The unexpected death of a loved one and risk for onset of PTSD and depression in the Nepal Chitwan Valley Family Study.

BACKGROUND

Adults who experience the unexpected death of a loved one are at elevated risk for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). We take a life course perspective to investigate age at loss and sociodemographic factors on subsequent mental health risk in a low- and middle-income country (LMIC) cohort.

METHODS

The Chitwan Valley Family Study (CVFS) included 10,714 participants surveyed in 2016-2018 on symptoms of MDD and PTSD via the Composite International Diagnostic Interview, and the unexpected death of a loved one. We used time-varying Cox proportional hazards models to estimate post-bereavement onset of PTSD and MDD. We stratified models by age at the first unexpected loss, as 0 to 19, 20 to 29, 30 to 39, and 40 to 65 years, compared to no loss, and stratified by gender in an interaction analysis.

RESULTS

Bereaved adults demonstrated a higher prevalence of PTSD and MDD relative to non-bereaved adults. First unexpected loss occurring between ages 0 to 19 had the greatest estimated increase in the risk for MDD (HR: 3.11, 95 % CI; 2.20, 4.39) and PTSD (hazard ratio (HR): 8.81, 95 % confidence interval (CI): 4.4.32, 17.96) compared to other life periods. Stratifying by gender, we found that women had the most consistent elevated risk for outcomes compared to men.

CONCLUSIONS

In a longitudinal cohort from an LMIC setting, risk for MDD and PTSD is elevated among Nepali adults who experience unexpected losses, with implications that gender and life course timing of the loss shape differential risk.