Interpersonal violence and suicidality among former child soldiers and war-exposed civilian children in Nepal.

Background: Suicide risk reduction is crucial for 15-29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal. Methods: A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People\u27s War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and physical IPV. Results: One of five participants (19%) reported any lifetime suicidal ideation, which was associated with sexual IPV, female gender, former child soldier status and lack of support from teachers. Among young men, the relationship between sexual IPV and suicidality was explained by depression, and teacher support reduced suicidality. Among young women, sexual IPV was associated with suicidality, independent of depression; child soldier status increased suicidality, and teacher support decreased suicidality. Suicide plans were associated with sexual IPV but not with depression. One of 11 female former child soldiers (9%) had attempted suicide. Conclusion: Sexual IPV is associated with suicidal ideation and plans among conflict-affected young women, independent of depression. Reducing suicide risk among women should include screening, care, and prevention programs for sexual IPV. Programs involving teachers may be particularly impactful for reducing suicidality among IPV survivors

Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial.

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling\u27s benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as depression improves without medication

Together but Alone: The Effect of Husband's Migration on Mental Health of their Wives in Rural Nepal

Thesis (Ph.D.)--University of Washington, 2022This dissertation aims to understand the relationship between husband's migration and the mental health of their wives who stay behind. It identifies, describes, and analyzes different pathways of this relationship, with a focus on labor migration, transnational families, Major Depressive Disorder (MDD), and South Asia, particularly Nepal. It further discusses the pattern of this association and how factors like household members and children moderates it. The findings in these papers are based on 1) qualitative data derived from a series of interviews and ethnographic observations, and 2) quantitative panel data on individual's migration and mental health history, as well as individual and household level demographic details collected rigorously over 21 years. Chapter II identifies and describes five pathways of interaction between husband's migration and their wives' mental health: communication, children as coping and stress-inducing agents, family support and difficulties, migration history in the family, and migration as a social process. It concludes that these mechanisms interact in a complex web within the individual and social domain of the migrant's wives that determines how they experience mental well-being and mental health problems. Chapter III is focused on understanding the pattern of association between husbands' time away and the onset of MDD in their wives. It concludes that the stress that comes immediately after the husband's departure significantly influences the onset of MDD among their wives. Chapter IV utilizes the theoretical framework of social ties, social support, and mental health in understanding how household members and children of wives of labor migrants can protect or increase their risk of MDD. It concludes that household members act differently in the context of migration and can reduce the risk of MDD. Overall, this dissertation contributes to the theoretical understanding of the association between migration and mental health. This knowledge can be used to guide public health policies and programs to address the mental health consequences of husband's migration on their families who stay behind

Child Soldiers

© 2015 Elsevier Ltd. All rights reserved. Child soldiers can be any person under 18 associated with an armed group and fulfilling many roles that may or may not involve combat. An estimated 300. 000 children across the globe are members of state militaries and other armed groups. Although armed groups used children throughout history, the widespread availability of small arms has made it physically possible for children to participate in a more lethal combat, thereby increasing their participation value. Children become involved in armed groups through abduction, threats, pressure, and manipulation. Voluntary association also occurs in the context of poverty, gender and ethnic discrimination, and state-sponsored violence. Among published studies of child soldiers, high levels of exposure to violence are reported. Moreover, post-traumatic stress disorder may affect more than half of all child soldiers at some point after association with armed groups. Postconflict factors such as educational and economic deprivation, stigmatization, and discrimination have been associated with adverse outcomes. Reintegration and rehabilitation is particularly difficult for girl soldiers. Potential protective factors for successful reintegration include community sensitization, cleansing rituals, transitional periods in interim care centers, religious support, psychosocial counseling, family mediation, and skills-based vocational training. Policy and advocacy is needed to provide educational and employment alternatives to children in place of joining armed groups; and, regulation and control of small arms trade is needed to reduce recruitment of children by armed groups

Pathways of association between husbands’ migration and mental health of their wives who stay behind

Background: Labor migration practices among married men have brought changes in gender roles and expectations, creating both opportunities and barriers for their wives who stay behind. When husbands migrate, their wives can experience major life events within private and public spheres. Literature on mental health suggests that important life events can induce or prevent the emergence of common mental disorders. Therefore, we aim to identify the psychosocial factors that link husbands’ migration to their wives' mental health. Methods: We conducted in-depth interviews with eighteen women whose husbands left home for work and three key-informant interviews with a local health worker, non-government organization worker and a psychosocial counselor. We held two focus group discussions with psychosocial counselors and researchers working in the field of mental health and migration in Nepal. We analyzed data using thematic analysis based on the grounded theory approach. Results: We identified five salient psychosocial factors that illustrate how the migration of men may impact the mental health of their wives: 1) communication; 2) children as coping and stress-inducing agents; 3) family support and challenges; 4) migration history in the family; and 5) social acceptance of labor migration. Conclusion: We identified several psychosocial factors that explain the relationship between husbands' labor migration with their wives' mental health. These factors interact through a complex pathway that can either ease or add burden to wives’ mental health

Elucidating adolescent aspirational models for the design of public mental health interventions: a mixed-method study in rural Nepal.

BackgroundAdolescent aspirational models are sets of preferences for an idealized self. Aspirational models influence behavior and exposure to risk factors that shape adult mental and physical health. Cross-cultural understandings of adolescent aspirational models are crucial for successful global mental health programs. The study objective was elucidating adolescent aspirational models to inform interventions in Nepal.MethodsTwenty qualitative life trajectory interviews were conducted among adolescents, teachers, and parents. Card sorting (rating and ranking activities) were administered to 72 adolescents aged 15-19 years, stratified by caste/ethnicity: upper caste Brahman and Chhetri, occupational caste Dalit, and ethnic minority Janajati.ResultsThemes included qualities of an ideal person; life goals, barriers, and resources; emotions and coping; and causes of interpersonal violence, harmful alcohol use, and suicide. Education was the highest valued attribute of ideal persons. Educational attainment received higher prioritization by marginalized social groups (Dalit and Janajati). Poverty was the greatest barrier to achieving life goals. The most common distressing emotion was 'tension', which girls endorsed more frequently than boys. Sharing emotions and self-consoling were common responses to distress. Tension was the most common reason for alcohol use, especially among girls. Domestic violence, romantic break-ups, and academic pressure were reasons for suicidality.ConclusionInability to achieve aspirational models due to a range of barriers was associated with negative emotions-notably tension-and dysfunctional coping that exacerbates barriers, which ultimately results in the triad of interpersonal violence, substance abuse, and suicidality. Interventions should be framed as reducing the locally salient idiom of distress tension and target this triad of threats. Regarding intervention content, youth-endorsed coping mechanisms should be fortified to counter this distress pathway