Parental depression and their children's marriage timing: The long-term consequences of parental mental disorders.

Although decades of research documents powerful associations between parents' characteristics and their children's marital behaviors, the role of parental mental health has largely been ignored, despite the high prevalence of mental disorders and their strong potential to shape multiple dimensions of family life. Many studies examine other consequences of mothers' mental disorders, particularly for young children, but rarely do studies investigate the consequences of fathers' mental disorders, especially the potential for long-term consequences. We construct a theoretical framework for the study of intergenerational influences on family formation behaviors, integrating parental mental health, and emphasizing the potential for father's disorders to shape their children's lives. To investigate these associations, we use new intergenerational panel data featuring clinically validated diagnostic measures of parental mental health for both mothers and fathers, assessed independently. Results demonstrate that fathers' major depressive disorder is associated with significantly earlier marriage timing among sons. These important new findings provide insights into key priorities for social research on family formation processes and intergenerational influences across many domains.

A cross-cultural examination of adverse childhood experiences in low-and middle-income countries and their relation with adolescent educational aspirations.

BACKGROUND: Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before the age of 18. Researchers have examined the negative associations between adversity and adolescent and adult outcomes, such as education and physical health. However, research on ACEs, and their association with other outcomes in non-western contexts is sparse. OBJECTIVE: The present study aims to increase our understanding of the prevalence of ACEs - and their association with educational aspirations - in low- and middle-income country contexts. PARTICIPANTS AND SETTING: We utilize data from the Family Migration and Early Life Outcomes (FAMELO) project, a multi-site survey project that collected data from families in historically high-migration contexts. ACEs and educational aspirations were measured in children aged 11 to17 years in Mexico (n = 853), Mozambique (n = 651), and Nepal (n = 1180). METHODS: We use Poisson regressions to examine the prevalence of ACEs in multiple cultures, and then use multinomial logistic regressions to examine whether ACEs are associated with educational aspirations, as a practical application of the utility of the ACEs framework in cross-cultural contexts. RESULTS: Our results suggest that adolescents in Mozambique have a higher average number of ACEs (2.7) than adolescents in Mexico (1.4) and Nepal (1.3). Female adolescents reported fewer ACEs, while socioeconomic vulnerabilities (low-income and low parental education) were associated with higher exposure to ACEs, with differences by country. Lastly, ACEs were associated with lower educational aspirations in Mexico and Nepal. CONCLUSIONS: Our study attempted to heed the call of many scholars who have pushed for an expansion of research on ACEs in non-western, low- and middle-income country contexts.

Factors associated with depressive symptoms among returnee migrants and non-migrants working adults in Madi municipality in Nepal: a community-based cross-sectional study.

BACKGROUND: Mental health is a growing concern worldwide. It is not well understood whether international labour migrants from Nepal who return to Nepal are at higher risk of developing mental health problems. The purpose of our study was to determine the prevalence of and examine the associated factors for depressive symptoms among returnee migrants and non-migrant working male adults in Nepal. METHODS: A cross-sectional survey of a probability-based sample of 725 participants was conducted in February 2020. The sample was comprised of two groups based on migration status: returning migrants and non-migrants. The 21-item Beck Depression Inventory (BDI-21) questionnaire was used to assess depressive symptoms. Logistic regression was applied to investigate factors associated with symptoms of depression. RESULTS: The overall prevalence of depressive symptoms was 10.1%. However, the prevalence of depressive symptoms was lower (7%) among returnee migrants compared to non-migrants (13.7%). Men in the lower income group had a higher chance of having depressive (AOR = 5.88, 95% CI: 2.17-15.96) than those in the higher income group. Similarly, Buddhists and Christians were more likely to be depressed (AOR = 2.20, 95% CI: 1.03-4.68) than Hindus. Participants with more than two children had a higher chance of having of depressive symptoms (AOR = 4.80, 95% CI: 1.15-20.05) compared with those without children. Unmarried men were more likely to be depressed (AOR = 4.07, 95%, CI:1.11-14.92) than those who were married. CONCLUSION: The working Nepali adult male population in Nepal, including returning migrants, is at risk of depressive symptoms, but this association was lower in those in the higher income group, returnee migrants, those who were married, Hindus and those with no children. Our results highlight the need to monitor and develop national policies to ensure the mental health of the Nepali male adult population, including returnee migrants.

Community exposure to armed conflict and subsequent onset of alcohol use disorder.

AIMS: To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict. DESIGN: A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence. SETTING: Chitwan, Nepal. PARTICIPANTS: Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%). MEASUREMENTS: Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022. FINDINGS: Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings. CONCLUSIONS: Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.

Neuropsychological Assessment of Older Adults in Nepal for Population-Based Dementia Ascertainment: Needs, Challenges, and Opportunities.

The population of Nepal is rapidly aging, as in other low and middle-income countries, and the number of individuals living with Alzheimer's Disease and related dementias (ADRD) is expected to increase. However, information about the neuropsychological assessment of ADRD in Nepal is lacking. We first aimed to examine the needs, challenges, and opportunities associated with the neuropsychological assessment of older adults in Nepal for population-based ADRD ascertainment. Second, we introduce the Chitwan Valley Family Study-Study of Cognition and Aging in Nepal (CVFS-SCAN), which is poised to address these needs, and its collaboration with the Harmonized Cognitive Assessment Protocol (HCAP) international network. We reviewed the existing literature on the prevalence, risk factors, available neuropsychological assessment instruments, and sociocultural factors that may influence the neuropsychological assessment of older adults for ADRD ascertainment in Nepal. Our review revealed no existing population-based data on the prevalence of ADRD in Nepal. Very few studies have utilized formal cognitive assessment instruments for ADRD assessment, and there have been no comprehensive neuropsychological assessment instruments that have been validated for the assessment of ADRD in Nepal. We describe how the CVFS-SCAN study will address this need through careful adaptation of the HCAP instrument. We conclude that the development of culturally appropriate neuropsychological assessment instruments is urgently needed for the population-based assessment of ADRD in Nepal. The CVFS-SCAN is designed to address this need and will contribute to the growth of global and equitable neuropsychology and to the science of ADRD in low- and middle-income countries.

Alcohol use and internal migration in Nepal: a cross-sectional study.

BACKGROUND: Alcohol use is a leading cause of disease. Although low- and middle-income countries (LMICs) have lower per capita alcohol consumption, the alcohol-attributable disease burden is high in these settings with consumption increasing. LMICs are also experiencing unprecedented levels of internal migration, potentially increasing mental stress, changing social restrictions on drinking, and increasing alcohol availability. We assessed the relationship between internal migration, opportunity to drink, and the transition from first use to regular alcohol use and alcohol use disorders (AUD) in Nepal, a low-income, South Asian country. METHODS: A representative sample of 7435 individuals, aged 15-59 from Nepal were interviewed in 2016-2018 (93% response rate) with clinically validated measures of alcohol use and disorders and life history calendar measures of lifetime migration experiences. Discrete-time hazard models assessed associations between migration and alcohol use outcomes. RESULTS: Net of individual sociodemographic characteristics, internal migration was associated with increased odds of opportunity to drink (OR 1.32, 95% CI 1.14 to 1.53), onset of regular alcohol use given lifetime use (OR 1.29, 95% CI 1.13 to 1.48) and AUD given lifetime use (OR 1.24, 95% CI 0.99 to 1.57). The statistically significant association between internal migration and opportunity to drink was specific to females, whereas the associations between migration and regular use and disorder were statistically significant for males. CONCLUSIONS: Despite high rates of internal migration worldwide, most research studying migration and alcohol use focuses on international migrants. Findings suggest that internal migrants are at increased risk to transition into alcohol use and disorders. Support services for internal migrants could prevent problematic alcohol use among this underserved population.

The transition to parenthood, opportunity to drink, drinking, and alcohol use disorder.

BACKGROUND: This study used life histories from a setting of near universal marriage and childbearing (Nepal) to identify associations between both marital transitions and the transition into parenthood and alcohol use and disorder (AUD). METHODS: A retrospective, cross-sectional survey using life history calendars documented lifetime marital and childbearing histories of 4876 men and 5742 women aged 15-59 in 2016-18. The clinically validated, Nepal-specific Composite International Diagnostic Interview assessed first alcohol use opportunity, use, and disorder. RESULTS: Being never married increased the odds of having the opportunity to drink for men (OR=1.30, 95% CI=1.14 - 1.48, p < 0.001) and women (OR=1.24, 95% CI=1.08 - 1.43, p = 0.003) compared to being married. While men were never married, widowed, or divorced they were at a greater risk of developing AUD. The transition to parenthood significantly increased the odds of AUD onset for men (OR=1.71, 95% CI=1.12 - 2.61, p = 0.013), independent of marital transitions. For women in this setting, becoming divorced increased the odds of having their first drink (OR=1.77, 95% CI=1.14 - 2.75, p = 0.011). Giving birth to a first child also increased the odds of first opportunity to drink for women (OR=1.30, 95% CI=1.07 - 1.57, p = 0.008). CONCLUSIONS: We found associations between marital transitions and AUD that are consistent with findings worldwide. In this setting of near universal childbearing, the transition into fatherhood increased the odds of postpartum AUD among men.

Drivers of prohibited natural resource collection in Chitwan National Park, Nepal.

Protected areas (PAs) are critical for achieving conservation, economic and development goals, but the factors that lead households to engage in prohibited resource collection in PAs are not well understood. We examine collection behaviours in community forests and the protected Chitwan National Park in Chitwan, Nepal. Our approach incorporates household and ecological data, including structured interviews, spatially explicit data on collection behaviours measured with computer tablets and a systematic field survey of invasive species. We pair our data with a framework that considers factors related to a household's demand for resources, barriers to prohibited resource collection, barriers to legal resource collection and alternatives to resource collection. The analysis identifies key drivers of prohibited collection, including sociodemographic variables and perceptions of an invasive plant (Mikania micrantha). The social-ecological systems approach reveals that household perceptions of the presence of M. micrantha were more strongly associated with resource collection decisions than the actual ecologically measured presence of the plant. We explore the policy implications of our findings for PAs and propose that employing a social-ecological systems approach leads to conservation policy and scientific insights that are not possible to achieve with social or ecological approaches alone.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example.

BACKGROUND: Potentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted). METHODS: Among individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes. RESULTS: On average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample. LIMITATIONS: Primary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection. CONCLUSIONS: Although population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

Women's employment and Children's education: Longitudinal evidence from Nepal.

This study examines how maternal employment is related to children's school enrollment in rural Nepal. Using the Chitwan Valley Family Study we combine over 30 years (1974-2008) of yearly data on mother's employment and their children's education. Results reveal heterogeneity by gender, social status, and type of work. Children from historically disadvantaged social groups were more likely to be in school when their mothers started working. This was largely driven by mothers with jobs that allowed them to more easily combine work and family tasks (i.e., those self-employed in the home). In fact, maternal self-employment outside the home was associated with boys dropping out of school. Additionally, we find evidence that some of the observed relationship between maternal wage labor and children's school enrollment is due to household-level selection effects on mother's work.

Community-Level Social Support Infrastructure and Adult Onset of Major Depressive Disorder in a South Asian Postconflict Setting.

IMPORTANCE: Individual-level social support protects against major depressive disorder (MDD) among adults exposed to trauma. Little is known about the consequences of community-level interventions in the general population. OBJECTIVE: To determine the potential consequences of neighborhood social infrastructure on incident MDD in a high-risk general population. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal, multilevel study estimated associations between a neighborhood-level program in a case-control design and subsequent individual outcomes across 10 years (2006-2015) in a cohort of young adults. Exogenously placed social programs simulate natural experiment conditions in a high-poverty population experiencing armed conflict (1998-2006). The western Chitwan valley in Nepal has a general population at high risk of MDD, with neighborhoods exposed to interventions to improve social support. From a random sample (response rate 93%) selected to represent the general population in 2016, participants aged 25 to 34 years in 2006 were studied. These individuals resided within 149 neighborhoods that varied in their availability of active social support programs. The analyses were conducted between October 2020 and November 2021. EXPOSURES: The Small Farmers Development Program (SFDP) uses shared, joint liability financial credit among neighbors to build social capital and cohesion within neighborhoods. MAIN OUTCOMES AND MEASURES: Onset of DSM-IV MDD after the conflict, assessed by the Nepal-specific, clinically validated World Mental Health Composite International Diagnostic Interview with a life history calendar. The hypothesis tested was that exposure to SFDP reduced adult onset of MDD. RESULTS: Of the 1917 survey participants, 886 (46.2%) were women, and 856 (44.7%) were of Brahmin or Chhetri ethnicity. Of the 149 neighborhoods, 21 had an active SFDP group, and 156 of 1917 (8.1%) participants experienced MDD between 2006 and 2015. Discrete-time hazard models showed participants living in neighborhoods with an SFDP experienced incident MDD at nearly half the rate as others (odds ratio = 0.55; 95% CI, 0.30-1.02; P = .06). A multivariate, multilevel matching analysis showed the incidence of MDD among adults living in neighborhoods with an SFDP was 19 of 256 (7.4%), compared with 33 of 256 (12.9%) in the matched sample with no SFDP (z = 2.05; P = .04). CONCLUSIONS AND RELEVANCE: Living in a neighborhood with community-level social support infrastructure was associated with reduced subsequent rates of adult-onset MDD, even in this high-risk population. Investments in such infrastructure may reduce population-level MDD, supporting clinical focus on potentially unpreventable cases.

Drought and migration: An analysis of the effects of drought on temporary labor and return migration from a migrant-sending area in Nepal.

Although the relationship between drought - a dimension of climate change - and migration has been explored in a number of settings, prior research has largely focused on out-migration and has not considered climate factors at the migrant destination. However, drought may impact not only out-migration, but also return migration, particularly in settings where temporary labor migration and agricultural reliance are common. Thus, considering drought conditions at origin and destinations is necessary to specify the effects of climate on migrant-sending populations. Using detailed data from the Chitwan Valley Family Study, a household panel study in a migrant-sending area in Nepal, we analyze the effect of drought at the neighborhood level on individual-level out-migration and drought at the origin district on return migration among adults from 2011 to 2017, assessing these associations among males and females separately. In mixed-effect discrete-time regressions, we find that neighborhood drought is positively associated with out-migration and return migration, both internally and internationally among males. Among females, drought is positively associated with internal out-migration and return migration, but not international migrations. We did not find an association between drought at the origin and return migration independent of drought status at the destination. Taken together, these findings contribute to our understanding of the complexity of the impacts of precipitation anomalies on population movement over time.

How Do Women Learn They Are Pregnant? The Introduction of Clinics and Pregnancy Awareness in Nepal.

The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and infant's health. This paper examines how women learn about their pregnancy status and measures how access to pregnancy tests affects earlier pregnancy knowledge. Using 10 years of individual-level monthly panel data in Nepal, we find that, on average, women learn they are pregnant in their 4.6th month of pregnancy. Living approximately a mile further from a clinic offering pregnancy tests increases the time a woman knows she is pregnant by one week (5 percent increase) and decreases the likelihood of knowing in the first trimester by 4.5 percentage points (16 percent decrease). Women with prior pregnancies experience the most substantial effects of distance within the first two trimesters, while, for women experiencing their first pregnancy, distance does not affect knowledge. These results suggest that, while access to clinics can increase pregnancy awareness for women who recognize pregnancy symptoms, other complementary policies are needed to increase pregnancy awareness of women in their first pregnancy.

COVID-19 worries, concerns and mitigation behaviours: A snapshot of Nepal during the first wave.

OBJECTIVES: To understand COVID-19 worries and how they influence COVID-19 mitigation behaviours, especially in communities prior to case surges, in Nepal. METHODS: Data related to COVID-19 impacts on life disruptions were collected from households in the Chitwan Valley Family Study, a 25-year community panel study, during February-April 2021. COVID-19 worry was measured by the extent of respondent concern for themselves or household members getting COVID-19 in the prior 2 weeks. 11 items examined COVID-19 mitigation behaviours. Logistic regression models assessed associations between socio-demographic characteristics and COVID-19 worry and then the influence of worry on any mitigation behaviour and behaviour type adjusting for age, education, sex, ethnicity and COVID-19 exposure, accounting for neighbourhood clustering. RESULTS: Of 2,678 households with a responding adult, ages 18-88, 394 (14.7%) reported moderate-to-extreme COVID-19 worry and 1,214 (45.3%) engaged in three or more mitigation behaviours. Prevalence of mitigation behaviours was higher among those with COVID-19 worry (e.g. avoided crowds: 62.7% versus 40.5% in those with minimal worry). Respondents self-reporting COVID-19 had higher odds of worry (adjusted odds ratio [aOR]: 2.73, 95% confidence interval [CI]: 1.13, 6.57). Odds of any mitigation behaviour were higher among those with COVID-19 worry compared to those with minimal worry (aOR: 6.19, 95% CI = 1.88, 20.35). CONCLUSIONS: COVID-19 mitigation behaviours were more common in people with COVID-19 worry. To address current and potential future waves of the pandemic, public health efforts should include informational campaigns about mitigation behaviours particularly for those unconcerned with COVID-19 risks.

Social Change, Out-migration, and Exit from Farming in Nepal.

Though international out-migration is widespread, little evidence exists regarding the consequences for economic change in sending countries, particularly in the densely populated agricultural areas of Asia. We examine associations between labor out-migration, remittances, and agricultural change in Nepal. Existing studies of this important population-environment relationship generally ignore the role of local community context, which is known to shape demographic behavior and likely exit from farming as well. Research offers opposing views of the consequences of out-migration for agricultural change - (1) loss of farm labor reduces engagement in agriculture, versus (2) loosening credit constraints from remittances increases engagement in agriculture - and indicates that both mechanisms likely operate simultaneously. Both of these mechanisms are likely to be shaped by changes in local context. Using multilevel dynamic models, we estimate associations between out-migration and remittances by household members and subsequent exit from farming, controlling for variations in community context. Results suggest international out-migration is associated with higher odds of exit from farming and simultaneously remittances are associated with lower odds of exit from farming. Results are robust against several key variations in model specification, including controls for household characteristics and local community context. However, local community context exerts an important independent influence on the hazard of exit from farming.

Husbands' Migration: Increased Burden on or More Autonomy for Wives Left Behind?

Migration of men has important influences on reshaping family and gender roles in left-behind wives. However, it is unclear whether husbands' out-migration increases the burden on or creates autonomy for left-behind wives. Using new data from Nepal, we examine the associations of husband's out-migration and remittance status with the work burden and autonomy of left-behind wives'. Results of our multi-level multivariate analyses show that the number of months a husband migrated internationally during the last year is significantly associated with an increase in participation in farming activities for the left-behind wives. Husband's out-migration and remittance status is also associated with an increase in wives' number of daily activities outside the home, and leisure activities and media use. In sum, husbands' out-migration might be good and bad for women, by increasing the burden on wives while also promoting their freedom of movement, leisure activities and media use. Importantly these findings are net of wives' individual background characteristics, household characteristics and community context measures.

A Good Age to Marry? An Intergenerational Model of the Influence of Timing Attitudes on Entrance into Marriage.

Do timing attitudes-subjective evaluations of particular ages as good ages to marry-influence entrance into marriage? To address this question, we formulated an intergenerational model of how parents' and children's timing attitudes influence children's marriage behavior. We theorized that both parents' and children's timing attitudes influence expectations of when children will marry. In turn, both parents' and children's marital expectations would influence children's actual entrance into marriage. We tested the model using intergenerational panel data from Nepal collected in 2008-2014. Timing attitudes of young people and their parents did influence expectations, as well as entrance into marriage. Young people's own attitudes were more influential than their parents' attitudes in determining children's expectations, but not behavior. Further, while the influence of parents was relatively even, mothers appear slightly more influential than fathers.

Resilience to mental disorders in a low-income, non-Westernized setting.

BACKGROUND: Cross-national studies have found, unexpectedly, that mental disorder prevalence is higher in high-income relative to low-income countries, but few rigorous studies have been conducted in very low-income countries. This study assessed mental disorders in Nepal, employing unique methodological features designed to maximize disorder detection and reporting. METHODS: In 2016-2018, 10714 respondents aged 15-59 were interviewed as part of an ongoing panel study, with a response rate of 93%. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) measured lifetime and 12-month prevalence of selected anxiety, mood, alcohol use, and impulse control disorders. Lifetime recall was enhanced using a life history calendar. RESULTS: Lifetime prevalence ranged from 0.3% (95% CI 0.2-0.4) for bipolar disorder to 15.1% (95% CI 14.4-15.7) for major depressive disorder. The 12-month prevalences were low, ranging from 0.2% for panic disorder (95% CI 0.1-0.3) and bipolar disorder (95% CI 0.1-0.2) to 2.7% for depression (95% CI 2.4-3.0). Lifetime disorders were higher among those with less education and in the low-caste ethnic group. Gender differences were pronounced. CONCLUSIONS: Although cultural effects on reporting cannot be ruled out, these low 12-month prevalences are consistent with reduced prevalence of mental disorders in other low-income countries. Identification of sociocultural factors that mediate the lower prevalence of mental disorders in low-income, non-Westernized settings may have implications for understanding disorder etiology and for clinical or policy interventions aimed at facilitating resilience.

The Child PTSD Symptom Scale: Psychometric Properties among Earthquake Survivors.

Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking.

AIMS: To disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio-demographic correlates for the opportunity to drink and transitions into life-time alcohol use, regular use and alcohol use disorder. DESIGN: A retrospective, cross-sectional population survey within a family panel study. SETTING: Chitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol. PARTICIPANTS: A total of 10 714 individuals aged 15-59 years (response rate = 93%). MEASUREMENTS: The Nepal-specific Composite International Diagnostic Interview assessed life-time alcohol use opportunity, any use, regular use, disorder and socio-demographic characteristics. FINDINGS: Seventy per cent [95% confidence interval (CI) = 69.08-70.82%] of the population had the opportunity to drink, 38.06% (95% CI = 37.14-38.99%) had life-time alcohol use, 32.37% (95% CI = 31.48-33.27%) had regular alcohol use and 6.04% (95% CI = 5.60-6.50%) developed an alcohol use disorder. Compared with high-caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI = 1.16-1.47 to 1.98, 95% CI = 1.81-2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR = 5.71, 95% CI = 5.41-6.03) to development of disorder (OR = 1.95, 95% CI = 1.35-2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR = 4.86, 95% CI = 4.47-5.29) to development of disorder (OR = 9.34, 95% CI = 6.88-12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR = 0.77, 95% CI = 0.71-0.83) to the development of disorder (OR = 0.73, 95% CI = 0.59-0.89)]. CONCLUSIONS: The prevalence of life-time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio-demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life-time use, regular use), but not later transitions (use and regular use to disorder).