Role of women empowerment on mental health problems and care-seeking behavior among married women in Nepal: secondary analysis of nationally representative data.

ABSTRACT

PURPOSE: This study investigates the associations between women empowerment and the prevalence of mental health symptoms and care-seeking behavior among ever-married Nepalese women aged 15-49 years. METHODS: We utilized 2022 Nepal Demographic and Health Survey data to measure women empowerment, employing the Survey-Based Women's Empowerment (SWPER) index. The index focuses on the domains of social independence, decision-making, and attitudes towards violence. Symptoms of anxiety and depression were measured using the Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), respectively. Multiple logistic regression was performed to estimate adjusted odds ratio (aOR) for associations of women empowerment domains and mental health problems and care-seeking behavior. RESULTS: Among 5556 women, the prevalence of symptoms of anxiety and depression was 23.1% and 6.1%, respectively. Among those with any symptoms of anxiety or depression, 18.3% sought care. Compared to women with low level of empowerment in the "social independence" domain, those with high level of empowerment were less likely to suffer from symptoms of anxiety (aOR = 0.68; 95%CI, 0.57-0.82) and depression (aOR = 0.69; 95%CI, 0.50-0.94). However, high empowerment in "decision-making" domain was associated with higher likelihood of anxiety (aOR = 1.67; 95%CI, 1.33-2.10) and depression (aOR = 1.80; 95%CI, 1.26-2.58). There was evidence of positive association between high empowerment in "decision-making" and care-seeking (aOR = 1.28; 95%CI, 0.96-1.71). CONCLUSIONS: This study underscores important roles of women empowerment on mental health symptoms and care-seeking behavior, suggesting the need to integrate empowerment initiatives into strategies to promote mental health among women in Nepal and similar low- and middle-income settings.