Anxiety and depression in Nepal: prevalence, comorbidity and associations

BACKGROUND: Anxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed. METHODS: A nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18–65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health. RESULTS: Age- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9 % respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p < 0.001) and neuroticism (AOR = 1.32; p < 0.001), and negatively with alcohol consumption (AOR = 0.71; p = 0.041). HADS-D was positively associated with marijuana use (AOR = 3.61; p = 0.017) and negatively with quality of life (QoL) (AOR = 0.86; p < 0.001). HADS-cAD was positively associated with widowhood (AOR = 2.71; p = 0.002), urban residence (AOR = 2.37; p = 0.001), living at altitude ≥2000 m (AOR = 2.32; p = 0.002) and neuroticism (AOR = 1.26; p < 0.001), and negatively with alcohol use (AOR = 0.56; p = 0.026) and QoL (AOR = 0.79; p < 0.001). CONCLUSION: Depression and anxiety are important mental health conditions in Nepal, and major contributors to public ill health, being very highly prevalent, comorbid and associated with psychosocial burden. They are also linked to the unique topography, habitation and social structure of the country. High prevalence coupled with the disabling nature of these disorders establishes their health-care priority and their importance in national health policy

Comorbidities of psychiatric and headache disorders in Nepal: implications from a nationwide population-based study

Background Headache disorders, anxiety and depression – the major disorders of the brain – are highly comorbid in the western world. Whether this is so in South Asia has not been investigated, but the question is of public-health importance to countries in the region. We aimed to investigate associations, and their direction(s), between headache disorders (migraine, tension-type headache [TTH] and headache on ≥15 days/month) and psychiatric manifestations (anxiety, depression and neuroticism), and how these might affect quality of life (QoL). Methods In a nationwide, cross-sectional survey of the adult Nepalese population (N = 2100), trained interviewers applied: 1) a culturally-adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire to diagnose headache disorders; 2) a validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) to detect anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD); 3) a validated Nepali version of the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N); and 4) the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Associations with headache types were analysed using logistic regression for psychiatric caseness and linear regression for neuroticism. Adjustments were made for age, gender, household consumption, habitat, altitude and use of alcohol and marijuana. Results HADS-A was associated with any headache (p = 0.024), most strongly headache on ≥15 days/month (AOR = 3.2) followed by migraine (AOR = 1.7). HADS-cAD was also associated with any headache (p = 0.050, more strongly among females than males [p = 0.047]) and again most strongly with headache on ≥15 days/month (AOR = 2.7), then migraine (AOR = 2.3). Likewise, neuroticism was associated with any headache (p < 0.001), most strongly with headache on ≥15 days/month (B = 1.6), followed by migraine (B = 1.3). No associations were found between HADS-D and any headache type, or between TTH and any psychiatric manifestation. Psychiatric caseness of any sort, when comorbid with migraine or TTH, aggravated the negative impact on QoL (p < 0.001). Conclusion Headache disorders are highly comorbid with anxiety and show associations with neuroticism in Nepal, with negative consequences for QoL. These findings call for reciprocal awareness, and a holistic coordinated approach to management and in the health service. Care for common headache and common psychiatric disorders should be integrated in primary care.publishedVersion© 2016 Risal et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/

Escape Orbits for Non-Compact Flat Billiards

It is proven that, under some conditions on $f$, the non-compact flat billiard $\Omega = \{ (x,y) \in \R_0^{+} \times \R_0^{+};\ 0\le y \le f(x) \}$ has no orbits going {\em directly} to $+\infty$. The relevance of such sufficient conditions is discussed.Comment: 9 pages, LaTeX, 3 postscript figures available at http://www.princeton.edu/~marco/papers/ . Minor changes since previously posted version. Submitted to 'Chaos

Comparing persistence diagrams through complex vectors

The natural pseudo-distance of spaces endowed with filtering functions is precious for shape classification and retrieval; its optimal estimate coming from persistence diagrams is the bottleneck distance, which unfortunately suffers from combinatorial explosion. A possible algebraic representation of persistence diagrams is offered by complex polynomials; since far polynomials represent far persistence diagrams, a fast comparison of the coefficient vectors can reduce the size of the database to be classified by the bottleneck distance. This article explores experimentally three transformations from diagrams to polynomials and three distances between the complex vectors of coefficients.Comment: 11 pages, 4 figures, 2 table

Dynamic scaling and universality in evolution of fluctuating random networks

We found that models of evolving random networks exhibit dynamic scaling similar to scaling of growing surfaces. It is demonstrated by numerical simulations of two variants of the model in which nodes are added as well as removed [Phys. Rev. Lett. 83, 5587 (1999)]. The averaged size and connectivity of the network increase as power-laws in early times but later saturate. Saturated values and times of saturation change with paramaters controlling the local evolution of the network topology. Both saturated values and times of saturation obey also power-law dependences on controlling parameters. Scaling exponents are calculated and universal features are discussed.Comment: 7 pages, 6 figures, Europhysics Letters for

Possible field-tuned SIT in high-Tc superconductors: implications for pairing at high magnetic fields

The behavior of some high temperature superconductors (HTSC) such as $\rm La_{2-x}Sr_{x}CuO_{4}$ and $\rm Bi_{2}Sr_{2-x}La_xCuO_{6+\delta}$, at very high magnetic field, is similar to that of thin films of amorphous InOx near the magnetic field-tuned superconductor-insulator transition. Analyzing the InOx data at high fields in terms of persisting local pairing amplitude, we argue by analogy that local pairing amplitude also persists well into the dissipative state of the HTSCs, the regime commonly denoted as the "normal state" in very high magnetic field experiments.Comment: Revised figures and reference

Preparation and properties of amorphous MgB2_2/MgO superstructures: A new model disordered superconductor

In this paper we introduce a novel method for fabricating MgB$_2$/MgO multilayers and demonstrate the potential for using them as a new model for disordered superconductors. In this approach we control the annealing of the MgB$_2$ to yield an interesting new class of disordered (amorphous) superconductors with relatively high transition temperatures. The multilayers appear to exhibit quasi-two-dimensional superconductivity with controlled anisotropy. We discuss the properties of the multilayers as the thickness of the components of the bilayers vary.Comment: 7 pages, 8 figure

Evolution of Proto-Neutron Stars with Quarks

Neutrino fluxes from proto-neutron stars with and without quarks are studied. Observable differences become apparent after 10--20 s of evolution. Sufficiently massive stars containing negatively-charged, strongly interacting, particles collapse to black holes during the first minute of evolution. Since the neutrino flux vanishes when a black hole forms, this is the most obvious signal that quarks (or other types of strange matter) have appeared. The metastability timescales for stars with quarks are intermediate between those containing hyperons and kaon condensates.Comment: 4 pages including 4 figures. Version with minor revisions. To be published in Physical Review Letter