Sree Subedi

Mental Illness and Disability among Elders in Developing Countries The Case of Nepal

Objective: This article attempts to document the prevalence of psychiatric disorders among elders in a rural village in Nepal. In addition, we investigate the relationship between psychiatric illness and functional disability to assess the impact of disorder on social functioning. Method: A semistructured interview checklist to diagnose six disorders was used (N = 182). In addition, elders older than age 60 were examined to assess the functional impact of mental health conditions by measuring functional disability. Results: Eighteen percent of elders seem to have a diagnosable psychiatric disorder. Furthermore, in general these elders were also less likely to receive assistance with the disabilities they report, compared with those who do not experience a psychiatric disorder. Discussion: Documenting the extent of psychiatric disorder among elders in developing societies sensitizes health planners to the growing reality of aging in their societies and the need for expanded physical and psychiatric health care services.

Measuring Community Mental Health in Developing Societies: Evaluation of a Checklist Format in Nepal:

Background: There is growing recognition of the importance of mental health problems in developing countries. In large part, however, we have very limited epidemiological data at national and/or community levels about the prevalence of mental illnesses. Aims: The purpose of this paper is to describe the reliability and validity characteristics of an assessment tool that may be useful for conducting community-level surveys (particularly in rural communities of developing countries) to obtain prevalence rates of mental illnesses. Methods: We used a sample of adults residing in a rural village in Nepal to assess disorders with a modified version of the DSM-III-R Checklist. We evaluated construct validity, scale reliability, convergent validity and discriminant validity. Results: There is strong evidence for the construct validity of generalized anxiety and depression in our sample. By contrast, the symptoms associated with mania and schizophrenia were not empirically distinct. Convergent validity is acceptable. As a test of validity characteristics, the pattern of sociodemographic correlations suggests that the specific social origins of disorder in Nepal will require further investigation. Conclusion: The first step in obtaining high quality information on the distribution of mental illness in developing countries is to establish some reliable and valid indicators of disorder. The checklist format for assessing disorder appears to meet this objective and offers the possibility that community-level prevalence studies can be reasonably conducted.

The bioethics of medical research in very poor countries

Sociologists have had only a marginal effect on the development of bioethical principles for medical research despite their interest in the effects of social and economic inequality on health and its implications for issues of social and individual justice. In this article we review existing bioethical standards for conducting medical research in very poor countries. Given the substantial differences in individual exposure to health risks and the availability of health protective resources as well as differences in the disease burden and mortality and morbidity at the population level, it is clear that illness in poor countries can be better understood using a social causation of illness perspective. In turn we suggest that such a perspective can be useful for identifying bioethical standards that better apply in this context.

Sociological Contributions to Developing Ethical Standards for Medical Research in Very Poor Countries: The Example of Nepal

This chapter discusses guidelines that specify the ethical standards for medical research in very poor countries in order to show how a sociological explanation of illness causation and health care access can offer some additional insight into the refinement of those guidelines. There has been considerable discussion on the proper ethical standards to apply given the context of extreme poverty and inadequate health care infrastructure that characterizes poor countries. Our analysis is intended to suggest that a sociological explanation for illness causation provides a clear justification for including the social context when specifying ethical guidelines and also clarifies the issues that must be addressed. This perspective is particularly sensitive to inequalities in health and access to health resources among medical research subjects, and therefore addresses core issues of justice and beneficence.