Prevalence, Determinants and Care Seeking Behavior for Anxiety and Depression in Nepalese Population: An Analysis of Nepal Demographic and Health Survey Data 2022
Authors: Pandey Achyut Raj , Adhikari Bikram , Bista Bihungum , Lamichhane Bipul , Joshi Deepak , Pratap KC Saugat , Sharma Shreeman , Baral Sushil Chandra 
Published: July 2023

Objective

To determine the prevalence and factors associated with anxiety and depression and the care seeking behaviour among Nepalese population.

Methods

We analyzed secondary data from nationally representative Nepal health demographic survey 2022. Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7) tools respectively. We performed weighted analysis to account complex survey design. We presented categorical variables as frequency, percent and 95% CI whereas numerical variables as median, interquartile range and 95% CI around median. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude odds ratio (COR), adjusted odds ratio (AOR) and their 95% CI.

Results

The prevalence of depression was 4.0% (95%CI: 3.5, 4.5) in both sexes, 5.4% (95%CI: 4.8, 6.1) among females and 1.7% (95%CI: 1.4, 2.3) among males. Similarly, the prevalence of anxiety was 17.7% (95%CI: 16.5, 18.9) in both sexes, 21.9% (95%CI: 20.4, 23.6) among females and 11.3% (95%CI: 10.0, 12.8) among males. Divorced or separated participants were found to have higher odds of developing anxiety (AOR=2.39, 95% CI: 1.73, 3.30) and depression (AOR=3.11, 95% CI: 1.81, 5.35). Among different ethnic groups, Janajati had lower odds of developing anxiety (AOR=0.77, 95% CI: 0.64, 0.91) and depression (AOR=0.67, 95% CI: 0.48, 0.92) compared to Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR=1.82, 95% CI: 1.57, 2.10) and depression (AOR=1.96, 95% CI: 1.52, 2.51), and those with a lot of difficulty/can’t do at all had higher odds of anxiety (AOR: 2.10, 95% CI: 1.48, 2.97) and depression (AOR: 2.06, 95% CI: 1.07, 3.94) compared to those without any disability.

Conclusion

The prevalence of depression and anxiety were relatively higher among females compared to males. Marital status and disability status are positively associated with anxiety and depression whereas Janajati ethnicity and males were negatively associated with anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals which can be helpful in reducing the burden of anxiety and depression in Nepal.

Strengths and Limitations

We analyzed data from large scale nationally representative survey that takes into consideration the recently federalized structure of the country.

Anxiety and depression have been assessed using PHQ-9 and GAD-7 tools that improves the comparability of findings with other studies

Weighed analysis was carried out to account complex survey design of the survey

The survey was during COVID-19 pandemic period which may have altered the prevalence of disease conditions to some extent