PTSD was first formally recognized by the American Psychiatric Association in 1980, though its symptoms have been recorded for centuries under different names, such as “shell shock” or “combat fatigue” during wars. Its recognition came after studies of Vietnam War veterans and survivors of accidents, assaults, and disasters revealed consistent patterns of debilitating psychological responses following traumatic events. This article seeks to evaluate PTSD in Nepal.

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can arise following exposure to traumatic events, with symptoms ranging from intrusive memories and nightmares to heightened anxiety and emotional numbing.This article seeks to evaluate PTSD in Nepal.

Worldwide Prevalence
Globally, the prevalence of PTSD varies widely. According to the World Health Organization (WHO), around 3.6% of the world’s population is affected by PTSD annually. High-risk populations include war veterans, survivors of natural disasters, sexual assault victims, and refugees. For instance, in post-conflict regions or areas affected by natural disasters, PTSD rates can range from 10% to 30%. Women are more likely to develop PTSD than men, with rates almost twice as high in many studies. Following Maoist insurgency PTSD in Nepal has seen an alarming increase in number staggering to 21.9% in combatants.

PTSD in Nepal
Nepal, a country shaped by its mountainous geography and a history of political upheaval, has been plagued by both natural disasters and human-induced trauma. Over the years, Nepali society has faced multiple challenges that have significantly contributed to the prevalence of Post-Traumatic Stress Disorder (PTSD), with two of the most prominent being the Maoist insurgency and natural disasters like earthquakes. Nepal’s history of armed conflict, particularly the Maoist insurgency (1996-2006), combined with recurrent natural disasters like the 2015 earthquake, has led to a significant burden of PTSD. PTSD was found in 21.9% of the combats and 20.5% were found to have depression. Both PTSD and depression were found to be associated with degree of combat exposure¹. Studies show that up to 24% of earthquake survivors in some regions exhibit symptoms of PTSD years after the events.

The Maoist Insurgency (1996–2006)

The decade-long Maoist insurgency in Nepal, also known as the “People’s War,” resulted in a significant loss of life and deeply impacted the social fabric of the country. Over 17,000 people died, and many more were left physically and emotionally scarred. The conflict disrupted normal life across the nation, leaving civilians, particularly in rural areas, exposed to violence, displacement, and trauma and PTSD in Nepal. Women, who were often directly or indirectly affected by the violence, frequently reported psychological distress, exacerbated by the socio-political and gender inequalities they faced. This period saw the development of PTSD among many, driven by the violence, fear, and uncertainties that characterized daily life during the war​.

The 2015 Earthquake

Another significant event contributing to PTSD prevalence in Nepal was the devastating earthquake in 2015. The earthquake, measuring 7.8 on the Richter scale, resulted in the deaths of nearly 9,000 people and left hundreds of thousands displaced. Survivors experienced severe trauma, with studies showing that even seven years after the event, PTSD symptoms remained prevalent. A survey conducted in Langtang Valley found that a significant proportion of survivors, especially those who were injured or experienced property loss, exhibited ongoing PTSD symptoms​.

In the aftermath of the earthquake, 24% of adult survivors in one study met the diagnostic criteria for PTSD. This psychological distress was often compounded by the loss of homes, livelihoods, and family members. The persistence of symptoms long after the disaster highlights the need for sustained mental health interventions​.

PTSD Prevalence and Demographic Factors

PTSD prevalence in Nepal is influenced by several demographic factors. A study assessing earthquake survivors found that older adults, women, and individuals with lower educational levels were more susceptible to developing PTSD. Females often reported higher levels of psychological distress, likely due to both the socio-economic vulnerability and the trauma experienced during such crises​.

Moreover, political conflict and natural disasters have placed significant stress on Nepal’s mental health system, which has limited resources to address such widespread trauma. Coping strategies vary, with active coping mechanisms being more prevalent among men and younger survivors, while women and older adults tended to adopt passive coping mechanisms, such as religious or emotional reliance​.

Major Causes of PTSD

1. Biological Factors
   • Neurobiological Mechanisms: PTSD is often associated with abnormal functioning of the amygdala (fear processing), hippocampus (memory), and prefrontal cortex (executive function). Traumatic events trigger a cascade of stress hormones, including cortisol and norepinephrine, which can lead to enduring changes in brain circuits involved in fear and stress responses.
   • Genetic Susceptibility: Individuals with a family history of mental health disorders, such as anxiety and depression, may be more vulnerable to developing PTSD after exposure to trauma.
2. Psychological Factors
   • Pre-existing Mental Health Issues: People with pre-existing anxiety, depression, or other mental health disorders are more likely to develop PTSD.
   • Personality Traits: Those with higher levels of neuroticism or emotional instability may be at increased risk of PTSD when exposed to trauma.
   • Cognitive Factors: A person’s appraisal of the trauma and their coping mechanisms (e.g., avoidance or denial) can influence PTSD development.
3. Social and Environmental Factors
   • Trauma Exposure: Direct involvement in violent conflict, accidents, or natural disasters is a major trigger for PTSD.
   • Social Support: A lack of social support after a traumatic event significantly increases the likelihood of developing PTSD. Conversely, strong social networks can act as a protective factor.
   • Cultural and Societal Context: In societies with ongoing conflict, poverty, or displacement (like post-insurgency Nepal), the chronic stress of daily life can exacerbate trauma-related mental health issues.

Mental Health Support and Interventions for PTSD

1. Pharmacological Interventions
   • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and paroxetine, are often the first-line treatment for PTSD. These medications help regulate mood and reduce symptoms of anxiety and depression.
   • Anti-anxiety Medications: Short-term use of benzodiazepines may be prescribed to manage acute symptoms of anxiety, though long-term use is generally discouraged due to the risk of dependency.
   • Prazosin: This medication is sometimes used to treat nightmares associated with PTSD, particularly among war veterans.
2. Psychological Interventions
   • Cognitive Behavioral Therapy (CBT): CBT is one of the most effective psychological treatments for PTSD. It focuses on changing negative thought patterns related to trauma and teaching coping strategies.
   • Prolonged Exposure Therapy: This form of therapy involves repeated exposure to trauma-related memories, sensations, or places, allowing the individual to gradually reduce their fear and avoidance behaviors.
   • Eye Movement Desensitization and Reprocessing (EMDR): EMDR involves the use of guided eye movements while processing traumatic memories, which can help reduce the emotional intensity of the memories.
   • Trauma-Focused Cognitive Therapy (TF-CBT): This approach is particularly beneficial for children and adolescents, focusing on helping them process the trauma in a developmentally appropriate way.
3. Community and Social Support
   • Support Groups: Peer-led support groups offer individuals the opportunity to share their experiences and coping strategies with others who have undergone similar traumas.
   • Family and Community Support: Encouraging involvement from family and community members can enhance recovery by fostering a sense of safety and belonging, which is crucial for PTSD recovery.

In countries like Nepal, where mental health resources are limited, community-based support and low-cost interventions like group therapy are especially important for reaching underserved populations.

References

1. Rawal N, Karki R, Shrestha DB, Manandhar P, Pathak N. Factors Associated with Post Traumatic Stress Disorder and Depression among Nepalese Combatants during Armed Insurgency. J Psychiatr Assoc Nepal. 2017;6(1):24–8.
2. Adhikari Baral I, K.C B. Post traumatic stress disorder and coping strategies among adult survivors of earthquake, Nepal. BMC Psychiatry. 2019 Apr 18;19(1):118.
3. http://workshop.co WSDS. Women and the Armed Maoist Struggle in Nepal [Internet]. [cited 2024 Sep 8]. Available from: https://mitgovlab.org/news/women-and-the-armed-maoist-struggle-in-nepal/
4. Sharma R, Tamang ND, Bhattarai G. Assessing Prevalence of Post- Traumatic Stress Disorder Symptoms Following the 2015 Earthquake in Langtang ,Nepal. BJPsych Open. 2023 Jul;9(S1):S71–S71.