Fundamental Causes in Illness and Health Behavior: A Comparison in the U.S. and Nepal.

Extensive research has examined the nature of stress and its relationship with social and health outcomes in industrialized nations. On the other hand, considerably less study has focused on the role of stress in the well-being of individuals living in developing nations, and almost no research has directly compared this relationship across developed and developing nations. In this study, we compare the relationship between stress from the death of a parent and two indicators of well-being, substance use and mental health, in the United States and Nepal. Additionally, differences between urban and rural contexts are emphasized. US data come from the third wave of the National Longitudinal Survey of Adolescent Health (Add Health), a nationally representative survey of adolescents and young adults. Data from Nepal come from two sources, the Kathmandu Mental Health Survey and the Jiri Health Survey, which respectively represent urban and rural settings in this developing nation. Data from the US are consistent with most research in developed nations. Females have higher rates of depression whereas males have higher rates of substance use with stressors more strongly tied to these gendered outcomes. In Nepal, the relationship of gender and education on both being depressed and substance use is similar to that in the US. However, significant socioeconomic effects on substance use beyond education are noted in the US, whereas age plays a unique role across all outcomes in Nepal. [ABSTRACT FROM AUTHOR]