Political violence and mental health: A multi-disciplinary review of the literature on Nepal

Tol, Wietse A.; Kohrt, Brandon A.; Jordans, Mark J. D.; Thapa, Suraj Bahadur; Pettigrew, Judith; Upadhaya, Nawaraj; Jong, Joop T. V. M. de

doi:10.1016/j.socscimed.2009.09.037

Cited by 97 publications

(78 citation statements)

References 50 publications

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“…Nepal is characteristic of low-income countries with a high burden of infectious disease, which contributes to high rates of infant and under-5-y-old mortality (57). In addition to high exposure to infectious disease and lack of adequate health care, children in Nepal also experience adversity in the form of political violence (58). From 1996 to 2006 during the People's War in Nepal, the Communist Party of Nepal (Maoists) People's Liberation Army (PLA) and the Royal Nepal Army conscripted children as soldiers, sentries, spies, cooks, and porters (59,60).…”

Section: Methodsmentioning

confidence: 99%

Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers

Kohrt

Worthman

Adhikari³

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Adverse social conditions in early life have been linked to increased expression of proinflammatory genes and reduced expression of antiviral genes in circulating immune cells-the conserved transcriptional response to adversity (CTRA). However, it remains unclear whether such effects are specific to the Western, educated, industrialized, rich, and democratic (WEIRD) cultural environments in which previous research has been conducted. To assess the roles of early adversity and individual psychological resilience in immune system gene regulation within a non-WEIRD population, we evaluated CTRA gene-expression profiles in 254 former child soldiers and matched noncombatant civilians 5 y after the People's War in Nepal. CTRA gene expression was up-regulated in former child soldiers. These effects were linked to the degree of experienced trauma and associated distress-that is, posttraumatic stress disorder (PTSD) severitymore than to child soldier status per se. Self-perceived psychological resilience was associated with marked buffering of CTRA activation such that PTSD-affected former child soldiers with high levels of personal resilience showed molecular profiles comparable to those of PTSD-free civilians. These results suggest that CTRA responses to early life adversity are not restricted to WEIRD cultural contexts and they underscore the key role of resilience in determining the molecular impact of adverse environments.biocultural anthropology | child abuse | global mental health | low-income countries | social genomics

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Section: Methodsmentioning

confidence: 99%

Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers

Kohrt

Worthman

Adhikari³

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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“…Displacement can lead to disruptions of traditional family and community structures that support mental health [3]. Although successful adaptation to adverse circumstances occurs for most people (e.g.…”

Section: Introductionmentioning

confidence: 99%

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

Adaku¹,

Okello²,

Lowry³

et al. 2016

Confl Health

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BackgroundSince December 2013, an armed conflict in South Sudan has resulted in the displacement of over 2.2 million people, more than 270,000 of whom are presently in refugee settlements located throughout Uganda. Existing literature suggests that refugees are at increased risk for a range of mental health and psychosocial problems. There is international consensus on the importance of needs and resource assessments to inform potential mental health and psychosocial support (MHPSS) interventions.MethodsWe conducted a MHPSS needs and resource assessment in Rhino Camp refugee settlement in northern Uganda, between June and August 2014. We followed World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) guidelines for MHPSS needs assessments in humanitarian settings. The assessment used a range of methodologies including: 1) a desk (literature) review to understand the context for mental health service provision; 2) an analysis of data from existing health information systems (HIS); 3) an assessment of the current infrastructure for service provision using a shortened version of a Who does What Where until When (4Ws); and 4) semi-structured individual and group interviews (total n = 86) with key informants (n = 13) and general community members (individual interviews n = 28, four focus groups with n = 45).ResultsData from the HIS indicated that visits to health centers in refugee settlements attributable to psychotic disorders, severe emotional disorders, and other psychological complaints increased following the refugee influx between 2013 and 2014, but overall help-seeking from health centers was low compared to estimates from epidemiological studies. In semi-structured interviews the three highest ranked mental health and psychosocial problems included “overthinking”, ethnic conflict, and child abuse. Other concerns included family separation, drug abuse, poverty, and unaccompanied minors. The 4Ws assessment revealed that there were very limited MHPSS services available in Rhino Camp.ConclusionsThe types of MHPSS problems among South Sudanese refugees in northern Uganda are diverse and the burden appears to be considerable, yet there are currently few available services. The assessment indicates the need for a range of services addressing social concerns as well as varied types of mental conditions. The idiom of “overthinking” may form a useful starting point for intervention development and mental health communication.

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“…Furthermore, Subedi et al, (2004) conclude in their work that health planners in Nepal are going to have to expand the physical and psychiatric health care systems to accommodate for the needs of an aging population. The lack of work in assessing the effectiveness of mental health and psychosocial support in Nepal is highlighted in a review of the literature conducted by Tol et al, (2010). Given the post-conflict situation Nepal now finds itself in, this is an area that needs urgent attention, not only for the elderly but throughout the whole of Nepal.…”

Section: Health Considerations Of the Changing Population Structure Imentioning

confidence: 99%

Longevity in Nepal: health, policy and service provision challenges

Parker

Pant

2011

IJSSS

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Longevity is a relatively recent phenomenon in Nepal; over the past few decades the priority in Nepal has been reducing infant and maternal mortality. With an increasingly aging population and changing patterns of migration, this brings with it challenges to Nepali society in terms of meeting the needs of an aging population and creating a policy environment that ensures these needs are met. This paper explores some of the complexities of an aging population in Nepal and focuses on examining the various health and service implications to a nation that has recently been engaged in a decade long "People"s War". Through highlighting the paucity of research in this area, this paper argues for an urgent need for research, both scientific and within the social sciences, into the complexities of meeting the needs of an aging population in the context of Nepal. It clearly demonstrates the need for new spaces of dialogue to emerge where these debates and lessons can be shared.

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Political violence and mental health: A multi-disciplinary review of the literature on Nepal

Cited by 97 publications

References 50 publications

Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers

Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

Longevity in Nepal: health, policy and service provision challenges

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