Population-attributable burden of modifiable risk factors for depression and anxiety among reproductive-age women in Nepal

Identifying the critical modifiable risk factors for anxiety and depression is crucial for reducing the increasing burden of mental illness among reproductive-aged women 15-49 years in Nepal. We investigated Population Attributable Fractions (PAFs) of generalized anxiety disorder and major depressive disorder attributable to potentially modifiable risk factors among reproductive-age women. This cross-sectional study analysed the data from the Nepal Demographic Health Survey in 2022. Multilevel logistic regression analyses determined odds ratio (ORs) for risk factors associated with depression and anxiety. PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor. This study included a weighted sample of 7,410 women, with a mean age of 30 (± 10) years. Highest PAFs of depression were associated with women who experienced emotional abuse (PAF: 18.2%; 95%CI: 15.4-20.2), physical violence (PAF: 12.1%; 95%CI: 5.1-16.7), and sexual abuse (PAF: 9.0%; 95%CI: 5.9-11.5), functional difficulty (PAF: 6.9%; 95%CI: 2.8-10.1) and food insecurity (PAF: 6.6%; 95%CI: 4.4-8.4). These five potentially modifiable risk factors accounted for 52.8% (95%CI: 33.7-67.0) of depression cases. Highest PAFs for anxiety were associated with women who experienced emotional abuse (PAF: 10.8%; 95%CI: 8.7-12.7), functional impairment (PAF: 7.8%; 95%CI: 5.7-9.6), physical violence (PAF: 7.8%; 95%CI: 4.4-10.6), sexual abuse (PAF: 5.6%; 95%CI: 3.9-7.3), and food insecurity (PAF: 3.7%; 95%CI: 2.4-4.9). These five potentially modifiable risk factors accounted for 35.7% (95%CI: 25.2-45.1) of anxiety cases. The results of this study highlight the necessity of targeted strategies at the community and household levels to address violence against women. Couple-based approaches involving men are particularly relevant to break the cycle of intergenerational violence and fostering environments conducive for better mental health.