What doesn’t kill you, makes you more anxious and depressed: The effect of civil conflict on mental health in Nepal

This paper provides the first nationwide evidence on the effect of early-life exposure to civil conflict on mental health status in adolescence and adulthood. Leveraging variation by district and year of birth, I analyse the effect of childhood exposure to Nepal’s civil conflict in 1996-2006 on anxiety and depression using the 2022 Nepal Demographic and Health survey (DHS). 

For the first time, the DHS contains clinically valid measures of Generalised Anxiety Disorder (GAD) and depression measured by the Patient Health Questionnaire (PHQ). Controlling for a rich set of covariates, including physical health and food insecurity, the results show that any past exposure to conflict increases the GAD score by 0.643 and the PHQ score by 0.592. This corresponds to approximately one-quarter and one-third of the respective sample means. Exposure to conflict also raises the probability of developing moderate to severe anxiety by 7.5 percentage points. With each additional year of conflict exposure, the risk of developing moderate to severe anxiety increases by 1.5 percentage points. For depressive disorders, an extra year of childhood conflict exposure leads to a 0.104 increase in the PHQ score and a 0.6-percentage point higher risk of moderate to severe depression. The results are driven by women and individuals residing in rural areas.