Violence exposure among adolescent psychiatric patients in Nepal: Socio-demographic and familial risk factors

BACKGROUND: Violence exposure is a major public health concern among adolescents. Yet, evidence on socio-demographic and familial risk factors in adolescent psychiatric populations in Nepal and other low- and middle-income countries is limited. OBJECTIVES: To identify risk factors associated with different forms of violence exposure among adolescents attending a child and adolescent psychiatric unit in Nepal. METHODS: A total of 810 adolescents aged 11-15 years (392 boys, 418 girls) at Kanti Children's Hospital in Kathmandu, were included. Adolescents reported past-year exposure to violence using adapted PedHITSS and ICAST-C items, while parents provided socio-demographic and family data. Associations were examined using ordinal and logistic regression analyses in SPSS 29. RESULTS: Physical abuse was more frequent among adolescents from the Dalit caste (OR 1.86, 95% CI 1.03-3.34, p = 0.04), whereas neglect and domestic violence were more frequent among Indigenous/minority groups compared with Brahmin/Chhetri castes (OR 1.72, 95% CI 1.17-2.52, p = 0.006; OR 1.63, 95% CI 1.17-2.27, p = 0.004). Compared with urban areas, emotional abuse was less frequent in rural (OR 0.52, 95% CI 0.34-0.80, p = 0.003) and semi-urban areas (OR 0.60, 95% CI 0.41-0.85, p = 0.005), while sexual abuse and neglect were less frequent in semi-urban areas (OR 0.40, 95% CI 0.21-0.77, p = 0.01; OR 0.35, 95% CI 0.20-0.60, p < 0.001). Emotional abuse, sexual abuse, and neglect were more frequent among females (OR 1.59, 95% CI 1.19-2.13, p = 0.002; OR 3.70, 95% CI 2.27-6.06, p < 0.001; OR 1.75, 95% CI 1.22-2.50, p = 0.002). Increasing maternal age was associated with lower odds of emotional abuse (OR 0.97, 95% CI 0.95-1.00, p = 0.02). Emotional abuse and domestic violence were more frequent in single-parent families compared with extended families (OR 1.98, 95% CI 1.04-3.78, p = 0.04; OR 2.84, 95% CI 1.04-7.78, p = 0.001), and parental illiteracy was linked to increased domestic violence compared with university-level education (OR 2.93, 95% CI 1.15-7.49, p = 0.03). CONCLUSION: Violence exposure was more frequent among Dalit and Indigenous/minority groups, females, urban residents, was associated with younger maternal age, single-parent households, and parental illiteracy reflecting need for culturally informed, trauma-focused prevention and intervention.