Risk Factors for Drug Abuse Among Nepalese Samples Selected from a Town of Eastern Nepal

Systematic Review and Meta-analysis: Depressive Symptoms and Risky Behaviors Among Adolescents in Low- and Middle-Income Countries

OBJECTIVE

Several studies conducted in high-income countries have found an association between depressive symptoms and risky behaviors among adolescents. Evidence from low- and middle-income countries (LMICs), where 90% of the world's adolescents live, remains scarce. This meta-analysis systematically reviewed evidence examining the association between depressive symptoms and risky behaviors among adolescents in LMICs.

METHOD

Fifteen electronic databases were searched for published or unpublished cohort and case-control studies about adolescents in LMICs. The primary outcome was the association (odds ratio [OR]) between depressive symptoms and risky sexual behavior and substance use. Secondary outcomes included delinquency, adverse school behavior, self-harm, and suicidal behavior. ORs from all studies were pooled using the random-effects model. Quality of studies was assessed using the Newcastle-Ottawa scale, and strength of the overall body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.

RESULTS

Searches yielded 31,148 potentially relevant studies. After screening, 33 studies were included in the systematic review, of which 30 comprised the meta-analysis. Studies encompassed 35,918 adolescents living in 17 LMICs: 5 from Africa, 7 from Asia, and 5 from Latin America and the Caribbean. Adolescents with depressive symptoms were more likely to engage in risky sexual behavior (OR 1.3 95% CI 1.1-1.5) and substance use (OR 1.8, 95% CI 1.4-2.2) compared with nondepressed adolescents. Results for secondary outcomes showed a similar pattern, with higher delinquency (OR 3.2, 95% CI 1.8-5.6), self-harm (OR 4.4, 95% CI 1.3-14.4), and suicidal behavior (OR 6.6, 95% CI 2.3-18.9) among adolescents with depression compared with healthy adolescents.

CONCLUSION

This study suggests that adolescents with depression in LMICs carry a double burden: depression and increased risk of engaging in risky behaviors. This combination may lead to further psychological and physical health problems that persist over the life course and may impose a health burden on society as a whole. Taken together, these findings highlight the urgent need for scalable and sustainable approaches to prevent and/or treat depression among adolescents in resource-poor settings.

Social-Contextual Factors Associated with Alcohol Use among Adolescents of Traditional Alcohol User and Nonuser Ethnic Groups of Nepal

Nepalese society has diverse ethnic groups that can be categorized based on views toward alcohol. In this study, adolescents from the traditional alcohol nonuser (TANU) and traditional alcohol user (TAU) ethnic groups of Nepal are examined for their: (1) alcohol use behavior and (2) social-contextual factors associated with alcohol use. Based on a self-administered questionnaire of adolescents, alcohol use was reported by 19.4% of TANU (N=544) and 40.1% TAU (N=309). Significant variables in a multivariate analysis of ever using alcohol were parental alcohol use, peer alcohol use, perceived parental approval, and perceived peer approval.

Contribution of Indian psychiatry in the development of psychiatry in Nepal

Psychiatric services remained virtually unknown in Nepal until 1961. The first psychiatric outpatient service was started in 1961, at Bir Hospital, Kathmandu. In 1984, the Psychiatry Department at Bir Hospital was separated and a mental hospital was created, which was later shifted to its current location at Lagankhel, Patan, in Kathmandu valley, in 1985. It is the only mental hospital in Nepal with a current bed strength of 50 beds. The new era in medical learning and teaching was ushered in Nepal with the establishment of the Institute of Medicine (IOM) under the Tribhuban University and the 400-bed Tribhuban University-Teaching Hospital (TU-Teaching Hospital), in the year 1983. BP Koirala Institute of Health Sciences (BPKIHS) at Dharan was established in 1993, as a part of the joint Indo-Nepal collaboration on developing an international standard teaching, training, and research-oriented medical institute similar to AIIMS, New Delhi. During the last one-and-half decades a number of privately run medical colleges have come up in Nepal. Outpatient and inpatient Psychiatry Departments have been established in most of these government as well as private medical institutes. At present, the postgraduate course (MD) in psychiatry has been running in two government-run institutes as well as three privately run medical colleges. Indian psychiatrists have played and are still playing significant roles in establishing as well as maintaining Psychiatry Departments, especially in the private sector medical colleges. They have also contributed to the growth of psychiatry research and postgraduate teaching in psychiatry, in Nepal.