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OBJECTIVE:To investigate whether heavy load carrying, wearing a patuka, and body position at work are risk factors for uterine prolapse among Nepali women. METHODS:Community-based case-control study of 448 women (170 cases of uterine prolapse; 278 controls) aged 18-60 years in Kaski district, Nepal was conducted. Women diagnosed with uterine prolapse were cases. Two controls were recruited for each case, frequency-matched by residential area and age. Multivariate logistic regression was used to investigate associations between outcome and exposures. RESULTS:No association of heavy load carrying with uterine prolapse was observed; women who never used a patuka had lower odds of uterine prolapse (odds ratio = 0.18, 95% confidence interval = 0.05-0.71). Women working in a sitting position had higher odds than those working in a standing position (odds ratio = 2.94, 95% confidence interval = 1.74-4.96), as did women who mainly worked in a bending position (odds ratio = 2.45, 95% confidence interval = 1.12-5.34). Housewives were more prone to uterine prolapse than women engaged in farming (odds ratio = 2.13, 95% confidence interval = 1.31-3.47). CONCLUSION:Using a patuka, occupation, and body position during work were all associated with uterine prolapse. No association was found with heavy load carrying, although that might be attributable to the cross-sectional nature of study recruitment.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective Background Method Results Conclusion This work investigates the potential associations between maternal major depressive disorder (MDD) and daughters' family formation behaviors, specifically the timing of marriage and first birth.Family and life course research has established the importance of intergenerational ties and linked lives for children's health, education, social life, and transition to adulthood more broadly. However, mothers' MDD has remained a relatively understudied factor shaping young people's family formation behaviors.The analyses used a sample of 1127 linked mother–father–daughter triads from the Chitwan Valley Family Study (CVFS) in Nepal. Discrete‐time event‐history models at the month level were run to assess whether daughters' differential exposure to maternal MDD was prospectively associated with entry into marital unions and parenthood.Although there was no relationship between maternal lifetime MDD and daughters' family formation, results showed that being first exposed to maternal MDD during childhood, specifically between the ages of 0 and 10, increased the monthly odds of transitioning to parenthood by more than 80%. Additional findings showed that an increased pace of getting married was a primary determinant of accelerated childbearing.Daughters' exposure to mothers' depression was associated with daughters' family formation transitions. The timing of exposure, however, was a particularly important driver of that association. We argue that the study of parents' mental ill‐health provides untapped opportunity for future intergenerational research. [ABSTRACT FROM AUTHOR]

Aims: To disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio‐demographic correlates for the opportunity to drink and transitions into life‐time alcohol use, regular use and alcohol use disorder. Design A retrospective, cross‐sectional population survey within a family panel study. Setting: Chitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol. Participants: A total of 10 714 individuals aged 15–59 years (response rate = 93%). Measurements The Nepal‐specific Composite International Diagnostic Interview assessed life‐time alcohol use opportunity, any use, regular use, disorder and socio‐demographic characteristics. Findings Seventy per cent [95% confidence interval (CI) = 69.08–70.82%] of the population had the opportunity to drink, 38.06% (95% CI = 37.14–38.99%) had life‐time alcohol use, 32.37% (95% CI = 31.48–33.27%) had regular alcohol use and 6.04% (95% CI = 5.60–6.50%) developed an alcohol use disorder. Compared with high‐caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI = 1.16–1.47 to 1.98, 95% CI = 1.81–2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR = 5.71, 95% CI = 5.41–6.03) to development of disorder (OR = 1.95, 95% CI = 1.35–2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR = 4.86, 95% CI = 4.47–5.29) to development of disorder (OR = 9.34, 95% CI = 6.88–12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR = 0.77, 95% CI = 0.71–0.83) to the development of disorder (OR = 0.73, 95% CI = 0.59–0.89)]. Conclusions: The prevalence of life‐time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio‐demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life‐time use, regular use), but not later transitions (use and regular use to disorder). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper addresses methodological challenges of investigations of international migration, including difficulties in obtaining information about representative samples of migrants and both their origin and destination location. Our project used an origin-based sample with a destination-focused survey and interviewed 91% of migrants from a community in Nepal to any destination and shares techniques employed. Our procedures and high response rate constitute a significant improvement in survey methods that permit the creation of unbiased data on migrants and allow the study of migration in conjunction with origin communities. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) is the leading cause of disability globally, with moderate heritability and well-established socio-environmental risk factors. Genetic studies have been mostly restricted to European settings, with polygenic scores (PGS) demonstrating low portability across diverse global populations., Methods: This study examines genetic architecture, polygenic prediction, and socio-environmental correlates of MDD in a family-based sample of 10 032 individuals from Nepal with array genotyping data. We used genome-based restricted maximum likelihood to estimate heritability, applied S-LDXR to estimate the cross-ancestry genetic correlation between Nepalese and European samples, and modeled PGS trained on a GWAS meta-analysis of European and East Asian ancestry samples., Results: We estimated the narrow-sense heritability of lifetime MDD in Nepal to be 0.26 (95% CI 0.18-0.34, p = 8.5 × 10 -6 ). Our analysis was underpowered to estimate the cross-ancestry genetic correlation (rg = 0.26, 95% CI -0.29 to 0.81). MDD risk was associated with higher age (beta = 0.071, 95% CI 0.06-0.08), female sex (beta = 0.160, 95% CI 0.15-0.17), and childhood exposure to potentially traumatic events (beta = 0.050, 95% CI 0.03-0.07), while neither the depression PGS (beta = 0.004, 95% CI -0.004 to 0.01) or its interaction with childhood trauma (beta = 0.007, 95% CI -0.01 to 0.03) were strongly associated with MDD., Conclusions: Estimates of lifetime MDD heritability in this Nepalese sample were similar to previous European ancestry samples, but PGS trained on European data did not predict MDD in this sample. This may be due to differences in ancestry-linked causal variants, differences in depression phenotyping between the training and target data, or setting-specific environmental factors that modulate genetic effects. Additional research among under-represented global populations will ensure equitable translation of genomic findings.

Psychiatric disorders are one of the leading causes of disease-related disability in the world today. However, little is known about the ethnic variation of these disorders within populations. This is especially true in contexts outside of the United States and the European Diaspora. This study provides new evidence from South Asia on ethnic differences in Major Depressive Episode, Major Depressive Disorder, Panic Attack, Panic Disorder, Post-Traumatic Stress Disorder, and Intermittent Explosive Disorder. We use data from 400 adult interviews conducted in Nepal in a controlled comparison design as a case study. We use a series of multilevel logistic regression models to predict ethnic group differences in psychiatric disorders and episodes with measures from clinically validated World Mental Health survey instruments. Compared to the Brahmin/Chhetri group, we found historically excluded Dalits had statistically significantly higher odds of almost all psychiatric disorders and episodes. We also found that historically resilient Janajatis had statistically significantly lower odds of being diagnosed with PTSD than the majority Brahmin/Chhetri group. We also found no significant gender difference in MDD or MDE. Psychiatric disorders and episodes vary significantly by ethnicity within a rural Asian population, but gender differences are small.