Study of psychiatric disorder in Nepal during political conflict (violent activities) C.P.Sedain1, MD, 1Assistant Professor, 2 Department of Psychiatry, CMSTH, Bharatpur, Nepal

Abstract

This study shows violent activity (political conflict) leading to many psychiatric disorders in Nepal. Among them commonest psychiatric disorder is depressive disorder (N-463,31.52%) Other psychiatric disorders associated violent activity in Nepal are conversion disorder (N-210,14.26%), Somatoform disorder (N-184,12.53%) and generalized anxiety  disorder (N-167,11.37%). Similarly post traumatic stress disorder (PTSD), schizophrenia, mania, grief reaction, childhood depression, tension headache, and sleep disorder are also noticed and husband (parents) in foreign country is the leading cause of stress factors (N-576,39.21%).

Introduction

Psychiatric disorder is associated with different types of conflict in different parts of the world¹.  Nepal has faced political conflict. Nepal is landlocked country surrounded by India in three directions and northern side is located by china. This study reflects the effect of political conflict on mental health in Nepal. This study shows that patients attending psychiatric department of College of Medical Science Bharatpur Chitwan,Nepal. This study shows mental illness which is linked with political conflict during the year 2004-2005 which is always important on the history of Nepal that brought big political changes. Now Nepal is on peace process. Because of political instability during 10 years period can be taken as “dark period” on the history of Nepal. During that period no any economic development works at all. The entire budget was kept on the police force and arm due to which it was very difficult to sustained for a land locked developing country². Communist party “Maoist” took arms to cut down the autocratic regime which was supported by Seven Parties Alliance(SPA). During this period huge political awareness developed on Nepali people.                  

Nepal was suffered from violent activity 2052-2063 BS. The Maoist, one of the communist party started war with government demanding “Republic Nepal”. They started bullet war. Many thousands of people left Nepal and migrated in India and Gulf countries. People started to expose many  bad news like bomb blast, attack on barrack and district head office and “Nepal Banda” or strike and war etc. Because of bad news and death of many people by violent activity many Nepali developed mental illness. The “Revolution 2063” (B.S) which was biggest demonstration against the king which was successed by Seven Parties Alliance (SPA) and Nepal Communist Party Maoist (NCPM) which is very important on the history of Nepal. It is taken as major event on the world’s history, which bring “Loktantra” and kicked out  autocratic regime and open the door for constitutional assembly. About 13000 people sacrificed their life during 10 years people’s revolution.³

Objectives:

1)    To identify different psychiatric disorders that is related with violent activities.

2)    To identify stress factors related with psychiatric disorders.

 

Material and methods

The subjects for this study comprised of all consecutive patients associated with political conflict of Nepal which attended psychiatric Department of CMS Teaching Hospital Bharatpur Chitwan and Bharatpur jail were taken as case. The study was performed over 2 years (1st January 2004 to 30 th December 2005).A brief explanation about the study was offered to the subjects and written or verbal consent was obtained either from them or guardians and all the subjects   referred were included in the study.

A continuous sequential number was given to each subject and available necessary information was kept confidential in a separate file.The socio demographic profile which contains name, age, sex, caste, address, marital status, occupation, and other information also filled. The diagnosis was done on the basis of I.C.D. - 10 diagnostic research criteria (WHO, 1992).⁴

Results

Table-1

Distribution on the basis of age sex

AGE	Male	Female	Total	%
0-10	16	14	30	2.04
11-20	170	161	331	22.53
21-30	121	128	249	16.95
31-40	132	99	231	15.72
41-50	218	201	419	28.52
5-60	90	89	179	12.19
61-70	19	11	30	2.04
TOTAL	766	703	1469	100

Table-1 shows highest numbers of patients were age group 41-50 (N-419, 28.52%) followed by age group11-20 (N-331, 22.53%). and most of cases were male (N-766,52.14%)

Table –2

Distribution on the basis of marital status

Marital status N % Married 1035 70.46 Unmarried 358 24.37 Widow/widower 63 4.29 Total 1469 100

Table-2 shows highest numbers of patients were married (N-1035, 70.46%).

 

Table-3

Diagnosis of patients by using ICD-10 Diagnostic Research Criteria (ICD-10 DCR)

Diagnosis	Farmer	Political activist	Service holder	Police/army	Housewife	Unemployed	Total	%
Depressive disorder	231	116	39	42	31	4	463	31.52
PTSD	20	13	7	6	5	1	52	3.54
GAD	86	41	19	13	8	0	167	11.37
Schizophrenia	16	9	4	3	2	0	34	2.31
Acute psychosis	26	13	7	3	3	0	52	3.54
Conversion disorder	105	51	22	16	13	3	210	14.26
Mania	23	10	6	5	3	1	48	3.27
Grief reaction	18	9	5	1	1	2	36	2.45
Somatoform disorder	95	46	24	6	12	1	184	12.53
Child psychiatric disorder	45	0	0	0	0	51	76	5.17
Tension Headache	51	26	13	6	0	0	96	6.54
Sleep Disorder	29	17	0	5	0	0	51	3.47
Total	725	351	146	106	78	63	1469	100

Legend

PTSD –Post Traumatic Stress Disorder

GAD –Generalized Anxiety Disorder

Tabel-3 shows distribution on the basis of diagnosis by using ICD-10, most of cases were diagnosed as depressive disorder (N-463, 31.52 % followed by conversion disorder N-210, 14.26). and most of cases were farmer (N-725, 49.35 %).

Table-4

Distribution on the basis of stress factors

Stress factors	Male	Female	Total	%
Husband/parent  in foreign country	0	576	576	39.21
Shifted  to foreign country for job	293	6	299	20.35
Death of parents/family member	83	19	102	6.94
Bomb blast	43	9	52	3.54
Ambus explosion	19	4	23	1.57
Bad news on tv/radio	138	58	196	13.34
Loss of job	119	3	122	8.30
Abduction	4	5	9	0.62
Turture	6	5	11	0.75
Nepal bandha	26	9	35	2.38
Bullet injury	14	2	16	1.09
Shifted to jail	21	7	28	1.91
Total	766	703	1469	100

Table-4 shows distribution on the basis of stress factors, most of cases were husbands/parents in foreign country (N-576, 39.21 %) followed by shifted to foreign country (N-299, 20.35 %)

Discussion:

This study shows that many people of Nepal were suffered with mental illness due to bad political condition i.e. violent activity (Political conflict)leading to many psychiatric disorder. Many thousands of people left Nepal and migrated in India and Gulf countries. People started to expose many to bad news like bomb blast, attack on barrack and district head office and “Nepal Banda” or strike and war etc. Because of bad news and death of many people by violent activity many Nepali developed mental illness. The samples were collected from 1-1-2004 to 30-12-05. This study shows that total numbers of psychiatric patients due to violent activities were 1469. The interview was taken and diagnosis was made by psychiatrist using ICD-10 diagnostic research criteria.

Study regarding psychiatric morbidity (Regmi et al, 1999) found that commonest psychiatric disorder was depressive disorder (N-451,31.45%)⁵. This study shows similar result in which the commonest psychiatric disorder leading to conflict was depressive disorder (N-463, 31.52%) Other psychiatric disorder associated violent activity in Nepal are conversion disorder (N-210,14.26%), Somatoform disorder (N-184,12.53%) and generalized disorder (167,11.37). Similarly post traumatic stress disorder (PTSD), schizophrenia, mania, grief reaction, childhood depression, tension headache, and sleep disorder also noticed.

This study shows that  stress factors leading to psychiatric disorder related bad political situation during 2004-2005 are husbands (parents) in foreign country is the leading cause of stress factors (N-576,39.21%). Similarly shifted to foreign country (N-299, 20.35%) The period was danger period. Many people left job because of fear of forceful inclusion Maoist army. Some people left country because the army will give punishment. Another factor is that to get job on foreign country to get rid from poor financial condition. Similarly death of parents, bomb blast, ambush explosion, bad news on radio, bullet injury, Nepal Banda, loss of job and shifted to jail were the stress factors.    

References

1.       Vander-Knob, B. A.: Psychological trauma.  Washington DC, American Psychiatric press, 1987.

2.        Annual report: Department of Health Services Government of Nepal, Ministry of Health Kathmandu, 2003-2004,1,11-19.

3.        Bungert Martina: Psychosocial support for conflict affected children second international SAARCE Psychiatrists conference 2006,1,72-74.

4.        WHO: International Classification of disease and related heath problems, Tenth revision: Clinical description and diagnostic guideline; Geneva: World Health Organization. 1992.

5.       Regmi S.K et al,: A study of socio-demographic characteristics and diagnostic profile in psychiatric out patients of TUTH, Nepalese Journal of Psychiatry 1999, 1, 27-33.