Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal

Kohrt, Brandon A.; Speckman, Rebecca A.; Kunz, Richard D.; Baldwin, Jennifer L.; Upadhaya, Nawaraj; Acharya, Nanda Raj; Sharma, Vidya Dev; Nepal, Mahendra K.; Worthman, Carol M.

doi:10.1080/03014460902839194

Cited by 136Mental Health Treatment and AccessSouth Asian Studies and DiasporaHealth disparities and outcomes

Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal

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Kohrt, Brandon A., Speckman, Rebecca A., Kunz, Richard D., Baldwin, Jennifer L., Upadhaya, Nawaraj, Acharya, Nanda Raj, Sharma, Vidya Dev, Nepal, Mahendra K. +1 more·2009·Annals of Human Biology

DOI 10.1080/03014460902839194PMC PMC3907946

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Abstract

BACKGROUND: The causes of ethnic and caste-based disparities in mental health are poorly understood. AIM: The study aimed to identify mediators underlying caste-based disparities in mental health in Nepal. SUBJECTS AND METHODS: A mixed methods ethnographic and epidemiological study of 307 adults (Dalit/Nepali, n=75; high caste Brahman and Chhetri, n=232) was assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories. RESULTS: One-third (33.7%) of participants were classified as depressed: Dalit/Nepali 50.0%, high caste 28.4%. One quarter (27.7%) of participants were classified as anxious: Dalit/Nepali 50.7%, high caste 20.3%. Ethnographic research identified four potential mediators: Stressful life events, owning few livestock, no household income, and lack of social support. The direct effect of caste was 1.08 (95% CI -1.10-3.27) on depression score and 4.76 (95% CI 2.33-7.19) on anxiety score. All four variables had significant indirect (mediation) effects on anxiety, and all but social support had significant indirect effects on depression. CONCLUSION: Caste-based disparities in mental health in rural Nepal are statistically mediated by poverty, lack of social support, and stressful life events. Interventions should target these areas to alleviate the excess mental health burden born by Dalit/Nepali women and men.

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Some anthropologists are already using workflows similar to the proposed integration, without agent-based modeling, to good effect.
“Some anthropologists are already employing similarly oriented workflows -- minus the agent-based modeling -- to good effect (Brown et al., 2009; Kohrt et al., 2009).”
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Authors: Kohrt, B. A., Speckman, R. A., Kunz, R. D., Baldwin, J. L., Upadhaya, N., Acharya, N. R., Sharma, V. D., Nepal, M. K., & Worthman, C. M.
Affiliations: Emory University (US)
Virginia Commonwealth University (US)
University of Illinois Urbana-Champaign (US)
Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
Tribhuvan University (NP)
Corresponding author: Kohrt, Brandon A.
ORCID: Kohrt, Brandon A.
Speckman, Rebecca A.
Worthman, Carol M.
Venue: Annals of Human Biology
Publisher: Informa UK Limited
Published: 2009-01-01
Volume: 36
Issue: 3
Pages: 261-280
ISSN: 0301-4460 (ISSN-L)
1464-5033
DOI: 10.1080/03014460902839194
PMC: PMC3907946
OpenAlex: W2127351918
Cited by: 136
References: 41
Citations by year: 2026: 5 · 2025: 10 · 2024: 3 · 2023: 28 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 11 · 2017: 7 · 2016: 8 · 2015: 10 · 2014: 7 · 2013: 6 · 2012: 8
FWCI: 7.80
Type: journal article
Language: en
Open access: green
europepmc.org
Locations: Annals of Human Biology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (F31MH075584)
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Arts and Humanities › Philosophy › South Asian Studies and Diaspora
Social Sciences › Health › Health disparities and outcomes
Keywords: Brahman, depression, anxiety, social support, poverty, life events, livestock ownership, rural Nepal, mediation
MeSH terms: Adult, Age Factors, Animal Husbandry, Anthropology, Cultural, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Life Change Events, Male, Marriage, Models, Psychological, Nepal, Personality Inventory, Poverty, Psychological Tests, Risk Factors, Sex Factors, Social Class, Social Support, Socioeconomic Factors, Stress, Psychological, Confounding Factors, Epidemiologic

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Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal

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