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Population-attributable burden of modifiable risk factors for depression and anxiety among reproductive-age women in Nepal
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  • Published: 17 March 2026

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

  • Santosh Giri1,3,
  • Nancy Ross2,
  • Rachel Kornhaber5,
  • Allen G. Ross6,
  • Kedir Y. Ahmed1,7,8,
  • Pushpanjali Adhikari4,
  • M. Mamun Huda1,9,
  • Anayochukwu E. Anyasodor1,
  • Feleke H. Astawesegn1,10,
  • Shakeel Mahmood1 &
  • …
  • Subash Thapa1 

Scientific Reports , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Epidemiology
  • Risk factors

Abstract

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.

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Data availability

The datasets supporting the conclusions of this article are available in the DHS repository, (https:/dhsprogram.com/data/available-datasets.cfm). The DHS provides open access to survey data files for legitimate academic research purposes. To initiate the download process, registration is mandatory. Researchers are required to provide their contact information, research title, and a brief description of the proposed analysis. Approval for dataset access is typically confirmed via email. It is important to note that these datasets are third-party resources and not under the ownership or collection of the authors, who possess no special access privileges.

Abbreviations

CI:

Confidence Interval

GAD:

Generalised Anxiety Disorder

MHM:

Mental Health Module

NDHS:

Nepal Demographic and Health Survey

OR:

Odds Ratio

PAF:

Population Attributable Fraction

PCA:

Principal Component Analysis

PHQ:

Patient Health Questionnaire

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Acknowledgements

The authors are grateful to Measure Demographic Health Survey, ICF International, Rockville, MD, USA, for providing the data for analysis.

Author information

Authors and Affiliations

  1. Rural Health Research Institute (RHRI), Charles Sturt University, Orange, NSW, Australia

    Santosh Giri, Kedir Y. Ahmed, M. Mamun Huda, Anayochukwu E. Anyasodor, Feleke H. Astawesegn, Shakeel Mahmood & Subash Thapa

  2. School of Social Work, Dalhousie University, K’jipuktuk Halifax, NS, Canada

    Nancy Ross

  3. School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW, Australia

    Santosh Giri

  4. Community Medicine Department, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Kavrepalanchowk, Nepal

    Pushpanjali Adhikari

  5. School of Health, University of Armidale, Armidale, NSW, Australia

    Rachel Kornhaber

  6. College of Medicine, Ajman University, Ajman, United Arab Emirates

    Allen G. Ross

  7. Discipline of General Practice, School of Medicine, Adelaide University, Adelaide, SA, Australia

    Kedir Y. Ahmed

  8. Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia

    Kedir Y. Ahmed

  9. School of Rural Medicine (SRM), Charles Sturt University, Orange, NSW, Australia

    M. Mamun Huda

  10. College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia

    Feleke H. Astawesegn

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Contributions

SG: Conceptualization, Methodology, Investigation, Software, Formal analysis, Writing - Original Draft; NR: Writing- Reviewing and Editing; RK: Writing- Reviewing and Editing; AGR: Investigation, Writing- Reviewing and Editing; KYA: Methodology, Software, Validation, Formal analysis, Writing- Reviewing and Editing; PA: Investigation, Writing- Reviewing and Editing; MMH: Writing- Reviewing and Editing; AEA: Writing- Reviewing and Editing; FHA: Writing- Reviewing and Editing; SM: Writing- Reviewing and Editing; ST: Conceptualization, Methodology, Validation, Formal analysis, Writing- Reviewing and Editing, Supervision.

Corresponding author

Correspondence to Santosh Giri.

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Competing interests

The authors declare no competing interests.

Ethics approval

The NDHS received ethical approval from the Ethical Review Board of Nepal Health Research Council (Reference number: 678, Date: Sep 30, 2021) and the institutional review board of ICF International (Reference number: 180657.0.001.NP.DHS.01, Date: April 28, 2022). All procedures were conducted in accordance with relevant ethical guidelines and regulations, including the principles outlined in the Declaration of Helsinki. Informed consent was obtained from all participants prior to the interviews.

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Giri, S., Ross, N., Kornhaber, R. et al. Population-attributable burden of modifiable risk factors for depression and anxiety among reproductive-age women in Nepal. Sci Rep (2026). https://doi.org/10.1038/s41598-026-43908-8

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  • Received: 18 December 2024

  • Accepted: 09 March 2026

  • Published: 17 March 2026

  • DOI: https://doi.org/10.1038/s41598-026-43908-8

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Keywords

  • Generalized anxiety disorder
  • Major depressive disorder
  • Emotional abuse
  • Sexual abuse
  • Population attributable fraction
  • Violence against women
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