Bhogendra Sharma

Preparing Instruments for Transcultural Research: Use of the Translation Monitoring Form with Nepali-Speaking Bhutanese Refugees

Preparing instruments for transcultural research is a difficult task. Researchers typically do not publish their attempts to create equivalent translation. The quality of the translation depends mostly on the translators’ ability to be consistent in identifying and correcting incomprehensible, unacceptable, incomplete and irrelevant translated items. This paper presents a translation monitoring form to enhance the methodical preparation of instruments for transcultural use. Use of the form requires the systematic use of strategies advocated by previous translation and adaptation researchers. A detailed example of use of the translation monitoring form with Nepali-speaking Bhutanese refugees illustrates the usefulness of the form as well as the difficulties of creating equivalent translation.

Disability associated with psychiatric symptoms among torture survivors in rural Nepal.

Our objective was to explore the relationships between psychiatric symptom categories (posttraumatic stress disorder (PTSD), anxiety, and depression) and disability among torture survivors. We conducted a cross-sectional study of help-seeking torture survivors in highly affected conflict areas in rural mid-Western Nepal, using rating scales to assess symptomatology and disability. Validated screening instruments for the Nepali setting revealed that a high amount of psychopathology was present. Exploration of the relationships between psychiatric symptomatology and disability showed a central role for PTSD and anxiety complaints, but not for depressive complaints. A recursive model in which PTSD has (a) a direct relationship with disability and (b) an indirect relationship with disability mediated by anxiety and depression best fits the data. Findings are consistent with research on tortured refugees, suggesting the importance of a PTSD–anxiety mechanism. Implications for refugees in Western settings are discussed. Complexity of the mental status of torture survivors indicates multidisciplinary treatment.

Brief multi-disciplinary treatment for torture survivors in Nepal: a naturalistic comparative study.

Background: Little is known about the effectiveness of treatment for torture survivors in low-income settings. Multi-disciplinary treatment is an often used approach for this target group. Aims: This study was aimed at examining the effectiveness of brief multi-disciplinary treatment for torture survivors in Nepal. Methods: A naturalistic comparative design with help-seeking torture survivors and internally displaced persons assigned to a treatment and a comparison group respectively ( n = 192; treatment group n = 111, comparison group n = 81), with baseline measurements on psychiatric symptomatology, disability, and functioning and a five-month follow-up (n = 107; treatment group n = 62; comparison group n = 45), was employed. Intervention consisted of brief psychosocial services, minimal medical services and/or legal assistance. Results: Study groups were generally comparable and non-completers did not significantly differ from completers. The treatment group improved more than the comparison group on somatic symptoms, subjective well-being, disability and functioning, with mostly moderate effect sizes. Conclusion: Treatment was moderately effective, with regards to reducing the nonspecific mental health consequences of torture, but disability scores remained high. For clients presenting with more severe mental health problems, other treatments that are realistic in the resource-poor Nepali context need to be sought.

Cultural challenges to psychosocial counselling in Nepal

This article describes the way in which the practice of psychosocial counselling was adapted culturally to the context of Nepal within the Centre for Victims of Torture, Nepal (CVICT). After a brief description of the Nepali setting and CVICT’s counselling and training approach and the relationship of its psychosocial counselling intervention with existing methods of dealing with psychosocial problems, the cultural challenges of implementing psychosocial counselling and our response to them are sketched along with concepts deemed important in psychosocial counselling. A discussion follows in which the authors’ stance on the export of psychosocial counselling to non-western cultures is outlined.

Preventing Torture and Rehabilitating Survivors in Nepal

Preventing torture and rehabilitating survivors in a country that practices torture is difficult but possible. The Center for the Victims of Torture Nepal (CVICT) documents and treats torture survivors in four ways: (a) fact-finding teams, (b) referrals to its clinic in Kathmandu, (c) prison visits, and (d) a community-based rehabilitation program for Bhutanese refugees. In addition, the center also conducts research in four ways: (a) a quantitative matched-control study of tortured refugees to identify consequences of torture, (b) a case note survey, (c) a narrative study to identify local idioms of distress, and (d) focus groups to identify issues pertinent in the local context.

Limited Cultural Validity of the Composite International Diagnostic Interview’s Probe Flow Chart

The probe flow chart of the Composite International Diagnostic Interview (CIDI) was designed to assess psychiatric somatic complaints in various cultures. The CIDI’s probe flow chart does not appear to function properly in the Nepali context as the chart contains two assumptions that do not hold in Nepali culture, namely that: (i) respondents attribute their symptoms to mental, physical or substance-related processes, and (ii) doctors communicate diagnoses to their patients. The cultural validity of the CIDI is questioned.