Academic journal article Social Behavior and Personality: an international journal

The Psychological Disease Burden in Nepal and Its Relationship to Physical Health Problems

Academic journal article Social Behavior and Personality: an international journal

The Psychological Disease Burden in Nepal and Its Relationship to Physical Health Problems

Article excerpt

Psychological disorders are a substantial part of the disease burden in many developing countries, yet few health services are directed toward the detection and treatment of these disorders. The relationship between psychological disorders and physical health problems was investigated by means of a community survey (N = 653) in a small village in Nepal, using a shortened version of the DSM-III-R Checklist to estimate the prevalence of several psychological disorders and a version of the Cornell Medical Index to assess physical illness symptoms. Results indicate that approximately 18.4 percent of this rural population has had a diagnosable mental illness. Moreover, there is substantial overlap between physical health problems and psychological disorder for those with a psychological disorder (32.5%). The findings indicate that health providers in developing countries need to screen for psychological disorders as a standard part of health assessments.

Keywords: mental health, health, comorbidity.

High rates of physical illness in developing countries such as Nepal have been recognized for years and health services have emphasized the control and treatment of physical illness (World Bank, 1993). Psychological disorders, however, are also a part of the disease burden (Desjarlais, Eisenberg, Good, & Kleinman, 1995; Murray & Lopez, 1996). The World Health Organization estimates that disability-adjusted life years attributed to mental illness account for 10% of all disability adjusted life years and that behavior-related illnesses associated with psychological disorder account for an additional 34% of disability years (World Bank, 1993; World Health Organization, 1999). Despite the high prevalence of mental illness, health services largely ignore these disorders (Cohen, Kleinman, & Saraceno, 2002; Institute of Medicine, 2000). Health planners have little or no reliable data about the community prevalence of psychological disorders and hence no real basis for planning treatment.

The physical disease burden in Nepal is high. Life expectancy is 58 years. Infant mortality is 101-116 per 1000 live births. The major causes of adult mortality include maternity-related diseases, infectious diseases and accidents (Gallagher & Niroula, 1995). Ninety percent of the population in Nepal is rural and modern biomedical health posts and hospitals in rural areas are severely illequipped, ill-staffed and ill-funded (Dixit, 1999; Sharma & Yogi, 1994; Subedi, 1989; Subedi et al, 2000).

Almost nothing is known about the psychological health burden at the population level in Nepal. The "modern," Western mental health system in Nepal is also extremely underdeveloped (Tausig & Subedi, 1997). In 2002 there were only 18 trained psychiatrists in the country and none of them practiced outside Kathmandu (Acland, 2002). Because the clinical presentation of depression and other disorders in many cultures is associated with somatic symptoms, and because few health care providers recognize psychopathology, it is unlikely that mental disorders will be diagnosed (Cohen, Kleinman, & Saraceno 2002; Patel, 2001).

In order to examine these issues we collected data on symptoms of psychological and physical illness in a small village in Nepal.

METHOD

MATERIAL

Data for this study were collected during a larger study of genetic risk factors for helminthic infection among the population of the Jiri Valley, in Eastern Nepal (Williams-Blangero et al., 1998). The Jiri valley consists of a total of nine villages in the Dolakha District of Nepal. The region is 190 kilometers east of the capital city of Kathmandu. In general, the Jirels are subsistence farmers whose domestic economy is based on agro-pastoral production. The villages of Jiri have access to electricity and tap water, and a few houses have radios and television sets as well. In Jiri, health care is provided largely by indigenous practitioners. …

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