Sumeera Shrestha

University of Warsaw, Development Economics, Graduate Student

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Papers by Sumeera Shrestha

Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems

Social Psychiatry and Psychiatric Epidemiology, 2020

Suicide is a leading cause of death among Nepali women of reproductive age. Suicidal ideation has... more Suicide is a leading cause of death among Nepali women of reproductive age. Suicidal ideation has known associations with stressful life events, which Nepali widows disproportionately experience. We aimed to identify risk and protective factors that could lead to effective interventions for this population. To study suicidal ideation in Nepali widows, we collected data from 204 women in urban, semi-urban, and rural areas whose husbands died at least one year prior. The questionnaire included sociodemographic information, the Hopkins Symptom Checklist-25, PTSD Checklist—Civilian Version, Somatic Symptom Scale–8, and the Multidimensional Scale of Perceived Social Support. Overall severity of prolonged grief was assessed by a counselor after completing a structured clinical interview. Using multivariate regression models, we assessed associations of sociodemographic and psychosocial indicators with past-year suicidal ideation. Latent profile analysis was also performed to estimate profiles of comorbidities. Past-year suicidality was high, with 16.2% (N = 33). Each year increase since husband's death was protective and reduced odds of ideation 8% (95% CI 0.85–0.98) and being educated and of older age also reduced the odds of ideation by 0.21 (95% CI 0.06–0.70), and 0.09 (95% CI 0.01–0.64), respectively. Depression (OR = 6.37, 95% CI 2.78–14.59), PTSD (OR = 3.84, 95% CI 2.15–6.86), prolonged grief (OR = 6.04, 95% CI 3.04–12.00) and anxiety (OR = 6.52, 95% CI 2.96–14.38) were highly associated with suicidality, and mapped onto the three profiles of increasing mental distress severity. Suicide remains a major issue among Nepali widows, showing high comorbidity with other mental disorders. Screening for depression, anxiety, and prolonged grief, may aid in identifying widows at increased risk of suicidal ideation.

From Flying Geese to Leading Dragons

The Industrial Policy Revolution II

Page 1. Development Workshop Presentation From Flying Geese to Leading Dragons Florian Urbschat S... more

Adaptation and psychometric validation of the Prolonged Grief Disorder scale among widows in central Nepal

Journal of Affective Disorders

BACKGROUND Symptoms of grief vary by culture and societal reactions to death may be gender specif... more BACKGROUND Symptoms of grief vary by culture and societal reactions to death may be gender specific. We aimed to validate a Nepali language version of the Prolonged Grief-13 item scale (PG-13) among widows. METHODS We tested two adapted versions of a Prolonged Grief Disorder (PGD) instrument with 204 Nepali-speaking widows: one was a Nepali translation of the original PG-13 items, while the other contained five additional items derived from qualitative research. We evaluated internal consistency, factor structure, and construct and criterion validity. RESULTS Participants were on average 44 years old (SD=9.3), completed 6.7 years of school (SD=3.3) and had survived their husbands by 10 years (SD=8.1). Thirteen percent met global criteria for PGD. The removal of one original PG-13 item (felt emotionally numb) from both versions due to poor discriminant validity resulted in 12- and 17-item versions. Exploratory factor analysis supported a one-factor structure for the PG-12 and PG-17. Both versions of the scale exhibited high internal consistency (0.89 and 0.93 respectively). Confirmatory factor analysis suggested that symptoms of PGD were distinct from post-traumatic stress disorder (PTSD), anxiety and depressive symptoms. The PG-12 had lower sensitivity (74.1%) but higher specificity (83.6%) compared to the PG-17 (81.5% and 73.5% respectively). LIMITATIONS Psychosocial counselors' clinical interview global ratings were used as the standard for comparison in criterion validity analyses. Generalizability to other socio-cultural (e.g. non-widowed, low-caste) populations and men in Nepal cannot be assumed. CONCLUSIONS Results indicate satisfactory psychometric properties and validity of both versions of the PG instruments, supporting their use with Nepali speaking widows.

Gender and Disaster: The Impact of Natural Disasters on Violence Against Women in Nepal

Journal of Asian and African Studies

In April 2015, a 7.8 magnitude earthquake hit the Gorkha district of Nepal. This was followed in ... more In April 2015, a 7.8 magnitude earthquake hit the Gorkha district of Nepal. This was followed in May by a second earthquake. Nepal experienced another natural disaster in 2017. Floods affected large swathes of the country from east to west. Using both qualitative and quantitative data, this article examines the impact of these climate disasters on violence against women. In doing so, it adds to a small but growing and fundamentally important body of literature that explores the intersections of gendered violence and natural disaster. It is well-established that 35% of women worldwide have experienced physical and/or sexual violence. What we know much less about is how other events impact on these figures. Given the growing intensity of climate change and the reality that adverse impacts are here to stay, understanding the detrimental legacy of natural disasters is now more urgent than ever.

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Prolonged Grief Disorder Scale--Nepali Version

Understanding Nepali widows’ experiences for the adaptation of an instrument to assess Prolonged Grief Disorder

Transcultural Psychiatry

The experience of grief varies across different cultures and contexts. Women in Nepal who lose th... more The experience of grief varies across different cultures and contexts. Women in Nepal who lose their husbands confront discrimination, social isolation, and abuse that influence their experience of grief. Through eight focus group discussions with Nepali widows, we elicited socially sanctioned grief reactions and local idioms used to describe common cognitive, behavioral, and emotional symptoms of grief. Accordingly, modifications to an existing instrument for Prolonged Grief Disorder, the PG-13, are suggested to capture grief symptoms as experienced by Nepali widows. Items in the PG-13 were translated to colloquial Nepali and adapted to maintain comprehensibility, acceptability, relevance, and completeness. Based on the grief-related issues reported in the focus group discussions, the addition of five new items and a new criterion to capture symptoms related to social discrimination are proposed. Widows perceived elevated symptoms one year after the loss to be problematic. It is th...