures and analytical techniques designed to study the impact of macro-level social contexts on micro-level individual behavior. The results show that neighbors' age at first birth, travel to the capital city and media exposure tend to reduce the first birth rate, while neighbors' non-family work experience increases first birth rate. These effects are independent of neighborhood characteristics and are robust against several key variations in model specifications.

Associations between the social organization of communities and psychiatric disorders in rural Asia.

PURPOSE: We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health. METHODS: Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level-controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders. RESULTS: Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups. CONCLUSIONS: Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population.

Impact of the spread of mass education on married women's experience with domestic violence.

This paper investigates the association between mass education and married women's experience with domestic violence in rural Nepal. Previous research on domestic violence in South Asian societies emphasizes patriarchal ideology and the widespread subordinate status of women within their communities and families. The recent spread of mass education is likely to shift these gendered dynamics, thereby lowering women's likelihood of experiencing domestic violence. Using data from 1775 currently married women from the Chitwan Valley Family Study in Nepal, we provide a thorough analysis of how the spread of mass education is associated with domestic violence among married women. The results show that women's childhood access to school, their parents' schooling, their own schooling, and their husbands' schooling are each associated with their lower likelihood of experiencing domestic violence. Indeed, husbands' education has a particularly strong, inverse association with women's likelihood of experiencing domestic violence. These associations suggest that the proliferation of mass education will lead to a marked decline in women's experience with domestic violence in Nepal.

Parental depression and their children's marriage timing: The long-term consequences of parental mental disorders.

Although decades of research documents powerful associations between parents' characteristics and their children's marital behaviors, the role of parental mental health has largely been ignored, despite the high prevalence of mental disorders and their strong potential to shape multiple dimensions of family life. Many studies examine other consequences of mothers' mental disorders, particularly for young children, but rarely do studies investigate the consequences of fathers' mental disorders, especially the potential for long-term consequences. We construct a theoretical framework for the study of intergenerational influences on family formation behaviors, integrating parental mental health, and emphasizing the potential for father's disorders to shape their children's lives. To investigate these associations, we use new intergenerational panel data featuring clinically validated diagnostic measures of parental mental health for both mothers and fathers, assessed independently. Results demonstrate that fathers' major depressive disorder is associated with significantly earlier marriage timing among sons. These important new findings provide insights into key priorities for social research on family formation processes and intergenerational influences across many domains.

A cross-cultural examination of adverse childhood experiences in low-and middle-income countries and their relation with adolescent educational aspirations.

BACKGROUND: Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before the age of 18. Researchers have examined the negative associations between adversity and adolescent and adult outcomes, such as education and physical health. However, research on ACEs, and their association with other outcomes in non-western contexts is sparse. OBJECTIVE: The present study aims to increase our understanding of the prevalence of ACEs - and their association with educational aspirations - in low- and middle-income country contexts. PARTICIPANTS AND SETTING: We utilize data from the Family Migration and Early Life Outcomes (FAMELO) project, a multi-site survey project that collected data from families in historically high-migration contexts. ACEs and educational aspirations were measured in children aged 11 to17 years in Mexico (n = 853), Mozambique (n = 651), and Nepal (n = 1180). METHODS: We use Poisson regressions to examine the prevalence of ACEs in multiple cultures, and then use multinomial logistic regressions to examine whether ACEs are associated with educational aspirations, as a practical application of the utility of the ACEs framework in cross-cultural contexts. RESULTS: Our results suggest that adolescents in Mozambique have a higher average number of ACEs (2.7) than adolescents in Mexico (1.4) and Nepal (1.3). Female adolescents reported fewer ACEs, while socioeconomic vulnerabilities (low-income and low parental education) were associated with higher exposure to ACEs, with differences by country. Lastly, ACEs were associated with lower educational aspirations in Mexico and Nepal. CONCLUSIONS: Our study attempted to heed the call of many scholars who have pushed for an expansion of research on ACEs in non-western, low- and middle-income country contexts.

Community exposure to armed conflict and subsequent onset of alcohol use disorder.

AIMS: To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict. DESIGN: A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence. SETTING: Chitwan, Nepal. PARTICIPANTS: Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%). MEASUREMENTS: Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022. FINDINGS: Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings. CONCLUSIONS: Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.

Influences on the Knowledge and Beliefs of Ordinary People about Developmental Hierarchies.

This paper is motivated by the idea that development and developmental hierarchies have been constructed and embraced for centuries by scholars and policy makers, and have been disseminated among ordinary people. Recent research shows that most people have constructions of development hierarchies that are similar across countries. In this paper, we extend this research by examining how basic social factors influence ordinary people´s beliefs about development and developmental hierarchies in six countries: Argentina, China, Egypt, Iran, Nepal and the United States. Results show that the understanding and perception of developmental hierarchies vary by gender and education. These results are important because they show how distinct groups of people have differential access to information or ideas.