Pilot study of national mental health survey, Nepal.

Research Report.

SUMMARY: Mental health is an integral part of overall health and wellbeing. The prevalence and disease burden of mental disorders have remained incredibly high globally and the treatment gap is also huge with about four in five people with mental illness in low and middle-income countries receiving no effective treatment. It is estimated that in Nepal 20-30% population are at risk of suffering from one or more mentally ill conditions and the sporadic studies done in different parts of the country indicate an increasing prevalence. However, there are no any national level studies on mental disorders conducted in Nepal till date. So, the aim of the national mental health survey, Nepal is to assess the prevalence of mental disorders in Nepal; to identify the help seeking behavior and barriers in accessing care among people with mental disorders; and to assess the impact and disability due to mental disorders in the Federal Democratic Republic of Nepal. The national mental health survey, Nepal has been designed to be implemented after series of works in different phases. In the first step, necessary works on translation and validation of data collection tools including the pretesting has been completed. In the second phase a pilot study has been completed that will subsequently be followed by the comprehensive national level study. In this report we are sharing the major works performed for translation and validation of tools and the findings of the pilot study. The major tools of data collection were Mini International Neuropsychiatric Interview (MINI) tools for adult and adolescents, version 7.0.2. For the pilot survey, a total of 1647 participants were included and the data were collected using face to face interview with population aged 13 years and above. Besides the disorders included in MINI tools, other questionnaire on disorders such as epilepsy, dissociative conversion disorders etc., were also included. Questionnaire on barriers in accessing care and help seeking behavior were also administered with the participants aged 18 years and above. Pilot survey was conducted in three districts: Dhanusha, Bhaktapur and Dolakha; one from each ecological region. The analysis of data from 1647 participants (1371 adults above 17 years, 276 adolescents aged 13-17 years) showed that the current prevalence of any form of mental disorders was 12.9%. Current prevalence of any form of mental disorders was found to be 11.2% and 13.2% among 13-17-year-olds and above 17 yearolds respectively. Current major depressive disorder was found among 0.7%, adolescents. Similarly, 1.8% of adolescents had taken any substance in past 12 months but substance use disorder was present among 0.7% only. Similarly, among participants above 17 years age, some of the major disorders found were: Major depressive disorder (current) (3.4%), alcohol use disorder (3.4%), substance use disorder (7.3%), current psychotic disorder (1.1%) and dissociative conversion disorder (6.1%). Suicidality was found to be high in both the groups. Current suicidality among adolescents was 8.7% and 10.9% among adults. Among those with any form of mental disorder, only 18.4% received the treatment in last 12 months. The major barriers in accessing and receiving care were related to the knowledge and attitude related barriers. For example, about 79.8% of the participants who did not receive treatment did so because they wanted to solve their problem on their own followed by the feeling that the problem would get better by itself. Similarly, about 63% thought that they did not have any problem. Experiences and findings from the pilot survey will be used for making necessary modifications in the tools, as well as to plan the national level survey. Given the lack of nationally representative data on prevalence of mental disorders in Nepal, this study will help to estimate the prevalence, treatment gap and help-seeking behavior of the people of the Federal Democratic Republic of Nepal.